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How good is American health care?

A study in the Journal of the Royal Society of medicine has assessed the effectiveness of health care in 19 western countries and come up with a simple ranking system: a measure of the the number of lives saved relative to expenditures proportional to the GDP. One parameter, called the GDPHE, or GDP Health Expenditure was a measure of how much money the country was sinking into health care per citizen; by dividing this by the mortality rates, they got a measure of the effectiveness of the health care system.

This is a ranking system, and I have mostly a hyper-competitive American audience, so you all want to know whether you win or not, right? You want the data that shows that the US is #1! And here it is, the one result that shows us at the top of the ladder, our average health care as a function of GDP.

Look at that: we don’t just win, we win big, leaving our closest competitor, Germany, in the dust. We spend 125% of the money Germany does per person. Does it feel good, America? We are tossing bigger buckets of money into health care than anyone else.

But now for the number that really matters, the GDPHE ratio. How many lives are we saving with all that money? Here’s the answer. Look at the last column, which is the ratio of money spent to lives saved.

Oops. We’re…#17. We’re almost the worst — thanks, Portugal and Switzerland, for neglecting the medical needs of your citizenry more than we do.

Our health care is miserably inefficient, and we pour extravagant sums of cash into it, but you might ask whether it works at all. And the answer is a bit of good news, yes, it does. This study also compared death rates over time and came to the conclusion that, in the US, more than half a million people are alive today who would not have been with the medical care we offered 25 years ago. Medicine in the US is good, it’s just far more economically wasteful than it ought to be.

I’m still thinking I ought to retire to Ireland.

(Also on Sb)

Comments

  1. says

    huh; that the US does shitty is no news to me, but I’m surprised at Germany being just barely better. That doesn’t seem to agree with my personal experience… but then, I guess people don’t generally die because they have to have teeth extracted rather than getting them properly fixed, so there’s that.

    I’m also surprised at how well the UK scores; I guess I’ve heard too much anti-NHS propaganda, and it’s begun to sink in

  2. caudex says

    I think the reason for the inverse correlation is that countries that spend the most tend to spend it on extending the lives of the terminally ill.

  3. AusieMike says

    Maybe someone out there can clarify my thinking.

    Is it possible that because the US has 50 states to get in between funding and the provision of health care that this could be a reason for such inefficiency. Look at the leaders. They are smaller countries with fewer state boundaries. Therefore less state and local government to soak up money.

    Remove the outliers that are small but have hopeless Governments and just eyeballing it, it seems plausible.

    Happy to be corrected of course. I appeal to a higher authority.

  4. says

    Is it possible that because the US has 50 states to get in between funding and the provision of health care that this could be a reason for such inefficiency.

    or it could be because the US doesn’t have one system, and thus everything is multiplied endlessly: in the last town I lived in, the local hospital had seven billing departments to deal with all the different insurance schemes etc.

  5. Nerd of Redhead says

    The US could save a huge amount of money, and increase the effectiveness of health care, if it got the insurance people and their obscene profits out of the business. Single payer, like medicare. Extend to all people, like in all first world countries.

  6. Paul Durrant says

    It seems that the main difference in the rankings is more dependent on how effective the health care is, rather than how much is spent on it.

    The GDPHE average ranges from 6.8 to 12.2, a factor of less than two separating low and high.
    55-74 deaths reduced ranges from 3229 to 12903, very nearly a factor of four.

    In short, there’s twice as much variation in death reduction as there is in spending. Some countries seem to just make much better use of the money spent (in terms of reduced mortality) than others.

  7. Dianne says

    I’m sorry, but I think you’re misreading this table. It doesn’t say we’re spending too much, it says we’re spending too little! Look at the public health expenditures. Pathetic! Far behind Germany, France, Sweden, Norway, etc. More money for Medicare, Medicaid, and the NIH! Now!

