Sunday, November 04, 2007

Beyond Those Health Care Numbers: US Looks Good


Greg Mankiw has an article in today's NYTimes "Beyond Those Health Care Numbers," where he addresses the statement: "The United States has lower life expectancy than Canada, which has national health insurance." Mankiw points to a study by economists June and Dave O’Neill, and writes:

Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50% higher in the United States than in Canada, but the O’Neills show that accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach us nothing about our system of health care.

1. In a previous CD post, I cited a study from researchers at the University of Iowa that compares unadjusted life expectancy means in OECD countries from 1980-1999 to standardized life expectancy means, which account for the effects of premature death resulting from a non-health-related fatal injury. As the chart above shows (click to enlarge), the U.S. has the highest standardized life expectancy among the OECD countries (76.9 years), and 0.70 years higher than in Canada (76.2 years).

2. Another important measure of how the effectiveness of a health care system relates to life expectancy is to look not at life expectacy at birth, but life expectancy at older ages when the quality health of care (surgery, treatment, advance testing and screening, MRIs, expensive drugs, radiation, chemotherapy) is probably most important.

I couldn't find data for Canada, but the bottom chart above (click to enlarge) is from a previous CD post that compares additional life expectancy at ages 70, 75 and 80 for men and women in the U.S. and U.K. (see previous post for links to the data). As the chart shows, life expectancy at birth is about one year longer in the U.K. than in the U.S. But once somebody reaches age 70 or older, life expectancy is higher in the U.S. by about 2/3 of a year.

Bottom Line: Once you go beyond the the standard health care data on life expectancy at birth, the U.S. looks pretty good, and actually has the highest standardized life expectancy in the world, according to the University of Iowa study.

16 Comments:

At 11/04/2007 10:28 AM, Anonymous Anonymous said...

You know (or should know) that the numbers you quote would not pass muster in a legitimate study by legitimate researchers in the real world.

By the way you posted this information about a month ago.

 
At 11/04/2007 10:53 AM, Anonymous Anonymous said...

Mark J. Perry said...

As the chart shows, life expectancy at birth is about one year longer in the U.K. than in the U.S. But once somebody reaches age 70 or older, life expectancy is higher in the U.S. by about 2/3 of a year.

2/3 of a year does not sound like much of a return (quality of life wise) for spending more than twice what is spent on health care in the U.K. (See P. 6 of http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf

 
At 11/04/2007 12:08 PM, Anonymous holymoly said...

Mark -- would you care to comment on Table 1-1 from the same publication, showing years of healthy life (i.e., quality/disability-adjusted) at birth and at age 60 that show the U.S. below countries that spend half as much per-capita as we do?

 
At 11/04/2007 12:09 PM, Anonymous holymoly said...

Haha -- silly me. I said "publication" when I meant "presentation." Publication actually implies that their analysis went through peer review! Silly silly me.

 
At 11/04/2007 1:30 PM, Anonymous Anonymous said...

Anon 10:53am:

That actually does sound like quite a significant return, considering the US also has many more black people than the other countries listed, and even with the accident/unnatural death factor removed, blacks simply don't live as long as whites, or the dominant minority groups in the listed nations.

 
At 11/11/2007 5:01 AM, Blogger Jennifer said...

I don't understand how a contry's life expectancy "standardized" can go down, when accidental deaths are excluded. Is the study saying that my country (Australia) doesn't have enough homicides or suicides, and standardising it involves killing more people?

 
At 11/12/2007 11:16 AM, Blogger radovan said...

If you have too many pensioners ending under wheels or flying from the windows, it can drop down...

 
At 11/13/2007 8:57 PM, Anonymous A Real Researcher said...

I always find it amusing how professional ranters criticize others' work with meaningless statements.

One critic claims that, "You know (or should know) that the numbers you quote would not pass muster in a legitimate study by legitimate researchers in the real world," which is typical of their rants, which are devoid of any useful information or criticism. These people are usually failures in life who have nothing to offer, but want to be heard.

Another useless criticism is the one about the cost of health care. In the table, only one variable was changed to see its effect, as is expected in research. The author made no claims to include a 2nd variable, amount spent, nor should have. Only phony researchers will introduce several variables to cloud the issue and the results. That criticism is also pointless.

 
At 11/15/2007 3:43 PM, Anonymous holymoly said...

