Wednesday, May 23, 2012

About that socialized medicine chart...

The following charts has shown up a couple of times in my Facebook feed in the last couple of days.

It was produced by Oliver Uberti and posted at the National Geographic Magazine's blog. It wound up on my Facebook after it was posted at by Sara Critchfield with the comment, "It looks like that 'socialism' thing seems to be working out pretty well for the rest of the world." The little icon on the Upworthy page indicates that "27k" people have "liked" Critchfield's post on Facebook.

Critfield seems to want us to take away from the graph that countries with health care "socialism" have health outcomes that are generally comparable or a bit better than the United States. The author of the National Geographic blog post that originally accompanied the chart made a much more precise claim:
The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones... The U.S. has a fee-for-service system—paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn’t reliably improve a patient’s health.
Here are my thoughts on the chart in the order in which they occurred to me:

1. Ubertis's post is correct in one key respect: There is basically no relationship between health care spending and life expectancy at birth in this small set of developed and developing countries. Even within the group of universal health care countries, there is an awful lot of noise in the relationship between spending and life expectancy.

2. If non-universal health care is so awful, why is life expectancy in Mexico so good?

3. Life expectancy seems like its has more to do with development than health care. Developing countries have life expectancies clustering loosely around 75, developing countries cluster around 80. I am sure we could track down some data on under-developed countries with some kind of universal care showing that their life expectancies are well below the 75-ish year mark we see in the small number of developing countries shown here.

4. Beyond making sure that most people have access to some pretty basic stuff (e.g. childhood vaccines, antibiotics, medically supervised child birth, etc.), spending more money on health care won't help people live much longer since most people don't use much health care until they are old.

5. I would bet that Americans' diet (fatty, salty) and lifestyle (sedentary with lots of driving and, therefore, exposure to accident risks) has a lot more to do with our marginally lower life expectancy than anything related to how we deliver health care.

6. Given that Americans, as a group, live a less healthy life in many ways than Western Europeans or Japanese, it may simply cost more money to keep us, as a group, living as long as we do.

7. How long someone lives is a really crude measure of "health." Eliminating or rationing care for non-life threatening health conditions could certainly reduce total health care costs without injuring a country's life expectancy. Are other countries achieving these "savings" because they have moved away from private health care or a fee-for-service model, or do they simply provide a smaller ranger of services on a less frequent basis? Might people in other countries choose to spend more on health care to improve the range and availability of health care options if that were an option?

1 comment:

  1. From a reader:

    In a previous life, before I decided to take the entrepreneurial challenge, I was well known in the realm of pharmacoeconomics. As such, I had some expertise with this very subject.

    A couple of additional comments to what you wrote.

    1. When you use life expectancy at birth, this takes into account the concept of what is a live birth. For example, there was a time and I believe it hasn't changed, when a delivery in Japan was not considered a live birth unless the baby survived for 24 hours. I don't think that concept has change. A live birth was only a live birth if it survived for a period of time. In other countries, unless the gestation is greater than a certain number of weeks (ie no premature babies) it is not counted as a live birth. This contrasts with the US in that any birth where there was at least a breath or heart beat is considered a live birth.

    So looking at infant mortality, the denominator is different between countries. When you control for some of those factors, the infant mortality rate in the US becomes much better. So using life expectancy at birth where the infant mortality is artificially low due to counting differences, will have an impact on the final result.

    2. There is no question that there are racial differences and ethnic differences between people. For example, it has been proven that even when you control for income and social economic status, that blacks have a greater percentage of premature babies and a higher infant mortality rate. There is a difference between the life expectancy of people in Finland versus other Europeans due to a greater proportion of certain genetic diseases. American Indians have a higher rate of diabetes and a lower life expectancy than asians. All of this is true even when other factors are controlled.

    So a country that has a higher proportion of racial and ethnic diversity will have more regression toward the mean. A country that has a less ethnic diversity will tend to be more of an outlier compared to the mean. It is not surprising that in your graph, the highest scoring countries tend to have less ethnic diversity.

    3. A better score would be life expectancy after age 50 or 60. That would be a better reflection of the quality of the health care, though no score of life expectancy can truly be reflective of the quality of health care because other factors (nutrition, weight, smoking, etc) are still much more important.