    Also the measurement of health care efficacy doesn’t measure absolute health care outcomes, only relative improvement per dollar/euro/pound/etc spent. Britain’s health care is not so great in absolute terms (measured by, for example, their cancer outcomes) and only appears relatively good because of their low absolute spending. And what’s with the 15-74 measurement? The life expectancy in some of the listed countries is over 80, at least for women. What’s with the lack of concern about people age 75+? The US would actually come out looking pretty good there: standard Medicare is a fairly decent insurance and the US is fairly good about continuing to provide medical care for people as they age (at least compared to other countries.)

  8. Wowbagger, Madman of Insleyfarne says

    I’ve always felt it kind of sad that health care became an area where profits are made; by necessity it becomes more about the money than the well-being of the people being treated.

    Oh, and before anyone complains, I’m not suggesting doctors and other healthcare professionals work for free. That’s not what I mean by profit; what they earn is appropriate remuneration for hard, almost immeasurably valuable work.

  9. ekwhite says

    Dianne @9:

    I’m sorry, but I think you’re misreading this table. It doesn’t say we’re spending too much, it says we’re spending too little!

    Dianne, I am afraid that you are reading the table wrong. The number in Table 1 is a ratio of expenditures to GDP. The number of 12.2 indicates we are spending more of our GDP than everyone else. Germany, which has the second highest expenditure in relationship to GDP, spends almost 50% less for slightly better results.

    I am impressed that Ireland, of all places, has the best results in mortality. What type of health care system does Ireland have?

  10. Steve says

    I’m a New Zealander living in the UK. I win :)
    I realise that the Irish get better care, but they also have to live in Ireland. :P

  11. AusieMike says

    Given all the Irish jokes I heard as a kid I think the Irish Darwinised themselves to become a healthier species. All those Paddies from the jokes have died out leaving only healthier more risk averse models that need less health care.

  12. LexAequitas says

    My wife just returned from Japan — while there, our youngest needed a dental diagnosis including a CT scan and a visit to a specialist. It was free (he has dual citizenship).

    He might eventually need non-emergency surgery, which would also be free.

    It’s not life-saving, but just relates to quality of life for a five-year old child. There’s a whole world of what universal health care means beyond mortality rate. Not to take anything away from these simple and clear numbers, of course.

  13. Adam says

    Ireland has a hybrid model – core healthcare such as emergencies, maternity, outpatient care is free. Elective stuff, gp visits, prescriptions and dental work is not free. So 50% of people have health insurance to cover these things. There is also a means tested medical card under which some people get free cover. There are also more expensive plans that cover private hospitals and other things.

    So it’s not completely “socialized” but it does provide a safety net. It’s perplexing to see the hysteria that surrounds the debate in the US when the standard of care is little different and possibly worse overall.

  14. Gwehydd says

    Ireland might top the list, but abortion is still illegal there, which is more than enough reason for me to remain an Australian in the UK (and one of the best parts, Wales, where any prescription medicine is free! Hurrah!).

  15. Matt Penfold says

    I’m a New Zealander living in the UK. I win :)
    I realise that the Irish get better care, but they also have to live in Ireland. :P

    Especially since as a New Zealand national you get free NHS treatment, which is not always the case with foreign nationals.

  16. harold says

    What is interesting is that the US has an efficient universal health care system embedded within it.

    The Medicare system, which may now be targeted for ill-conceived “budget cuts”, has been, until now, extremely well-accepted and efficient.

    It’s not perfect and has a “copay” feature, but it much more efficient than the private health insurance system.

    It already pays over 30% of medical bills in the US. It covers the elderly and disabled, so the incremental cost of adding younger, healthier people is low.

    Is it possible that because the US has 50 states to get in between funding and the provision of health care that this could be a reason for such inefficiency

    The main unique feature of the US is its degree of reliance on inefficient, for profit health insurance.

