Monday, August 10, 2009

Life Expectancy Higher in US than UK at Age 65+


In the debates on health care, many claim that the relatively low life expectancy in the U.S. compared to Canada and Europe and elsewhere is evidence of an inferior, second-rate American health care system. See some examples below:

Example 1
: Canada's life expectancy average is 82.1 years. The life expectancy for citizens of France is 80.9 years and the average life expectancy of those living in the U.K. is 78.9 years. In the United States, the average life expectancy rate is 78.1. But more importantly than life expectancy averages is the fact that in each of those nations, every single citizen has access to health care. The United States is the only developed country in the world that does not offer health care to all of its citizens.

Example 2: Out of 30 developed nations, life expectancy in the United States ranks 21st: Life expectancy in the United States is 4.6 years less than Japan, 2.1 years less than France and 2.6 years less than Canada. The United States has fewer physicians, nurses and hospital beds than most developed nations. In terms of continuity of care (i.e., five-plus years with the same doctor), the United States is the worst of all developed nations. By every objective measure, the United States has a second-rate health care system.
The chart above (click to enlarge) displays data for the U.S. (
data here for 2004) and the U.K. (data here for 2004-06) showing: a) life expectancy at birth for males and females in both countries, and b) the additional life expectancy once a person reaches a certain age in each country. (Note: I'm looking for comparable data for Canada or France, etc.)

It's true that life expectancy is higher at birth in the U.K., by 1.7 years for males and .90 years for females, but life expectancy at older ages is greater in the U.S. than in the U.K. For men, life expectancy is greater at birth and up until age 60 in the U.K., but then the pattern reverses and men can expect to live longer in the U.S. at ages 65, 70, 75, 80 and 85. By age 75, male life expectancy is greater than in the U.K. by at least six months. Likewise, U.K. women have higher life expectancy at birth and up until age 55; at ages 60 and above, American women have greater life expectancy than their U.K. counterparts, and by age 75 women live longer in the U.S. than in the U.K. by 8-9 months.

Since quality health care (surgery, treatment, critical care, advanced testing, expensive prescription drugs) is most important during the last years of our lives, couldn't we say that the U.S. has a first-rate health care system, especially at the time when quality care is most important, and it extends the lives of older people in U.S. by at least 1/2 year?

23 Comments:

At 8/10/2009 4:12 PM, Anonymous Devil's Advocate said...

While I agree with your premise (the lower life expectancy in the US is likely attributable to auto accidents), couldn't this same data be used to argue in favor of medicare... If and only if an American makes it to age 65 (and is then covered by medicare) will he be in same or better situation as his British counterpart.

 
At 8/10/2009 4:30 PM, Blogger ExtremeHobo said...

How would Medicare protect you from fatal accidents Mr Devil? Its a little late at that point!

 
At 8/10/2009 4:54 PM, Anonymous Anonymous said...

OECD longitudinal data for life expectancy (LE) for females/males @ age 65 is here

 
At 8/10/2009 5:52 PM, Anonymous Dr. T said...

Here are two situations to discuss with social medicine lovers:

You are walking in a big city and are half a mile from a large hospital. You suddently have a massive myocardial infarction. In which country will you have the greatest chance of surviving? (Hint: It's got the initials USA.)

You're a middle-aged person with a bizarre set of symptoms that don't fit any common disease. (You have widespread tuberculosis with no lung involvement.) In which country will you most likely receive the correct diagnosis quickly enough so that your kidneys and adrenal glands survive? (Hint: Those USA initials again.)

When trying to compare medical systems using life expectancies, inclusion of accidental and homicide deaths is inappropriate. If we remove those and correct for variations in how premature baby deaths are counted, then our life expectancies exceed those of most social medicine developed nations.

 
At 8/10/2009 7:03 PM, Blogger bob wright said...

Dr. T,

You said:
"If we remove those and correct for variations in how premature baby deaths are counted....."

Do you happen to have a publicly available source for this?

 
At 8/10/2009 7:37 PM, Blogger PeakTrader said...

The U.S. is the only developed country with a fertility rate greater than its replacement rate, because of a large Third World immigrant population (and their children). A higher infant mortality rate lowers life expectancy.

 
At 8/10/2009 8:04 PM, Anonymous Anonymous said...

The American health care debate is fascinating. If you have good reliable health care now you will pay more and get less with universal coverage. If you are old and have Medicare or are permanently poor and have Medicaid you will lose since those programs will lose funds to pay for universal coverage. If you lack medical coverage or lose coverage you will win. Universal health care forces middle class workers to pay for the low wage earner in addition to paying for the elderly and the poor. Raising taxes on the rich and corporations will not come close to paying for it.

A few months more or less on average at the end of your life is not the point. It is the freedom to fly to the Mayo Clinic if five local doctors cannot diagnose your serious illness. It is the freedom to fly to MD Anderson for cancer treatment. Many Americans who can this today will not be able to it after this becomes law.

 
At 8/10/2009 9:48 PM, Blogger Michael said...

