Quality Health Care : True or False?

When it comes to getting the facts, things are not always as they seem. People are arguing constantly about the quality of health care here in the US as opposed to the quality of care in the countries that practice socialized medicine (i.e. Canada, UK, Cuba, New Zealand, Australia). The thing is, you have to challenge those supposed “facts” because chances are they don’t tell the story that person really wanted to tell. They want you to say: “omg i didnt kno that i totes belive u now!” You high-five them, you both go get a pizza. Then they just pray that you don’t question their logic. Unfortunately for them, there are a lot of us who still think for ourselves.

So. This is going to be an entry where I take arguments that people make to support their position, and then completely invalidate them. It is loads of fun. I refer to the OECD countries in this post, which refers to 30 Democracies: United States, Luxembourg, Switzerland, Norway, Iceland, Canada, France, Austria, Australia, Belgium, Germany, Netherlands, Denmark, Sweden, Ireland, United Kingdom, Italy, Japan, Finland, Greece, Spain, New Zealand, Portugal, Czech Republic, Hungary, Korea, Poland, Slovak Republic, Mexico and Turkey. Most of these are considered the most economically advanced countries in the world, and they each have a government that funds at least 90% of their health care… except for the United States, that is. Onward.

#1 : OECD countries have higher life expectancy than the US.

TRUE. The average life expectancy for a person in the United States is 77 ½ years — slightly below the OECD average (78.3%), and 4½ years less than top-rated Japan (82.1).

HOWEVER… This doesn’t reflect the quality of our health care and certainly does not prove that our care is inferior to theirs. Consider the lifestyles of Americans compared to other countries. We have the highest number of overweight people out of everyone (about 3 in 5 Americans are overweight, 1 in 3 are obese). Considering the complications that come with obesity (diabetes, heart disease, hypertension, and dozens more), that alone explains our lower life expectancy. That still isn’t even considering all of our other detrimental habits. We’ve also got a higher instance of AIDS than the 0ther OECD nations, second only to Portugal, because we’re still not wrapping out shit up for some reason. It’s no wonder we’re not living as long when there are more of us with compromised immune systems. Considering all of these factors, you’ll find it has nothing to do with the actual quality of care and everything to do with the higher instance of the stupid decisions that US citizens make*.  When you get to #3 you’ll find another good explanation.

#2: OECD countries have a lower mortality rate than the US.

TRUE. The United States has a higher rate of deaths from natural causes than 17 OECD countries. 

HOWEVER… Refer to the “however” explanation in #1. The US overall has an unhealthier lifestyle than other countries. There are more of us who practice bad habits that harm our health, thus more of us who develop disease, thus more of us with compromised immune systems, and thus more of us dying. Again, this does not reflect quality of care, but rather the less-than-great  lifestyles of the patients.

#3: People in the US visit health care facilities more often.

FALSE. When comparing U.S. utilization of hospital care with other OECD countries, the United States is well below the average. The United States experienced 121 hospital discharges per 1,000 people in 2004 compared with the OECD average of 161.

HOWEVER… This might be another explanation as to why the US has lower life expectancy and a higher mortality rate. When the country with the least healthy habits has the lowest tendency to visit a doctor, obviously the outcomes are going to be worse than those in the countries that are better at avoiding the same unhealthy habits. But why aren’t we going to see our doctors as much as the other countries? That answer should be fairly obvious – We Have To Pay. Sometimes a helluva lot. But that is a different entry for a different day.

#4: Patients in the US have longer stays in clinics and hospitals.

FALSE. Patients in the US have the shortest visits of all. The average length of stay in a hospital in America is 5.6 days, only about 2 days more than the lowest (Denmark at 3.4) and almost 15 days less than the highest (Japan at 20.2 days, but that’s quite an outlier. Refer to the PDF).

HOWEVER… This measurement is not a good way to decide the quality of health care. If you think about it one way, a short visit is good. Maybe there are more staff available, the procedures are more efficient, and the recovery rates are quicker, thus leading to a shorter stay. But, if you think about it another way, a short visit is bad. It could mean there’s not enough time, not enough room, or the staff do not care enough to keep you any longer. I think it’s safe to conclude that length of stay is not the best way to judge the overall quality of care unless you have detailed accounts of each visit.