    1) Many people can’t afford private health insurance (and “mandating” that they buy it does not affect this) http://www.usatoday.com/news/nation/2010-09-17-uninsured17_ST_N.htm. These people may tend to seek health care only in urgent situations, and unless they are retroactively found to qualify for Medicaid or Medicare, the treatment they receive is not paid for. The latter situation often creates an atmosphere of constant financial crisis at health care facilities that serve areas with many uninsured.

    2) Although this abuse may be partly corrected by the United States National Health Care Act of 2009 when and if it takes effect, it is currently common for people with health insurance to reach “spending caps” and go bankrupt anyway. http://news.consumerreports.org/health/2009/06/health-care-bankruptcy-on-rise-medical-debt-medical-bills-how-to-avoid-bankruptcy.html

    3) Medicare administrative costs are generally agreed to be lower than more private insurance administrative costs.

    http://healthcare-economist.com/2006/07/27/medicares-true-administrative-costs/

    4) The rational long term solution is a true universal health care system. The easiest way to achieve such a system would be, assuming that the Medicare system isn’t rendered untenable in the meantime, to enroll all Americans in Medicare on a voluntary basis.

    Realistically, this would massively contract the health insurance industry, but any real reform would do that.

    The Canadian system, which is, like any system, imperfect, serves as a reasonably decent model of what the US system might look like with a universal coverage plan. Medical culture is almost identical in Canada and the US and cross-training of physicians in both systems is common. Large clinical studies often use both Canadian and US centers. The primary difference is method of payment. Canadians are highly satisfied with their system, Americans are not.

    http://www.world-psi.org/TemplateEn.cfm?Section=Home&Template=/ContentManagement/ContentDisplay.cfm&ContentID=23215

    http://abcnews.go.com/sections/living/US/healthcare031020_poll.html

    5) Obviously, there is also a strong ethical argument for universal health care coverage, regardless of economics.

    In this case, ethics, economics, and public opinion all point in the same direction.

    Bluntly, the primary obstacle is the political power of the insurance industry and some other industries that are perceived, rightly or wrongly, as being allied to it.

  17. ronmurp says

    Another factor is the distribution of that care across the economic spectrum. How much is spent on the top earners against the bottom earners and those without jobs. How are the deaths spread across this spectrum of income?

    If the spending is biased towards the top, and the deaths towards the bottom, rather than a more even distribution, what would that tell us?

  18. Matt Penfold says

    If the spending is biased towards the top, and the deaths towards the bottom, rather than a more even distribution, what would that tell us?

    It would tell is that the system is performing poorly, if the intention of the system is to provide good quality healthcare regardless of ability to pay at the time of use.

  19. Dianne says

    Tsk, everyone. Forget the “private insurance” figure. That’s not the figure of merit because there’s nothing much the government can do about that apart from making it illegal or outcompeting it. Look at column 3: public spending per GDP. We’re behind, way behind! We’re spending less than Germany, France, Norway, and a slew of other countries. Add to that the fact that a lot of the US public health spending goes towards paying for care of the highest risk populations (older people and people living in poverty-the very populations with the highest medical needs and highest risk of undertreatment) and you get clear evidence of lack of adequate spending in the public sector. Private insurance…that’s just a for-profit game. Forget it and let it die a natural death or continue as a pathetic shadow of the real system. It can be done, but it’ll take more money. Of course, that money will go to a personnel intensive industry and thus lower unemployment…really, massive increases in spending on medical care is probably the best thing that could happen to the US economy.

  20. Nate says

    I was very surprised that Switzerland was so low as their health care system is generally very good. Reading the paper more closely, it’s calculating the ratio of the reduction in mortality rate to GDPHE (not per capita GDPHE, btw). Switzerland’s reduction in mortality rate was very low since it went from 5651 deaths per million to 4353 from 1980 to 2005. The US went from 9158 to 6660. That is, 30 years ago, Switzerland had a lower mortality rate than the US does now. Portugal’s MR, btw, went from 7787 to 6483. I think a better metric would be MR / GDPHE per capita.

