
The Economies With the Most and Least Efficient Health Care - Deinos
https://www.bloomberg.com/news/articles/2018-09-19/u-s-near-bottom-of-health-index-hong-kong-and-singapore-at-top
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Fernicia
The methodology here is not good. All they're doing is comparing average
health care cost vs life expectancy. They don't measure standard of care,
accessibility of treatment, etc.

This is especially important when looking at end-of-life care, which I
speculate affects these both of these metrics the most. A hospice with private
rooms, friendly staff, and social engagement will score lower than a hospital
that keeps someone alive in a coma.

~~~
nabla9
Bloomberg analysis gives one point of view.

OECD has published data where you can compares 5-year survival rates after
major cancers, heart attack 30-day survival after hospitalization, stroke,
ischemic stroke etc. They also keep track of infant mortality, maternal
mortality etc.
[http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#](http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#)

Data shows that Japan, South Korea, Israel and Nordics are have the best
healthcare quality using these measures. US is often in top 10, or at least
mid-tier. Beast cancer is treated very well in US.

But what is wrong with the US and infant mortality and perinatal mortality?
How can the US be so low?

~~~
rectang
In the US, we make services used by the poor inconvenient and ineffective in
order to (ahem) motivate people to not be poor. Lousy results are to be
expected for that segment of the population.

~~~
endymi0n
Motivate? Most definitely yes. Equip? Not at all. The American Dream
(especially that pesky part about "opportunity") died long ago. If you're born
with a chronic condition such as diabetes or your parents can't afford an
education giving you the chance of a decently paying job, better go die.

That being said, just looking at the raw numbers I'd dare to say that health
care in the US is just about as inconvenient and ineffective for rich people
as it is for poor...

~~~
SkyMarshal
Rektang was being facetious with that comment, as tipped off by the “(ahem)”,
implying the real reason we make services for poor inaccessible so they won’t
be able to use them and thus drive up costs for them.

~~~
rectang
That's part of it. But there are other factors at work including political
concerns -- for example in exempting rural majority-white counties in Kentucky
from Medicaid work requirements while imposing them full-force on urban
majority-black counties.

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triviatise
life expectancy is a bad measure of healthcare effectiveness

1) infant mortality heavily impacts life expectancy. The us has a few
subpopulations that have very high infant mortality regardless of
socioeconomic status.

2) The us has a high teen murder rate

3) The US has very high levels of obesity

4) There is a tremendous genetic component to life expectancy. Some sub
populations (asians) have very high life expectancy, their home countries
reflect that. Little dogs for example can live 20 years, where large breeds
die at 15.

If you pull out 1 and 2, we are up there with other euro nations.

Better measures are things like life expectancy after <pick an age where you
think we start needing lots of healthcare>

The sad thing is that the people who are experts in this _know_ these things,
but still push the narrative that it is our medical system.

~~~
terrywilcox
So if you simply eliminate some of America's health care problems, America is
like other nations?

That's convenient.

~~~
jlavine
The above commenter mentioned demographic and lifestyle discrepancies not
adequately accounted for in this comparison of outcomes among countries... not
health care problems, as you're implying.

~~~
terrywilcox
An infant mortality rate far above other first world nations isn't a health
care problem?

We're talking about kids too young to be be gunned down, so they're not part
of America's remarkable teen-gun-death statistics.

They're predominantly kids from poor families, who don't live healthy
lifestyles or have good health insurance. If the family doesn't have access to
good healthcare, the kid's chances of survival are lessened.

Maybe Russia could improve its placement on the list if they ignored the
health care issues caused by alcoholism.

And then America could improve its position by declaring obesity, and the
health problems that come with it, a lifestyle issue instead of a health
issue.

~~~
jlavine
You're conflating health issues with health care issues. What health care
system now implemented in any country, or proposed for implementation in
America by anyone, controls how people eat, how much alcohol, tobacco, and
other harmful drugs they consume, how often they exercise, how much they
sleep, whether they provide healthy environments for their children, etc.?

Just as schools and teachers are simply one factor in educational outcomes,
the medical system is simply one factor in health outcomes. You must consider
lifestyle, environmental, and genetic/epigenetic factors to get a full
picture. You must equalize for these factors - as far as this is possible - to
fairly compare the effect of the medical system and associated policies alone
on health outcomes in different countries. Properly accounting for genetic and
lifestyle differences in different sub-populations is largely taboo, and this
prevents a fair comparison of medical systems across countries.

Edit: Consider this article by the CDC on infant mortality:
[https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/...](https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/InfantMortality.htm)

 _Over 23,000 infants died in the United States in 2016. The five leading
causes of infant death in 2016 were: Birth defects. Preterm birth and low
birth weight. Sudden infant death syndrome. Maternal pregnancy complications.
Injuries (e.g., suffocation)._

While the medical system can intervene, these causes all seem far more
dependent on genetics, the mother's (and to a lesser extent the father's)
behavior during pregnancy and the infancy of the child.

 _In 2016, infant mortality rates by race and ethnicity were as follows: Non-
Hispanic black: 11.4; American Indian /Alaska Native: 9.4; Native Hawaiian or
other Pacific Islander: 7.4; Hispanic: 5.0; Non-Hispanic white: 4.9; Asian:
3.6_

Compare white Americans with European countries, and the discrepancy drops
significantly. There's something beyond the medical / health care system
playing a role here.

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maxxxxx
My favorite topic. And as always in the US there will be a lot of
fingerpointing and no action....