"Real researcher"

The whole point of the argument was the value-for-money of the various health care systems. Introducing cost wasn't adding an unnecessary variable -- it was highlighting the other key variable of the value debate.

If you are indeed a real researcher, you sure as hell aren't a health economist.

 
At 11/16/2007 9:37 PM, Blogger Douglas said...

How is it that the standardized life expectancy could be less than the raw numbers once one ignores homicide and car accidents? In Europe, do people come back to life in car accidents which make the raw numbers higher?

 
At 11/21/2007 5:05 PM, Anonymous Manny Goldstein said...

It's fascinating that the US has improved outcomes in folks 65 and older. Strangely, this is when they're covered by Medicare, that low-cost socialist program.

(Actually this is generally known to be true among folks who study medical outcomes - Americans have poor medical outcomes until they hit 65 - at that point the outcomes are world class even though the cost of care under Medicare is far lower when compared to private insurance, when adjusted for age.)

Also - Americans have a far lower rate of smoking than most other developed countries - so we should be living longer. Is this taken into account in the study?

Finally, it looks like being overweight or mildly obese increases life span, so our extra girth should actually be yielding a somewhat higher expectancy. Is this taken into account in the study?


All in all, I think that it's pretty unlikely that a good "normalization" process will lead to a conclusion other than, compared to the rest of the developed world, we get crappy health care, and pay twice as much for it.

Boy, are we dumb #$%@s!

 
At 2/16/2008 8:07 PM, Anonymous Anonymous said...

"Finally, it looks like being overweight or mildly obese increases life span, so our extra girth should actually be yielding a somewhat higher expectancy. Is this taken into account in the study?"

Holy god is this a list of awful criticisms. To address just one (because I don't care enough to say while they're all wrong) this factor is largely due to the phenomenon of wasting before death. Try googling cachexia and you might see why being mildly overweight when you're old might mean you're less likely to die soon. It's the same phenomenon as why sleeping a lot equals increased rate of death. Hint: IT'S NOT BECAUSE YOU'RE SLEEPING MORE.

I would like to think it is self-obvious that this does not mean for any given person who is of average weight, if you add weight to make them overweight their life expectancy goes up. But the difference between causation and correlation is lost on most.

 
At 7/17/2008 9:02 AM, Blogger Dallas Health said...

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At 8/21/2009 4:33 PM, Blogger Carey said...

According to "OECD Economic Surveys: United States 2008", p. 137 (http://tinyurl.com/mt3g76):
"It has been claimed (Ohsfeld and Schneider, 2006) that adjusting for the higher death rate from accident or injury in the United States over 1980-99 than the OECD average would increase US life expectancy at birth from 18th of of 29 OECD countries to the highest. In fact, what the panel regression estimated by these authors shows is that predicted life expectancy at birth based on US GDP per capita and OECD average death rates from these causes is the highest in the OECD. The adjustment for the gap in injury death rates between the United States and OECD average alone only increases life expectancy at birth marginally, from 19th on average among 29 countries over 1980-99 to 17th. Hence, the high ranking of adjusted life expectancy mainly reflects high US GDP per capita, not the effects of unusually high death rates from accident and injury."

In other words, the figures in Table 1-5 are not U.S. life expectancies adjusted for fatal injuries (which leaves the U.S. ranked at 17th if you actually do this), but rather a model that assumes that both the relationship of life expectancy to per capita GDP and injuries in the U.S. follow OECD trends.

That is - they are falsely giving the U.S. credit for having the same basic life expectancy as other other high GDP OECD countries, when in fact it is markedly lower.

Check it out for yourself, the Ohsfeld and Schneider report is at:
http://www.aei.org/docLib/9780844742403.pdf [aei.org]
See p. 20-21.

 
At 10/08/2009 10:45 PM, Blogger M. S. said...

Carey is right. Here is the equation that Ohsfeldt and Schneider use to derive their rankings, taken from the book, "The Business of Health" - the equation is not in the presentation:

LifeExpit = 50.78 + 3.020 * log(GDPPCit) - 0.077 * [mean(Trans)]
- 0.137 * [mean(Falls)] - 0.133 * [mean(Homicide)]
- 0.0326 * [mean(Suicide)] + year-effectsit

The equation includes "log(GDPPCit)", or GDP per capita (country i, year t) and it includes factors for transportation accidents, falls, homicide, and suicide. But it does not in any way use real-world life expectancy data as the authors suggest. I call it deceptive.

 
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