  21. says

    Hey, Ireland is backlashing against the church, so it sounds like a good place for you!
    Me, I wouldn’t wanna wait until I retire to get outta here…
    Anyway, giving peoples’ health to something whose main goal is to make money seems completely insane. That is literally putting health second. This should be obvious, and if it isn’t, let’s put the jurisdiction of personal freedoms under private care and see how well that goes.

  22. Nerd of Redhead says

    Just imagine where the American system changed from having me and my company pay for private health insurance, the same money was paid into the single payer system. Without the need for profits, another 10-20% of the present population could be covered without increasing costs. And once the costs of processing single forms wends through the system, even more savings would shake out, essentially allowing for universal coverage without any increase in costs. Then places like Walmart can be required to chip into the system, as they should.

  23. Marcus Hill says

    I probably doesn’t help that the US system incentivises treatments. If your employer (or you) get paid more if you perform more procedures, then that will inevitalby lead to more procedures, even when they’re not medically necessary. At the risk of opening a massiva can of worms, I’ll mention the relative prevalence of infant circumcision in the US and the UK.

  24. Dianne says

    I was very surprised that Switzerland was so low as their health care system is generally very good.

    The Swiss health care system is good, but very expensive. They use essentially private insurance with a distributed risk model: not the most efficient system possible. But they do get results.

    One reason I’m not thrilled with table 2 is that it contradicts a lot of the data I’ve seen on survival in various European countries. Particularly cancer survival. For example, here* Scotland’s survival estimates are considerably lower than Geneva’s, Saarland’s, or Norway’s for quite a number of common cancers, including expensive but treatable cancers like NHL. (Some caution is needed in interpreting the results since stage is not given, so it’s not clear if the lower survival is related to underdiagnosis or undertreatment.) So, “good for the amount we spend on it” is different from “good” in absolute terms.

    *Not sure if this’ll hit a subscription wall or not. The reference is Gondos et al Int J Cancer 2009;125(11)

  25. says

    I for one am not suprised at all about Germany doing so badly.
    Our health care system is completely FUBAR’d. It’s a bureaucratic monster of 1001 different compulsory providers and 1001 different private providers, all of them run for-profit too.

  26. unbound says

    @Dianne – You should be aware that a common problem trying to compare specific types of diseases and survival rates between countries is interpretation and what the primary causes of death are recorded as. For example, in Japan heart disease is rarely listed as cause of death in many areas due to cultural stigma of the condition (nice discussion of the discovery from the 90s – http://circ.ahajournals.org/content/89/1/109.full.pdf). This is also common between US and many European countries (of course, each country’s doctors believe their classifications are more accurate).

    This is one of the reasons that tables like the above are good, since they focus on a condition that has less flexibility in definition (death).

    As for the cause of the expense, one of the more interesting statistics from a couple of years ago was the percentage of money collected by US insurance companies that was actually spent on medical services (of any kind). In the early 90s, that percentage was about 95%…it is currently in the neighborhood of 80%. Guess where that 20% is going? Some nice housing, yachts, etc for the VPs and C-level executives as well as the stockholders that are handed thousands (or even tens of thousands) of shares seeming on whims.

  27. says

    One of the problem with the US health system is that the way it is set up, prevention doesn’t earn the insurance companies any money. Prevention is the biggie, don’t let people get sick in the first place, healthy eating, exercise, pick up genetic conditions that predispose to certain illnesses, make healthy food available at low costs, get rid of sugared fizzy drinks, curb smoking, all that kind of stuff. But the insurance companies there don’t care about prevention, which is why some minorities, and particularly the poor, have mortality rates as they did in the 1950s.

  28. Rev. BigDumbChimp says

    Hopefully the new provisions of the HITECH act will force providers into taking on EHR systems which should in the long run help reduce costs. There will be some up front pain to go through but it should help reduce costs in a number of areas.

  29. Nate says

    The Swiss health care system is good, but very expensive.