~~~
frockington
As much as dissapointment the Affordable Care Act was, at least someone tried
something. If only we could learn from those mistakes and make incremental
changes. Politicians are to obsessed with either tearing it all down or
healthcare for all for "free", no middle ground

~~~
Frondo
Not free and no one's saying that. Free at point of service, like the NHS or
the Canadian health care system, yes, but obviously everyone knows we'd pay
for it with taxes.

We could just do it, cover everyone, for less than we're paying now, by
rejiggering the system under a "medicare for all" banner. There aren't any
other serious options on the table. (replace and repeal, or whatever, is not a
serious option.)

~~~
ssambros
Medicare currently pays less than what it costs to provide for a lot of
services. And providers are either declining medicare alltogether or recouping
the missing funds from the other patients. Where would all those other
patients come from if medicare will be "for all"?

~~~
maxxxxx
"Medicare currently pays less than what it costs to provide for a lot of
services"

Is that even true? Personally I have my doubts.

~~~
ssambros
American Hospital Association: Underpayment by Medicare and Medicaid Fact
Sheet, December 2017 Update [0]

FINDINGS

In the aggregate, both Medicare and Medicaid payments fell below costs in
2016:

\- Combined underpayments were $68.8 billion in 2016. This includes a
shortfall of $48.8 billion for Medicare and $20.0 billion for Medicaid.

-For Medicare, hospitals received payment of only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2016.

\- For Medicaid, hospitals received payment of only 88 cents for every dollar
spent by hospitals caring for Medicaid patients in 2016.

\- In 2016, 66 percent of hospitals received Medicare payments less than cost,
while 61 percent of hospitals received Medicaid payments less than cost.

[0] [https://www.aha.org/data-insights/2018-01-03-underpayment-
me...](https://www.aha.org/data-insights/2018-01-03-underpayment-medicare-and-
medicaid-fact-sheet-december-2017-update)

~~~
maxxxxx
After having dealt with billing from hospitals for services they never
delivered or obscenely overpriced I am inclined not to trust them on
statements about their actual cost. In my view the billing practices of most
hospitals are very dishonest and intentionally confusing and opaque.

~~~
ssambros
"billing practices of most hospitals are very dishonest and intentionally
confusing and opaque."

Is that even true? Personally I have my doubts.

~~~
maxxxxx
Check out some hospital bills for major procedures and there is a good chance
that you will find things like charges for services nobody remembers or a
doctor who was in the room for 3 minutes charged $1200 or receiving an aspirin
costs $80. Maybe my experiences are all anecdotal but when I put my own
experiences together with what I hear from others and things I read I am
pretty convinced that something is going very wrong.

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oriol16
Enslaving the population of doctors would improve the index, since it reduces
salaries drastically. Halfway between slavery and market wages is where you
find Spain.

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bitxbit
You look at the list of most efficient health care systems across the globe
and they are not nearly as large as the US. They are typically small and
homogeneous. I like the concept of single payor in the US but I do see big
hurdles even if we get through the politics which is a big if. I'd point to
heterogeneous population and a very wide range of care quality across the
country and sometimes even within MSAs.

~~~
NeedMoreTea
You look at any list of anything across the globe relating to countries and
they are not nearly as large as the US.

For the very simple reason that most countries are smaller and more
homogeneous than the US, so I don't think it really proves a lot. Unless
you're suggesting US only compare itself to Russia and China in future?

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jasonlotito
I always look at these types of reports, and it makes me laugh. It doesn't
tell the whole story, and it doesn't tell the true story. We left Canada
precisely because of its healthcare system and came to the US. Canada would
have require substantially more out of pocket (10s of thousands) with a much
longer wait (years), whereas in the US, the out-of-pocket was substantially
less ($500) and substantially less time (-2 weeks) to receive assistance. And
that was without using insurance from my job.

~~~
jasonlotito
I hate meta comments, but I love how posting facts gets voted down here just
because people don't like the facts. That's why autism support in Canada is a
shit-show.

