Universal Care Produces Bigger Life Expectancy Improvement

In work done a year earlier than that I've been looking at recently, Gerard F. Anderson, Ph.D. and Patricia Markovich of Johns Hopkins, did more detailed analyses of mortality variances among nations for The Commonwealth Fund.  In the study, entitled Multinational Comparisons of Health System Data, 2008, the authors report the change in life expectancy at birth for the 20 year period 1986-2006.  For the period, covering nearly a generation, the United States showed the smallest improvement among the nine countries compared as you can see in this graph.  (Click to enlarge graph.)

In another look at relative change in life expectancy between countries, the authors looked at how life expectancy at age 65 has changed over the same 20 year period.  Here, the United States' relative position improves modestly, but still shows the eighth smallest change among nine nations for the period.  (Click to enlarge graph.)

These data support an argument in favor of health reform.  In nations which have universal coverage, life expectancies are generally longer than in the United States, as we saw here.  And, as noted today, progress in improving life expectancy has been better in countries with universal coverage than the progress made in the United States during the period from 1986 to 2006.  I expect that the Patient Protection and Affordable Care Act will begin to bring some of these benefits to America, when the law takes full effect.

Universal Coverage Improves Preventive Care

One area where America is far behind in delivering high quality health care is in the area of preventive services.  Preventive services are not terribly expensive, yet they pay enormous dividends in avoiding far greater costs that come from needing to treat preventable illness, or to treat poorly managed disease.

Gerard F. Anderson and Patricia Markovich, two researchers at Johns Hopkins, completed a study funded in part by Commonwealth Fund entitled Multinational Comparisons of Health Systems Data, 2009.  Two interesting comparisons show the strong benefits of universal coverage in obtaining better preventive healthcare outcomes.

The following graph shows the impact of poor diabetic care in the United States versus nine other countries.  Americans lose 99 years of life per 100,000, a rate that is 50 percent greater than the next worst performing country, and a rate that is three to five times greater than eight other countries.  American endocrinologists can manage diabetes as well as specialists in other countries, but patients need the financial resources to allow for regular follow-up care, routine monitoring and supplies, and insulin and/or medicines required to treat the disease.  (Click to enlarge graph.)

While not a perfect comparison, the following chart, which shows immunization rates for those over age 65, supports the argument that with universal coverage, we do about as well as other nations.  Because of Medicare, those over 65 are the only American population cohort that currently enjoys universal coverage.  When compared with other nations immunization rates, the United States' senior population falls in the middle of the pack -- having the fifth highest influenza immunization rate among 10 countries.  (Click to enlarge graph.)

Universal coverage also produces better outcomes for diseases that we know how to treat.  You can read more here about how America ranks last among 19 countries in preventing mortality resulting from diseases that we can treat successfully when patients have access to insurance coverage.

When the Patient Protection and Affordable Care Act is fully implemented, life will be better, and there will be more of it for American diabetics.  When this important law is fully implemented, life will be better, and there will be more of it for all Americans.

U. S. Has Lower Life Expectancy

Johns Hopkins researchers Gerard F. Anderson's and Patricia Markovich's study Multinational Comparisons of Health System Data, 2009, includes the following graph showing life expectancy at birth for 12 countries.  The U. S. ranks last, having the shortest life expectancy for males and females among the 12 countries compared.  (Click to enlarge graph.)

Using data from the Organization for Economic Cooperation and Development, I have developed a graph to show life expectancy at age 65.  While the U. S. position improves modestly, it still ranks near the bottom of the 12 countries measured. (Click to enlarge graph.)

It is reasonable to expect that as more Americans come to receive the benefits of health insurance coverage and preventive care through the Patient Protection and Affordable Care Act, our life expectancies should increase.

Universal Coverage Leads to More Physician Care

It is reasonable to assume that a country that covers its entire population will experience more physician visits per capita than a country, like the United States, which covers only 83 percent of its population.  

The study Multinational Comparisons of Health System Data, 2009, funded in part by Commonwealth Fund and conducted by Johns Hopkins researchers  Gerard F. Anderson and Patricia Markovich supports that assumption.  

Here's a graph showing physician visits per capita for 11 countries.  The United States has, on average only 60.3 percent of the physician visits as the average Organization for Economic Cooperation and Development country studied.  (Click to enlarge graph.)

Some have worried that as government plays a larger role in the health care system, the supply of physicians will shrink.  After all, physicians in nearly every country around the world earn less than physicians in the United States.   Without a strong financial incentive, why would anyone endure a long course of study in medical school and years of work in a residency program?   

The following chart seems to dispel that concern.  Of 12 countries studied, the average OECD median number of practicing physicians per 1,000 population was 50 percent higher than the number of practicing physicians in the United States, as seen in the following graph.  (Click to enlarge graph.)

Knee, Hip and CABG Rates

Today, I continue to explore how medical services are provided in the developed world using Johns Hopkins researchers Gerard F. Anderson's and Patricia Markovich's study Multinational Comparisons of Health System Data, 2008.  

The following graph shows the rate of knee and hip replacement operations performed in five developed countries.  Note the U. S. ranks first in the rate of knee replacements performed per 100,000, but last in the number of hip replacements.  In Italy, the United Kingdom, Germany and France, roughly two hip replacements are performed for each knee replacement.  In the United States, 1.2 knees are replaced for each hip replacement.  Are Americans equipped with stronger hips but weaker knees than Europeans?
(Click to enlarge graph.)  