On variable rarely pointed out is the definition of a live birth. In the US, after birth, if the doctor can detect one breath or one heart beat and the baby then dies, it is a live birth. In much of the rest of the developed world, the baby must live a day or two after birth, or must reach a certain body weight before it is considered a live birth. When you correct for these differences, the US quickly heads to the top of the health care lists.

 
At 8/10/2009 10:05 PM, Anonymous Anonymous said...

Don't dignify the fallacious arguments of our enemies by trying to argue within them.

Life expectancy has absolutely nothing to do with the quality of a health care system. Life expectancy is a function of genetics, diet, exercise, environmental considerations, lifestyle and consumption choices, and the current age distribution of the population. Health care systems affect NONE of these. Health care treats disease, it doesn't prevent it. And if Obama intends to prevent certain diseases, it will mean ever increasing government controls through regulation and taxation. Politics will determine what's paid for and what's subsidized, not economics.

A free market insurance system would just charge people more based on factors affecting disease but competition would ensure efficiency and proper risk pooling.

Compare the survival rates of diseases across the worl and you'll easily see the US is second to none. Our expenditures are higher in part because of higher quality, in part because of higher demand. Spending money on health care is a good thing.

 
At 8/10/2009 11:20 PM, Blogger rufus said...

Sure, our older people have Government Health Care.

 
At 8/11/2009 5:48 AM, Blogger bob wright said...

anonymous 10:05 pm:

nice summary. well done.

 
At 8/11/2009 7:42 AM, Blogger 1 said...

Two years ago Professor Mark posted this New York Times link of a Greg Mankiw posting: Beyond Those Health Care Numbers

anon @ 10:05 PM does a pretty good job of giving a precise short version of Mankiw's posting...

 
At 8/11/2009 9:05 AM, Anonymous Anonymous said...

I have seen data (can't find the reference yet) that explains much of the difference in LE at birth due to the treatment of what constitutes "birth." In the US, all live births are counted, including all preterm events. Other developed countries use other age standards for determining "birth", i.e., counting only neonates that have made full term, or even only counting infants at some age in the first year. As you can imagine this has a strong effect on LE at birth measurments.

Despite the tremendous resources spent on surviving these babies, there remains a high mortality rate. Accoding to Goldenberg (Lancet 2008 Jan 5;371(9606):75-84), Europe has a premature birth rate of 5-9%, while the US has 12-13%. You can easily imagine the impact of even a small number of 0-3week mortalities on LE at birth.

 
At 8/13/2009 5:31 PM, Anonymous Anonymous said...

As a fellow MBA, I have a question for you.

What are the assumptions that form the basis of the 'free market model'? I seem to recall something about 'perfect' market information, un-coerced buying decisions, etc.

Now, how many of those assumptions of the model apply in the situation of health-care, where purchase decisions are often made hastily under a situation of murky information and costs, and sometimes with life-and-death hanging in the balance on the decision, making a purchase entirely coerced?

Could the reason the health-care system has failed be because the "free market model" is an *inappropriate economic model* to apply to the health-care industry? Health-care does not meet the criteria to be treated as a 'commodity'.

Why is nobody in academia talking about this fundamental mis-match? Has academia not bothered with that level of economic introspection?

If the 'free market' could self-regulate to provide cost-effective health-care, then it would already have done so. The 'free market health-care' model has proven itself as a failure. It needs to be replaced with a system based upon an economic market-model that more aptly fits the actual situation of the health-care market.

This is a situation where business-folk enamored of the 'free market' hammer have seen every industry, including health-care, as a 'nail'. However on closer inspection, it turns out that health-care is a screw, and requires a screwdriver.

Currently, insurance companies skim 20% of each health-care dollar as profit *after* their expenses while hospitals and doctors average 1-3% profit. Insurance companies are essentially taking 1/5 of every dollar a sick person spends on health-care and handing it directly to Wall Street.

I would far rather see the 'non-profit' government handle the transaction than see 20% redirected away from contributing to care. The government would have to exceed its worst records of inefficiency to eat up more than that 20%. Simply by cutting out the 'profit incentive', the 'public option' starts off with a 20% cost advantage.

Lisa the GP
MD/MBA

 
At 8/16/2009 7:25 AM, Anonymous Kevin said...

There's a danger of a statistical falacy here -- there's an old chestnut of statistics courses which points out that a study done on smokers and non-smokers discovered that the life expectancy of smokers was longer than non-smokers once they were over 60, but this certainly would be a foolish reason to conclude that smoking is good for you. Unfortunately I couldn't find the study, but the theoretical point remains.

 
At 8/19/2009 6:57 PM, Anonymous Anonymous said...

All I had, when I came to this site, is one simple question, and no one yet has answered it. The title of your article is "Life Expenancy Higher in US than UK at Age 65+," but your article doesn't seem match that title at all - in my opinion.

Who has the highest life expectency? The U.S. or the U.K.?

Ayasha

 
At 8/21/2009 3:35 AM, Blogger joemomberg said...