    I agree it’s expensive, but everything here is expensive. I took the numbers from the study and computed 2005 mortality rate / GDPHE per capita for ages 15-74. Switzerland has the lowest rate: 0.77 deaths per million per dollar, Norway is second with 0.90, and the US (surprise!) is third at 1.04. The UK is in the middle (1.60), and Portugal is down at the bottom (3.72).

  30. Dianne says

    This is also common between US and many European countries (of course, each country’s doctors believe their classifications are more accurate).

    It’s certainly an issue. One way of determining how much of an issue it is would be to look at number or percentage of cases diagnosed by death certificate or autopsy. Those would include cases where people did not present because of stigma or lack of resources and so might falsely elevate a country’s apparent survival (because autopsy and DCO cases are excluded from the survival analysis.) And indeed, Scotland has a very good rate of inclusion, but rates of inclusion were greater than 90% for all countries involved and >95% for the majority of western European countries (those Scotland compared poorly with) so it doesn’t look like a major issue.

    Also note that all cases are pathologically confirmed to be the disease in question so it’s unlikely that different diagnoses play a major role, except in cases like leukemia where a number of diseases are being lumped into a single category.

    Reference for description of data: here.

  31. Dianne says

    This is one of the reasons that tables like the above are good, since they focus on a condition that has less flexibility in definition (death).

    Less flexibility but considerably more possibility for confounders to enter. As an easy example, more people in the US die of gun shot wounds and more are killed by serial killers than in Europe. That’s certainly a problem with US society, but I don’t see it as a direct problem with the US health care system. Which is why I’d rather compare outcomes for specific conditions. Although I agree that that’s not a perfect measure either.

  32. Matt Penfold says

    As an easy example, more people in the US die of gun shot wounds and more are killed by serial killers than in Europe. That’s certainly a problem with US society, but I don’t see it as a direct problem with the US health care system.

    It is not a direct problem of the US healthcare system, but it does show that there is more to healthcare than simply doctors, nurses and hospitals, and that a system that does not take note will fail to provide decent healthcare.

    As Rorschach points out above, there are a number of social factors that can impact on health. A good healthcare system requires joined-up thinking at a level no private provider could ever manage.

  33. says

    I wonder, if the poor efficiency of the German health care system also hails from the fact, that our providers cover all kinds of woo (like homeopathy, acupuncture, chirotherapy etc.)?

  34. MechaSasquatch says

    Although it’s nice to see Ireland getting credited I think the matter needs some further explanation.
    The table measures the reduction in deaths from 1980 to 2005 and compares it to expenditure. In 1980 Ireland was a medium income country with low health expenditure and during the period the economy expanded massively as did our health expenditure.
    http://www.tradingeconomics.com/ireland/gdp-per-capita
    Most of our performance was down to us reaching first world levels of survival and health prevention not any features of our current health system.
    I’m sure that if the data was reviewed in 2015 after years of cuts forced on us by the mismanagement of our economy since 2008 things will look differently.
    P.S. AusieMike, go fuck yourself.

  35. Dianne says

    Prevention is the biggie, don’t let people get sick in the first place, healthy eating, exercise, pick up genetic conditions that predispose to certain illnesses, make healthy food available at low costs, get rid of sugared fizzy drinks, curb smoking, all that kind of stuff.

    True, but not necessarily as one sided as you might think. For example, fewer women get mammograms in Germany than in the US and the recommendations are (or at least were, last time I looked) for fewer. Similarly, the German healthcare system provides for only 2 screening colonoscopies throughout life, at (IIRC) 55 and 65. Of course, those who have positive findings or symptoms get further screening.

    Prevention of damage from smoking seems to be progressing more slowly in Germany than in the US as well: There are still automatic cigarette dispensers on the corners (where kids can get at them with fair ease) and bans on smoking in public places are just coming in. (At least in Baden-Wurrtemburg.) OTOH, it’s much easier to bike or walk in BW than in the vast majority of the places I’ve lived in the US and I’ve lived in places supposedly famed for their wonderful bike paths and pedestrian friendliness. Can’t comment so much on food: it seems to me that restaurants everywhere encourage absolutely awful eating habits.