The United States ranks second among 12 countries in its rate of coronary artery bypass grafts (CABG) performed per 100,000 people.  Interestingly, the rate of CABG in Germany is 55 percent above the rate in the United States.  (Click to enlarge graph.)

These data do not provide evidence of severe restriction of health services in countries which provide universal health coverage for their populations.  

Less Hospital Care in U. S.

Continuing to explore Gerard F. Anderson's and Patricia Markovich's  study Multinational Comparisons of Health System Data, 2008, today, I look at the provision of services.  One of the reasons often cited for opposing the Patient Protection and Affordable Care Act is an irrational fear that government will withhold services or restrict the supply of services in ways that harm the population that elects the government.  

So, how do things in the United States compare with the rest of the developed world which has adopted programs to provide universal health care coverage?  The following chart shows that most of the world gets more hospital care than do Americans.  The number of hospital discharges per thousand is higher in eight of the 12 countries examined, and lower than the rate of discharges per thousand in the United States in only two countries.  In France and Germany, the number of discharges per thousand averages two times as many as in the United States.  (Click to enlarge graph.)

Following a heart attack, the amount of time patients spend in the hospital is longer in eight of 11 countries studied, than in the United States, and shorter than the United States' average in only two countries.  (Click to enlarge graph.)

These data, while not definitive, do not support a concern that health care services are severely restricted to hold down costs.  For hospitalization, and for care following AMI, OECD countries in general provide more care than is provided to Americans. Tomorrow, I will be looking at data for knee and hip replacements, and coronary artery bypass grafting.

Spending More, Getting Less Coverage

Gerard F. Anderson and Patricia Markovich of Johns Hopkins University have completed Multinational Comparisons of Health System Data, 2008 supported by the Commonwealth Fund.  The report includes an extensive series of charts that illustrate the strengths and weaknesses that exist between health systems.  Over the next several days, I will be including graphic examples from the report.

Today I look at coverage under public programs.  The following chart, combined with yesterday's charts, points out the fallacy of arguments that extending coverage to everyone is unaffordable.  In fact, what is unaffordable, is leaving millions of Americans without coverage.

The following chart shows that many countries cover their entire populations for what the United States spends to cover less than one-third of the population with Medicare, Medicaid, S-CHIP, CHAMPUS, the VA system and the Indian Health Service.  And many of these countries have populations that are substantially older, and need more health care than that of the United States, as seen here or here.  The chart also shows that among the eight nations compared, the United States has the second highest level of out-of-pocket spending for health services, exceeded only by Switzerland.

We Spend Most and Have Fastest Rising Costs

Gerard F. Anderson and Patricia Markovich of Johns Hopkins University have completed Multinational Comparisons of Health System Data, 2008 supported by the Commonwealth Fund.  The report includes an extensive series of charts that illustrate the strengths and weaknesses that exist between health systems.  Over the next several days, I will be including graphic examples from the report.

To begin, we'll look at cost comparisons, and see that the U. S. spends more per capita than any of the nine countries compared.  This chart shows spending per capita for 2006, adjusted for differences in cost of living between respective countries.  OCED is the Organization for Economic Development which is made up of European countries and Canada, Mexico, Australia, New Zealand, Japan, Korea and the United States.  (Click to enlarge graph.)

And costs are rising faster in the United States, than in any country with which it is compared.  (Click to enlarge.)

The Patient Protection and Affordable Care Act will begin to address this cost problem, by extending health insurance coverage to an additional 32 million Americans.  By doing so, we will improve our competitive position in the world economy, helping us improve exports, while keeping more jobs at home. 

Health Industry Supports Health Reform

A recently completed survey of healthcare opinion leaders undertaken by Commonwealth Fund and Modern Healthcare, which you can find here, shows broad support for key provisions of the Patient Protection and Affordable Care Act recently signed into law.  

Nearly nine of 10 leaders in health care and health care policy believe the comprehensive health reform legislation passed by Congress and signed into law by President Obama will successfully expand access to affordable health insurance coverage, the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey finds. Virtually all of the key features of the health reform law—including income-related subsidies, new insurance market rules, and innovative payment methods—are supported by an overwhelming majority of opinion leaders.

The World's Best Healthcare? Really?

Among the reasons cited for opposing health reform is the oft repeated line that the U. S. has the world's best healthcare, and we certainly would not want to do anything to hurt it. (As if providing greater access to its benefits will somehow ruin healthcare.)

But a Commonwealth Fund study shows that the United States' health system ranks last among 19 nations in doing what health systems are supposed to do -- reduce the rate of amenable mortality. That is, deaths that occur from certain causes, before age 75, which are potentially preventable with timely and effective health care. These are not the illnesses where medical miracles need to occur. These are the illness that medicine knows how to treat, such as treatable cancers, diabetes and cardiovascular disease.

Between 1997-98 and 2002-03, the amendable mortality rate fell by an average of 16 percent in all countries, except the U. S., where the decline was only four percent. In 1997-98, the U. S. ranked 15th among 19 countries; by 2002-03, America had fallen to last place.

Here's a graphical presentation of these data from 1997-98 and from 2002-03 taken from this October 2008 Commonwealth Fund report:

The authors of this study, Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., conclude with the obvious point, "The findings presented here are consistent with other cross-national analyses, demonstrating the relative underperformance of the U. S. health care system in several key indicators, compared with other industrialized countries."

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