How could you compare the health systems of the world in terms of outcomes with plausible verisimilitude, in other words by making assumptions that don’t just give you junk? I was sceptical when I read of this index, but think it’s a pretty good, though like any such exercise it’s not hard to see that it’s not perfect. Anyway, Bob Hahn and Peter Passell’s regulation2point0 newsletter drew my attention to this paper. And this is how they explain the methodology.
In order to provide a more precise measure of the outcomes that may legitimately be attributed to health care interventions, researchers have developed the concept of “mortality amenable to health care”. Amenable mortality is generally defined as premature deaths that should not occur in the presence of effective and timely care. It takes into account premature deaths for a list of diseases, for which effective health interventions are deemed to exist and might prevent deaths before a certain age limit (usually 75, though sometimes lower).
And here’s what the methodology – in two versions – says. I’ve not yet read the paper.
It is interesting to note that the USA, for all its wealth and power, has near third world numbers for mortality.
If mortality is higher in the States than most other western countries, does this point to inadequacies in their health and social infrastructure, lifestyle etc that bely the reputation of the US as a caring, sharing “home of the free”?
I suspect mainly an underclass.
Which reputation of the US as a ‘caring, sharing’ anything was that?
And Nicholas, sure, but all first world countries have ‘underclasses’ – the difference is that in other western countries the underclass can actually afford and access decent health care.
That’s interesting, Nichoilas. It raises are a couple of obvious questions, both of which are addressed in the paper.
First, if we’re looking for one measure that captures a county’s overall health performance, is this one more useful than life expectancy? It turns out that variations in amenable mortality acoount for 90% of the variations in life expectancy, so on that basis we could stick with life expectancy as long we’re painting with broad brush.
Second, is amenable mortality a more useful measure if we want to be more specific in assessing the performance of a country’s medical or hospital system? If it turns out that amenable mortality is poorly correlated with other causes of premature death, i.e. those in the unavoidable and avoidable-but-preventable categories, the answer seems to be yes. For example, if a country has an unusually low life expectancy due to natural disasters, accidents and homicides (‘unavoidable’); or lung cancer, heart-disease and suicide (‘preventable’), it would be a mistake to single out the medical system, narrowly defined, for blame.
On the US, their health system has mediocre outcomes on pretty well every measure you can think of; its ranking on this index is pretty typical of its ranking on the variety of indices the WHO use. That’s despite it spending a far bigger share of GDP on health than any other country in the world. It seems health, like education, is one of the minoroty of areas where market failure is so severe that socialism is more efficient, as well as equitable.
James, agreed, except I changed the heading of this post from including ‘health system’ to not including it. Because it seems to me there are plenty of things outside the health system – even broadly defined – that have their impacts like class structure (in particular the presence of an underlcass). The shocking state of aboriginal health is not solely down to the ‘health system’ including preventative measures. It’s deeper than that.
But so long as you broadly define health system to include preventative health, I guess that’s not too bad.
Wizofoz, 1) the underclass can access the US health care system at least in its accute form. And Aboriginal health is as bad as it is not just because of lack of access to the health care system. If we had a bigger aboriginal underclass we’d slide down those rankings too. Even with lots more health spending on them.
How does education make it into that basket DD? I’ve always thought that the US secondary education system is so dismal precisely because it is socialist not market-based!
Very few countries appear to have ever allowed there to be any reasonable market in education – but notably, in those countries in which there is a market (because there is no or very ineffective government provision) private education appears to flourish – like India and much of Africa.
As an aside to DD’s and Patrick’s discussion, I think one of the things that enables socialism to do as well as it does in education and health – better for instance than in lots of other commercial activities – is that both areas have very high levels of intrinsic motivation. I am amazed at how good our health system and even our education system is given the routine idiocies to which it is subjected. I credit the work ethic and desire to do a good job of employees right up and down the line in those industries, particularly health. I expect this applies a little more to health than education. I expect we’re pretty hard wired to help each other when someone’s sick.
Nicholas
I think that lack of access to health care – partly because of location – is quite a significant problem for the indigenous population.
The latest Australian Institute of Health and Welfare report on australia’s Health shows primary health care spending for indigenous Australians is $327 per person in 2006-07 (the latest figures available), compared with $563 for non-indigenous Australians.
Indigenous people do get much higher average hospital care spending on potentially avoidable health problems.
So not the whole story, but an important part of it, I suspect.
“The shocking state of aboriginal health is not solely down to the ‘health system’ including preventative measures. It’s deeper than that. ”
True. Australian Aboriginals engage in self-destructive behaviour that no health or welfare system can fix. Take this for example:
“It has been estimated that the prevalence of FASD [Fetal Alcohol Syndrome] in Australia is 0.06 per 1000 live births, and even higher in Indigenous populations at 8.11 per 1000 live births (Elliott, 2008). ” http://www.druginfo.adf.org.au/newsletter.asp?ContainerID=foetal_alcohol_spectrum_disorder
FASD in indigenous communities is therefore 135 times the Australian average.
Sadly, I’m forced to conclude that Lang Hancock’s old idea of offering indigenous women money in exchange for sterilisation is probably indicated on compassionate grounds, at least in the most debauched communities . However, unlike Hancock, I recognise the system would need to be voluntary.