  36. Adam says

    Irish VHI also promotes all kind of woo too, specifically the Healthsteps plan provides “€25 per visit, up to a maximum of 7 combined visits, per member, per year for Alternative Therapies including Acupuncture, Chiropractic, Osteopathy, Physical Therapy and Reflexology.”

    I expect the motivations behind this are complex. Perhaps some customers actually favour VHI over another insurer for this cover. Or perhaps a loss adjuster has figured that these treatments divert hypochondriacs away from more expensive procedures and therefore save money. However the fact that these things should occupy the same paper as other medical treatments gives them a legitimacy they do not deserve.

  37. frog, Inc. says

    I wonder, if the poor efficiency of the German health care system also hails from the fact, that our providers cover all kinds of woo (like homeopathy, acupuncture, chirotherapy etc.)?

    Japan covers a lot more “woo” — and succeeds much better. Don’t go chasing your favorite bogeymen, when the pattern is obvious — private health care suckzzzz.

  38. says

    Japan covers a lot more “woo” — and succeeds much better. Don’t go chasing your favorite bogeymen, when the pattern is obvious — private health care suckzzzz.

    And the majority of the German health care is … public.

  39. kraut says

    I think comparing “saved” lives to GDP is somewhat fucked up.
    Some of it was addressed, like the difference in mortality, live expectancy etc.
    What about measures that do not save lives, but increase the level of well being – in my case I had a total knee replacement done on both knees, due to arthritic damage that made working really painful. All paid in full by the Canadian health care system.
    What about waiting lists for elective surgery, wait time for emergency interventoion?
    I think the metric used is simply bullshit. Too many variables that did not enter the equation – simple but for simpletons.

  40. frog, Inc. says

    It’s also true for child mortality: http://www.reference-global.com/doi/abs/10.1515/IJAMH.2011.052

    And of course straight mortality rates: http://www.sciencedirect.com/science/article/pii/S014067361060517X

    Face it, the US is a third-world country by the most basic measure of “live-ability”, mortality. Below even Libya!

    The fact that we’re not really aware of that… well, what does it tell you about how well our information systems are managed? It’s the kind of thing that makes me wonder about skeptics who have managed to miss the most important story and are distracted by fools with morbid statuary at their clubs.

  41. says

    This is comparing apples with bananas anyway, the German health care system is not free, you pay 10% or so of your monthly income towards mandatory health cover. It’s not cheap, but it’s not outrageous either, and the cover provided covers everything from blood pressure tablets to having your tonsils out to cardiac stents.

  42. Yoritomo says

    This is a very, very strange standard of measurement. A country may rank as “highly efficient” if it lets all its citizens die but those which can be saved most cheaply. Is that really what we want?

    I’d expect that the better health care systems, those which prolong the lives of the population and promote general well-being the most, employing the most advanced technologies, are automatically the most “inefficient” in this regard: The additional lives saved with great technological and medical effort do not come as cheaply as those where a saw, a band-aid and a crutch are sufficient.

    Another caveat: If a rich country and a poor country spend the same amount of money to save a life, the poor country will get ranked “more inefficient” because that same amount of money represents a greater percentage of GDP.

    Now I’m prepared to believe that somewhere hidden in that data really is some sort of measurement of efficiency of the various health systems – but it’s well-hidden, and the ranking itself is worthless.

  43. frog, Inc. says

    Bjarne: And the majority of the German health care is … public.

    Whatever you need to believe for ideological purposes. Most of the funding for German health care comes from the government — but it’s funnelled through highly-regulated private insurance companies, as opposed to the UKs public system which cuts out the middle man.

    By your standards, most of US Health care is public — after you add up Federal Medicare and Medicaid plus state funding, you’re up to 50%.