And who said a borderline third world infant mortality rate is a bad thing? The argument that denying adults healthcare if they can't afford it is morally disgusting, but denying babies and children, who do not have the chance to work, is beyond the pale

 
At 8/22/2009 9:25 AM, Blogger class-factotum said...

insurance companies skim 20% of each health-care dollar as profit *after* their expenses

Data, please. Here is what I found, which indicates an overall 3.3% margin.
http://biz.yahoo.com/p/522qpmd.html

How would you get 20% profit after expenses? You'd have to have a loss ratio near 65%, which would make your premiums awfully high, which would just set you up to lose the business.

 
At 10/04/2009 3:09 AM, Anonymous Paul from the UK said...

I live in the UK and just came across this site whilst looking for life expectancy tables. Lets start with the original Blog point, that although the whole population lives a shorter life on average in the USA than the UK, at later points in the life tables the remaining older people in the US in some way ‘pull ahead’ of their UK counterparts.
If the UK is ahead on average, this means that more deaths occur in the US at earlier ages – so who is dying young do you think? the people from families in good jobs with good medical insurance? or are they drawn from the 50 million poor and uninsured? If the poor then, through this ‘social engineering’ effect, the remaining population are going to be on average richer than the dead. With better homes; food; social support networks; or fewer accidents, they are selected for survival. In addition, if that group make it to their mid 60s, the US government gives them a hand with the bills.
Another point raised here is that of choice; I get more choice than the average US citizen, not just the uninsured, but a better choice than the health care experience of those on the US insurance paid scheme that is the most common, an HMO. I can choose any GP (family doctor) in the NHS system (and 98% of them are in the system) – by the way our family doctors still make house calls, do yours? In addition I can access world class care throughout the UK (I have seen top specialists in Glasgow Scotland, where I live, and Southampton 700 miles away). US reporting of other health systems is usually done by people who not only have never really studied the other system, but have never had to sit (uninsured) for hours in an overcrowded emergency clinic their own country.

 
At 10/26/2009 6:41 PM, Blogger johnsal said...

I know I'm late here. But the comment thread now ends with such an ignorant and uninformed comment, that I am compelled to respond.

A short trip on google search will reveal such important comparative statistics as:

1. According to 2001 World Health Organization (WHO) statistics, the UK has an average of 163.93 physicians per 100,000 inhabitants compared to 279.0 in the USA and 229.1 in Canada.

2. The underfunding has also resulted in the closure of many rural hospitals, regional restrictions on certain types of treatment for certain individuals (in one case, the NHS refused to pay for chemotherapy for a child with terminal cancer), and a notorious lack of hospital beds (only 4.5 per 1,000 population). Hospital buildings often suffer from poor maintenance, lack of repair work, and cleanliness problems. (from MedHunters)

3. ...waiting times ranging from one to two years or more for non-emergency operations in NHS hospitals have made patients go private to "jump the queue" – if only for the one occasion. For the second quarter of 2002, for instance, a total of 74,814 patients in England were waiting for hospital admission for eye, nose, and throat complaints. Of these, 44.5% waited for less than three months, 27.3% waited three to five months, 17.75 waited six to eight months, and the remainder waited longer. Second, some patients are attracted by the better standards of accommodation in private facilities. Private pay and independent insurance are used almost exclusively to cover the costs of acute healthcare in a hospital. (from MedHunters)

And, of course, a statistical abstract such as "average life expectancy" cannot be compared since the statistics are calculated differently in each country. In the U.S. all live births, premature or not, are counted from the moment of delivery. This is not the case for any other country, many of which improve their statistics by not counting births under a certain weight, less than a certain length, or who do not survive at least 24-48 hours. Then, of course, my examination of the world map shows that the UK does not share a 2 thousand mile border with a tropical, "developing" country who illegally exports 12 million of its citizens to us with a wide variety of "pre-existing conditions." And, the U.S. also has the cultural and life style choice of significant portion of the population, including, but not limited to, the "African-American" murder rate - NOT a health care issue.

I could go on but the UKers observations are of such phony-baloney nonsense that I think I'll stop here.

 
At 11/11/2009 1:48 PM, Anonymous Anonymous said...

At age 65 in the U.S., you are eligible for Medicare, that is why the trend reverses itself. All of the other noise being brought up about auto accidents, etc, it crap. The numbers and the sample are large enough to overcome such noise. The only dimension that changes universally for Americans is access to a single payer health insurance program, plain and simple.

 
At 4/27/2010 1:44 PM, Anonymous Anonymous said...

How very stupid of all the above to fall for this statistic.If it is true that life expectancy for 65+ is higher in the US than the UK, it's because the UK is carrying sick peole who would have died earlier in the US through to 65+. Such people as a group are obviously not going to have as great a life expectancy as the healthier cohort of the population.Clearly a greater percentage of Americans die before 65. This is shameful, as is the attempt to use this fact to create a statistic that attempts to justify the system that results in Americans having the lowest life expectancy in the developed world, if fact even Cubans live longer.

 
At 3/23/2011 12:32 AM, Blogger Omerta said...

No.I would MUCH rather have a greater chance at licing when I was young than when I am old. Ask my uncle if he wanted to live the last six months of his life, he wasn't even coherent!!

 

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