#5: The US  has a better supply of resources.

TRUE. For example, the United States has nearly twice as many CT scanners and three times as many MRI machines per capita as the OECD average. In fact, the United States has the second-highest number of both CT scanners and MRI machines per population in the OECD, second only to Japan. They also perform more advanced invasive procedures (such as coronary bypasses and angioplasties) more frequently than the average OECD country.

HOWEVER… That advantage obviously comes at a cost. Having the most resource-intensive technology and procedures also means it requires more money from the patients to use them. Implementing such procedures and surgeries more often than the other countries is obviously going to affect more people. The question is whether or not the benefits outweigh the costs. How many more deaths would occur due to our habits if we didn’t have the advanced and resourceful health care that we do? Well if my opinion matters, our life expectancy would likely plummet and our mortality rate would climb.

#6: The US has a higher number of deaths due to medical mistakes.

TRUE. The United States has the third-highest rate of deaths from medical errors (0.7 per 100,000 people), among the OECD countries.

HOWEVER… Like I mentioned before, we perform a lot more invasive procedures than everyone else does. So yeah, no shit we are going to have a higher number of mistakes and resulting deaths. If the other countries performed as many surgeries as we do here, I wonder what their rates would look like then. Another thing to consider is the number of elective surgeries we conduct here. In 2008, there were: 355,671 boob jobs, 341,144 liposuctions, 152, 434 nose jobs, and 700,000 LASIK procedures conducted, and that’s only scratching the surface (Get it? Like scratching the surface of the cornea? Come on that’s funny). Overall, there were 1.7 million cosmetic surgical procedures performed in the US in 2008. And still, cosmetic surgeries only make up a fraction of all elective surgeries. Don’t forget gastric bypass, vasectomies, tubal ligation, circumcision, etc. Since all surgeries come with a risk, and the US takes the most risks, it only makes sense that we would have a higher number of deaths due to medical mistakes.

#7: OECD countries have longer waiting times than the US.

TRUE AND FALSE. The United States is one of eight countries in which wait times for elective surgery are reported to be very low. In a recent survey, a quarter to a third of respondents in Canada, the United Kingdom, and Australia reported waiting more than four months for a non-emergency procedure, compared with only 5% of Americans. In terms of doctor visits to primary care physicians, a five-country survey found that Americans had the greatest difficulty getting care on nights and weekends and were the most likely to forgo care because of cost.

HOWEVER… The US has fewer clinic hours open. I couldn’t find any documentation on open clinic hours in the US or other countries, but I did Google a few dozen clinic websites from the US and Canda, just to get an idea of how we differ in that respect. I found that most of our own private practices tend to close no later than 6:00 PM on weekdays and are open for only a few hours, if open at all, on Saturdays. Very few were open on Sundays. After checking out some Canadian clinic hours, many of them had similar hours to the US but there was a much, much higher chance of finding a clinic with longer hours. One center in Alberta is even open from 9am-10pm every day of the week. If you want to see a doctor after 5:00 PM on a weekday or anytime during the weekend, you’ve got a much, much better chance of finding that in Canada. So my suggestion to US practices would be to extend their hours a bit, just so people won’t have such a hard time making same-day or weekend appointments. Though that’s easy for me to say as I’ve never had to work at a medical clinic.

#8: The US spends the most money on health care, more than any other country.

TRUE. The US spends about 15% of its gross domestic product on health care. The only country to be even remotely close to that is Switzerland at 11.6%, and that isn’t even close. The average percentage of GDP spent on health care among the OECD countries is about 8.9%.

HOWEVER… Different topic for a different day.

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* Stupid decisions that we make because we have more freedom to make them. Which isn’t a bad thing.

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

http://www.who.int/whosis/whostat/EN_WHS09_Table7.pdf

http://www.cosmeticplasticsurgerystatistics.com/statistics.html

http://www.plasticsurgery.org/Media/stats/2008-US-cosmetic-reconstructive-plastic-surgery-minimally-invasive-statistics.pdf

http://www.mcithedoctorsoffice.com/patients/clinics.cfm?location=AB