    But it’s much more fun to focus on the marginal cases which fit ideological needs than to actually look at the numbers, eh? But get on your strawman to distract from who is really stealing health-care dollars and giving no results.

    In Japan, 70% of costs are paid directly by the government and all ownership of private medical facilities is directly in the hands of physicians (and non-profit to boot).

  44. Matt Penfold says

    True, but not necessarily as one sided as you might think. For example, fewer women get mammograms in Germany than in the US and the recommendations are (or at least were, last time I looked) for fewer. Similarly, the German healthcare system provides for only 2 screening colonoscopies throughout life, at (IIRC) 55 and 65. Of course, those who have positive findings or symptoms get further screening.

    There is a genuine lack of consensus in medicine as to how effective breast cancer screening is. It undoubtedly catches some cancers, and it does save lives. What is not so clear is how many, and whether the resources used in mass breast screening could be better utilised.

    It is not an easy question to answer, and it seems difference that different research projects have produced conflicting results.

  45. a_ray_in_dilbert_space says

    The basic problem now is the fact that the US ceased to exist as a country over a decade ago. We are now a farming operation, skimming $$$ from the people to make the rich ever richer. If you look at it that way, the US has precisely the healthcare system its leaders (the plutocracy) want it to have–one that costs a lot and accomplishes very little.

    The US–it’s easy to understand once you realize the “people” are really just domesticated animals.

  46. frog, Inc. says

    @Dianne: That’s certainly a problem with US society, but I don’t see it as a direct problem with the US health care system. Which is why I’d rather compare outcomes for specific conditions. Although I agree that that’s not a perfect measure either.

    The problem is that health is an essentially cumulative condition. If you chop it up into discrete events, you miss where you get most bang for the buck. If spending a dollar on gun-violence gives you more than oncology, or reducing stress in the work-place does more than MRI’s, how are you going to disentangle that? How are you going to pull out over-treatment — cases where folks would have been better off going to a witch-doctor, who at least did no harm?

    And of course all those lead to feedback loops — so poverty and stress among African-Americans leads to bad health results which increases poverty and stress and reduces inheritances and so forth and so on…

    You need to look at all the numbers and not have favorites. But the bottom line of “quality of life” is mortality, without BS made up to distract. Happy people live longer; people who live longer are happier.

  47. says

    Bjarne: And the majority of the German health care is … public.

    Whatever you need to believe for ideological purposes. Most of the funding for German health care comes from the government — but it’s funnelled through highly-regulated private insurance companies, as opposed to the UKs public system which cuts out the middle man.

    By your standards, most of US Health care is public — after you add up Federal Medicare and Medicaid plus state funding, you’re up to 50%.

    But it’s much more fun to focus on the marginal cases which fit ideological needs than to actually look at the numbers, eh? But get on your strawman to distract from who is really stealing health-care dollars and giving no results.

    In Japan, 70% of costs are paid directly by the government and all ownership of private medical facilities is directly in the hands of physicians (and non-profit to boot).

    Ah yes. So mentioning that, next to the messed up German health care system, paying for all kinds of woo might also be inefficient health care wise is now building a strawman for my ideological purposes? Honestly, is everything not masturbating your favorite nation a direct attack on you and your worldview?

  48. Dianne says

    It’s not cheap, but it’s not outrageous either, and the cover provided covers everything from blood pressure tablets to having your tonsils out to cardiac stents.

    There also seems to be some sort of vague subsidization of non-covered costs. For example, the price of prescription glasses is lower in Germany than in the US. Also prescription drugs. Not sure how that works exactly.

  49. says

    But to discuss this a bit calmer:

    Most of the funding for German health care comes from the government — but it’s funnelled through highly-regulated private insurance companies, as opposed to the UKs public system which cuts out the middle man.

    Well, yes somehow. If you earn less than a certain amount of money, you have to become a member/customer of a Krankenkasse. Then you have to pay 15.5 % of your income to the Krankenkasse and they direct it into some kind of national fund. The fund’s money is then split again between the Krankenkassen. From this money, the Krankenkassen have to cover a set of government regulated health services.
    Obviously this is a wasteful system.

