The Best Health Care in the World

Caduseus

Caduseus

Recently a commenter to another post here said we in the US have the best healthcare system in the world. Honestly, I’m not sure how to define that so I went looking for metrics to help. Here’s some of what I found. With the exception of the US, the nations listed here were chosen somewhat arbitrarily.

Infant Mortality — The UN, politics aside, gathers lots of statistics. So does the CIA as part of their threat analysis. The numbers reflect deaths per 1,000 births. The numbers from the UN are for 2006. The CIA’s numbers are 2009 estimates. The world-wide rate according to the UN is 49.4 and according to the CIA is 42.09.

Country UN Rank Deaths CIA Rank Deaths
Canada 23 4.8 36 5.04
France 12 4.2 8 3.33
Sweden 4 3.2 3 2.75
UK 22 4.8 32 4.85
USA 33 6.3 46 6.26

Maternal Mortality — Expressed as deaths of the mother per 100,000 births. Data from Nationmaster. World-wide weighted average is 207.2. For this one, the higher the rank, the better. Here I substituted Greece for Canada because I couldn’t find the data for Canada.

Country Rank Deaths
Greece 135 1
France 111 10
Sweden 130 5
UK 121 7
USA 116 8

Life Expectancy — Again, from the UN and the CIA. Numbers come from the same years, 2006 for the UN and 2009 estimate from the CIA. The number  represents age in years at death overall for men and women. The world-wide average according to the UN is 67.2 and by the CIA is 66.26. France outranks Canada, I think, because of the life expectancy of women.

Country UN Rank Age CIA Rank Age
Canada 11 80.7 10 80.34
France 10 80.7 5 80.7
Sweden 7 80.9 7 80.63
UK 22 79.4 26 78.7
USA 38 78.2 30 78.06

Health Care Costs as Percentage of GDP — Data from the Organisation for Economic Co-operation and Development (and yes, it’s spelled correctly). World-wide weighted average is 8.3%

Country 1997 2007
Canada 8.8 10.1
France 10.2 11
Sweden 8.1 9.1
UK 6.6 8.4
USA 13.6 16

Health Care Spending Per Person — Data from Nationmaster. Weighted Average is $503.8. Nationmaster got the data from the World Bank.

Country Rank Spending
Canada 14 1939
France 8 2288
Sweden 11 2145
UK 18 1675
USA 1 4275

Number of Doctors — This is measured as the number of doctors per 1,000 population. Data from Nationmaster. The figures do not differentiate doctors by specialty.

Country Rank Docs
Canada 58 2.1
France 25 3.37
Sweden 26 3.3
UK 55 2.2
USA 52 2.3

Hospital Beds — Hospital beds available per 1,000 population. Data from Nationmaster. World-wide weighted average is 7.3.

Country Rank Beds
Canada 25 3.9
France 9 8.4
Sweden 26 3.7
UK 22 4.1
USA 27 3.6

prenatal carePercentage of Pregnant Women Receiving Prenatal Care  — Data from the World Bank by way of Nationmaster. Dominica, Australia, Sri Lanka, Austria, Brunei, Barbados, Cuba, Finland, Antigua, Barbuda, Saint Kits and Nevis all tie for first place with 100% of pregnant women receiving prenatal care. I could not find data for Sweden, Canada or the UK. The US ranks 15th, tied with St. Vincent, the Grenadines, Czech Republic, France and Franada, at 99%

GDP — I threw this one in mostly for grins.By itself, I’m sure this has no direct effect on the health care system. These data are also from Nationmaster. This table shows both national GDP expressed in trillions and per capita GDP expressed in thousands. For per capita GDP, Luxembourg takes first place with almost $90k though their national GDP ranks 68 with just over $48 billion.

Country Rank GDP Rank Per Capita
Canada 9 1.2 14 38.4
France 7 2.2 18 36.5
Sweden 21 0.38 9 42.6
UK 6 2.3 13 38.8
USA 1 13.2 8 44.2

Parenthetically, I found this tidbit. In a study conducted by Ronen Avraham at the University of Texas School of Law and Max Schanzenbach at the Northwestern University School of Law, the effect of tort reform on health care costs would be “as much as two percent.”  Those are their words. I would characterize it as “only” two percent. Here is the full abstract from their paper.

This study evaluates the impact of tort reform on health insurance coverage using the Current Population Survey’s March Demographic Files. Proponents of tort reform argue that reform will reduce medical malpractice insurance costs, damage awards, and costs associated with defensive medicine. If proponents are correct, these cost reductions should lower the price of healthcare and increase health insurance coverage. On the other hand, if the prior tort law was functioning well, reform may increase medical costs by reducing doctors’ care-taking or increasing the number of unnecessary procedures. In this case, tort reform could actually decrease insurance coverage by raising the price of health care.

We evaluate the effect of eight common tort reforms on private health insurance coverage between 1981 and 2004. In triple-difference specifications, we find that reform generally increased health insurance coverage for the most price-sensitive groups (the young, the self-employed, and the single). We also find that those uninsured around the time of reform were more likely to obtain private insurance after reform. Given the multicollinearity of many reforms, it is difficult to gauge the impact of individual reforms. However, the evidence suggests that limitations on punitive and non-economic damages do not affect private insurance coverage, while caps on total damages, collateral source reform, and reforms to liability and payment structure are associated with increased private insurance coverage for price-sensitive groups.

Accordingly, we conclude that some tort reforms are effective in reducing healthcare costs. The magnitude of the effects on price sensitive groups suggests that some tort reforms can reduce health care costs by as much as two percent.

So after looking at all this, I have to question whether we, in actual fact, really do have the best health care system in the world. Allow me to personalize this to illustrate my point. Oh, and this is the short version.

In 1980, I contracted a very rare pneumonia. I was hospitalized for 10 days and then discharged with five or six abscesses remaining in my left lung and a bottle of antibiotics intended to complete the cure. That was the extent of the follow up. So far, not altogether bad.

healthcareBy 1987, the abscesses had not healed as intended. To the contrary, they had grown and festered, quite unknown to me. A portion of my lung had sealed itself off (a process called sequestration) to contain the infection. I became ill and was hospitalized again. It took three weeks to determine and identify the sequestration. The result was I had a giant pus bag in my chest which, if it burst, would kill me. Imagine six pints of pus in your chest cavity. Most of the lung was removed. Of the three pulmonologists, the infectious diseases specialist, and my general practitioner, none had seen this phenomenon before. Almost the entire lung was removed. For this go ’round, I spend a month in the hospital and was discharged with no physical therapy. That also was a serious disadvantage.

But here’s the kicker: The insurance disallowed more than $20,000 in charges — almost a third of the total bill. So, now I was doubly devastated both by the surgery and the bills. It irritates me when people say we have the best health care system in the world. From an anecdotal, personal perspective, I strongly disagree. To make sure that my conclusion about this wasn’t skewed by my personal experience, which could be, but isn’t, an anomaly, I wanted to see some numbers. Thus with these numbers above, I must still question the assertion.

What do you think?