This doesn’t really tell us we are healthier – it does tell us we are living longer. That might be a good thing.
It might also be that those extra last 5 years are bloody awful for most people.
We need to see a morbidity chart to get some idea.
We do know that living longer has increased the number of people living with debilitating dementia. And cancers. The rates of diabeties increase. Many live longer with all sorts of independence and dignity stripping illnesses.
Living longer is not all good.
I can’t find it now but Cuba outdoes USA on many health outcomes including efficiency/cost.
Yep Mel, It’s hard to imagine a worse crime than inflicting fetal alcohol syndrome on a poor baby human being. But it’s happening in under our noses without much fuss being raised about it.
Yes, I’d take on board Nicholas’ qualifier, we’d better be very careful before we examine any one else, given the horror that is aboriginal health in a supposedly civilised country.
In fairness, there was a tremendous outcry when a fuss was raised about it. There appears to be a substantial part of our community with a vested interest in protecting the Aborigines’ current lamentable state of affairs.
I find this repellent, especially because most of those who I met were not by any means paragons of classical liberalism in their policy preferences towards, eg, me.
Forced to conclude sterilization is a good idea…but only for people with a certain skin colour? What century are we living in again?
If (and only if) you could show that every conceivable effort had been made to educate Aboriginal communities as to the dangers of drinking while pregnant and the importance of using birth control (along with free supply of same), and there was still no improvement, then sure, I’d be willing to accept that we need even stronger restrictions on alcohol availability among such communities. But seriously, if this much failed to have any noticeable impact, why on earth would you think that offering free sterilization would do any good? Out of curiosity, has there ever been any program of sterilization (voluntary or otherwise) in human history that has actually had a net beneficial outcome?
I agree with wizofaus re sterilization. But I could see an argument for quasi-mandatory contraceptives like basically the pill, even to the length of putting it into free meals or something.
@10- the idea of the remoteness needs to be considered against the total populations being discussed.
Most indigenous persons live along the eastern seaboard and in or near major cities.There are plenty of kids with FASD around where I live and the burden then falls on the education system to care for them.
Access may be a problem in the NT but not elsewhere.
Unless you consider being more than 15 klms from The Royal North Shore Hospital remote!
http://www.abs.gov.au/ausstats/ABS@.nsf/e8ae5488b598839cca25682000131612/14e7a4a075d53a6cca2569450007e46c!OpenDocument
Patrick, that actually did occur to me while writing that post, but while I couldn’t condone it going into *meals* I could in principle condone contraceptives being added to alcoholic products, though the medical risks of doing so would be a concern. However at the VERY LEAST we should have mandatory labelling of alcoholic products making it absolutely clear that they are not dangerous for consumption by women who are pregnant or planning to become so. And there’s no reason this labelling need be restricted to products likely to be available to aboriginal communities.
One thing that I’ve always wondered about with the health data for indigenous populations is that to what degree could, for instance, life expectancy be put down to a conscious lifestyle choice? I.e. if an Aboriginal tribe chooses to eschew the benefits of modern education/medicine and maintain a relatively “traditional” existence, even though this may result in a significantly lower life expectancy, should we even be concerned about it? Of course, arguably most of the health problems affecting Aboriginal communities have been introduced by Westerners (FASD included obviously), and in that sense I would accept we have a moral/ethical duty to do whatever is possible to remedy such problems, but I’m not sure it extends as far as accepting we have little choice but to force people to give up their entire mode of existence.
Oops, strike “not” before “dangerous”! (I originally had ‘not suitable’)
Why restrict the sterilisation idea to Aborigines? Alcoholic mothers may be rarer amongst whites, but then there are many more whites – so there may well be more white alcoholoc mums than black alcoholic mums. For both groups the case for sterilising them is the same.
At least be consistent here. If you think this approach has both moral and practical merits (I think it has neither), then have a program that offers sterilisation for money to all alcoholic mothers, and only alcoholic mothers. There’s no need to limit it to race at all.
Patrick @8, the counterfactual for education is hard to observe because since the late 19th century no-one anywhere is silly enough to leave it purely to the market. I suppose it depends what you mean by “socialism”, but even on a strict definition of it the performance of iron curtain countries in education was always extremely impressive. And the best rated education systems in the world are determinedly secular and very heavily regulated. The US, of course, has a particular problem because it leaves funding largely to local property taxes – a recipe for severe ghettoisation and severe inefficiency in the long run.
Hmm, DD, a few quick queries spring to mind:
1 Did education only start to exist in the late 18th century then? I’m fairly confident that private, home- and community schooling were the dominant forms of education for most of human history. By community I mean essentially self-organised local community schools.
2 I wonder what the incentives in Iron Curtain countries were, DD? I’d have worked hard too.
I think Nick has a point about intrinsic motivation and education, but also pretty clearly a lot of the regulation at present is very harmful, and there seems to be a lot of benefit in allowing parents more choice over their children’s schools and schools more choice over their teachers.
I’m far from an expert on this area, but I was under the impression that Sweden’s highly-rated school system was too radical (i.e. liberal) to be wholly adopted in the UK… if the Swedish model of education is ‘socialist’ then I’ll eat my hat but that would be socialism that I could approve of.