    By your standards, most of US Health care is public — after you add up Federal Medicare and Medicaid plus state funding, you’re up to 50%.

    Well, do you want to deny, that Medicaid is a form of public health care? oO

    But it’s much more fun to focus on the marginal cases which fit ideological needs than to actually look at the numbers, eh? But get on your strawman to distract from who is really stealing health-care dollars and giving no results

    So, please show me, where I did deny, that the German health care system is stupid? Or do you just think, that I should keep my mouth shut about something wrong, just because there is something else even wronger?

  50. jrobertellis says

    As some people here have mentioned, the main problem is that this metric measures efficiency, rather than effectiveness. It promotes cut-rate systems over those that save more lives.

    Switzerland, France, and Germany all have excellent health care systems that cover nearly everyone with a higher quality of care (lower, almost zero, wait times; more coverage; and so on) than the UK, New Zealand, and Canada, but of course they spend more. They’re all still somewhat more efficient than the US system, and have better, more comprehensive care.

  51. 'Tis Himself, OM says

    One major difference between the US and other countries is administrative costs. The UK’s NHS has a single set of administrators. In the US each insurance company has its own set. Plus upper level management costs are cheaper under government systems. The US Medicare Administrator is a Level IV Executive making $165,000 a year. The CEO of WellPoint, the second largest American medical insurance company, makes $12 million, over 70 times as much.

  52. Carlie says

    For example, the price of prescription glasses is lower in Germany than in the US. Also prescription drugs. Not sure how that works exactly.

    In the case of American-based pharmaceutical companies, it’s because they charge the full price (with R&D built in) here, and then cut the rate they charge in other countries in order to get a market share there.

  53. David Marjanović, OM says

    Carlie! Where did you leave your lacy, gently wafting adjectives? :-)

    In the case of American-based pharmaceutical companies, it’s because they charge the full price (with R&D built in) here, and then cut the rate they charge in other countries in order to get a market share there.

    Also, as I just said on the ScienceBlogs thread…

    The same drugs often cost 3-4 times as much in the US compared with Canada/Europe.

    That’s because governments other than the US one negotiate prices with the pharma companies. As bulk customers, they can afford to.

    In the USA, the pharma companies sit in Congress.

  54. Matt Penfold says

    In the case of American-based pharmaceutical companies, it’s because they charge the full price (with R&D built in) here, and then cut the rate they charge in other countries in order to get a market share there.

    My understanding that is that drugs out of patent also cost more than in Europe. Since any licensed company can make drugs that are out of patent there are R&D costs to be recovered.

    So whilst I suspect you are right, it does not fully explain the high cost of drugs in the US.

  55. 'smee says

    Why can Pharma charge more for the same drug in the US than in Europe?

    because it can.

  56. Crys says

    This study also compared death rates over time and came to the conclusion that, in the US, more than half a million people are alive today who would not have been with the medical care we offered 25 years ago.

    Yea well you’re comparing the US to itself. When you compare the infant mortality rates, life expectancy and mortality rates of the US with other countries, you see that the US is worse off than almost all European countries. In that respect no, the health care system in the US is not good at all!

  57. opposablethumbs, que le pouce enragé mette les pouces says

    With all its failings – and FSM knows there are plenty – and for all it has been mucked around by various governments, I have always thought that the NHS is probably the UK’s single greatest achievement. The fact that healthcare is free at the point of access just means that no matter your income if you are/your loved one is ill you don’t have to be terrified of not being able to afford medical care. Illness is frightening enough without that; just taking away that extra fear means so much.

    That said, I suspect things now work out better in practice in several other countries. The thing about the NHS that I will always be grateful for is just that it was (I think? Speaking as a history dunce) the first step towards cutting the tie between being un/able to pay and getting the healthcare you need.