Data from the Organization for Economic Cooperation and Development (OECD), published in July 2009:
State | Grade |
Australia | B | |
Austria | C | |
Canada | B | |
Denmark | D | |
Finland | B | |
France | B | |
Germany | B | |
Ireland | C | |
Italy | B | |
Japan | A | |
Netherlands | C | |
Norway | B | |
Sweden | B | |
Switzerland | B | |
United Kingdom | D | |
United States | D | |
More detail and links below the fold.
[Scroll down for disease specific grades by country.]
People often refer to the World Health Report 2000 study when comparing the United States with other countries in terms of health care. This may not be the best source. It is, first of all, old data. The US took exception to being ranked 37th in overall quality of the 191 countries tallied. Commenters such as Fred Barnes, in an article in The Weekly Standard, have claimed the that the World Health Organization (WHO) report was "ideological" because it took into account things like "financial fairness" and "responsiveness distribution."
At this point, WHO is looking at its criteria and, even though they are not likely to drop such factors, it may be a while before they publish a follow-up to the World Health Report. Until then, it is possible to pull the concrete health indicators (such as risk factors and disease rates, age at death and cause of death that are collected world wide) out of the enormous WHO database, but the age of the 2000 report means it is not the best source to use.
However there are other sources of comparative data and increasingly this data is showing up online. The interfaces have improved over just a year ago.
The most recent eye-popping study is the 2008 comparative data on premature mortality statistics reported by the OECD. (Premature mortality is defined as the potential years of life lost compared to normal life expectancy). This is an annual study of the member organizations, all "First World" countries. The OECD's mission statement (so you know that it's not a "socialist" organization) is:
OECD brings together the governments of countries committed to democracy and the market economy from around the world to:
o Support sustainable economic growth
o Boost employment
o Raise living standards
o Maintain financial stability
o Assist other countries' economic development
o Contribute to growth in world trade
The organization provides a setting where governments compare policy experiences, seek answers to common problems, identify good practice and coordinate domestic and international policies.
The 2008 OECD data was first published in July. The Conference Board of Canada has supplied a very friendly user interface and assigned letter "grades" based on relative rank. Additional detail is presented on the Canadian site [Note this is the easiest interface of those listed below.] Here is a summary table of premature mortality for various conditions for each of the 16 OECD countries, at a high level, with the Canadian "grades."
Measure | AUL | AUS | CAN | DEN | FIN | FRA | GER | IRE | ITA | JAP | NTH | NOR | SWE | SWZ | UK | USA |
Life Expectancy | B | C | B | D | C | B | C | C | B | A | C | B | B | A | C | D |
Accidents | A | A | B | B | B | B | A | A | A | A | A | A | A | A | B | D |
Cancer | A | B | B | D | A | B | B | C | B | A | C | B | A | A | C | B |
Circulatory | B | D | B | C | D | A | D | C | B | A | B | B | C | B | C | D |
Respiratory | B | A | B | C | A | A | A | D | A | C | C | B | A | A | D | C |
Diabetes | B | D | C | B | A | A | B | B | C | A | B | A | B | A | A | C |
Musculoskeletal | C | A | C | D | B | B | A | D | B | A | B | B | B | C | D | C |
Mental | B | A | B | D | D | B | B | B | A | A | C | C | C | C | C | B |
Infant Mortality | C | A | C | B | A | B | B | B | B | A | B | A | A | B | C | D |
Medical Errors | D | D | B | A | A | C | C | C | A | A | A | A | C | -- | B | C |
Attitude | A | A | A | A | B | A | B | A | B | D | A | A | A | A | A | A |
OVERALL | B | C | B | D | B | B | B | C | B | A | C | B | B | B | D | D |
Overall, the US earned a "D." This is down from the "C" rating it held from the 1960s through 1980s.
The OECD data is not the only data source that is available. Another great source is the health information in the CIA Fact Book that is available at the NationMaster site. [warning, the interface can be slow.] In addition, the 2007 publication of The Commonwealth Fund is useful: Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care.
Oh right, I forgot: the one health indicator that the United States scores an "A" in? How we feel about our health. We feel great! Which is odd, given the other measures. It seems to be saying that we are either ignorant or in denial.
Notes in response to Fred Barnes and the Republicans on the Senate Finance Committee who have been citing his article.
- Claim: that US mortality is affected because 'Americans love our guns' [sic]. Not True. Not that "we" don't love our guns, but although America has a high rate of 'Premature Deaths' [Accidents, etc], the actual numbers are still small compared to other causes of death and do not materially affect total mortality. Firearms deaths account for about 1.25% of total deaths (compared with 26% for heart disease) and reduce live expectancy by an average of 103 days or about 1/3 of a year. It's not a good thing, but has a limited effect on the overall picture.
- Claim: Infant mortality brings down our life expectancy numbers. Not True. Infant mortality is calculated from livebirths at 28 weeks gestation or higher, to keep the numbers comparable over time. It does not depend on what we consider to be a viable infant. It does not depend on whether states decide to call aborted babies livebirths (again because of the 27 week criteria); HHS cannot, by international agreement, include such births in our counts. Though still high compared to other countries, US rates of infant mortality (both premature and term) have been declining steadily since the 1960s.
- Claim: The United States provides the best care in the world for heart attack patients. If you happen to live in an affluent part of a large city with a good ambulance service and excellent ER staff and cardiac surgeons at the ready, if you are male (women's heart attack symptoms have not been adequately studied and are often misdiagnosed), if you are white, and if you have insurance so you are not left sitting in an ER for hours with subacute symptoms, you have a right to be optimistic. But that's a lot of "ifs" -- and it does not keep the US from earning a "D" in premature mortality for cardiovascular disease based on the OECD data. So the claim is Not True.
- Claim: The United States ranks high in treating cancer. This is Partly True. The US scores a "B" in cancer (it has only one other "B"). Five other countries of the 16 countries received "A's." They are: Australia, Finland, Japan, Sweden and Switzerland. Six others scored "B's." In fact, only four countries scored worse: Denmark (D), Ireland (C), the Netherlands (C) and the UK (C).
Why is Fred Barnes' data seemingly so far off? There are several reasons. First it is not recent data, with the two studies from The Lancet which he cites using data collected in the mid-1990s with follow-up done up to 2003. That is because this is a specialized study of cancer survival, that is, how long you can expect to live after a diagnosis of cancer (not a prospect that most people care to comtemplate). Such data is difficult to collect because it involves tracking cohorts of patients over time. On the other hand, these patients have been identified and are being tracked, which gives them a certain advantage. In the case of the US, the National Cancer Institute's SEER data was used. For this study, the NCI actively sought out minorities and underprivileged groups to monitor, to provide a complete profile of the country's demographic mix.
So why does Barnes use this data? Have you ever tried to find positive data about US health care among the comparative information on web? It's not easy; to find, that is. It's so hard to find, in fact, it seems it led Barnes to these specialized studies. Or he may have used the report by Betsy McCaughey of the conservative National Center for Policy Analysis (NCPA), which reported on the same two studies in 2007. What the data actually shows is that when the US reaches out to a full spectrum of its citizens and provides them with unfettered and well managed access to the health care system, we do well, in sharp contrast to the reality of our system as reflected in the WHO, OECD and CIA Factbook data.
As Tom Daschle put it on Meet the Press, the US "has centers of excellence surrounded by a sea of mediocrity." He hits it dead on. In the end it all comes down to things like "financial fairness" and "responsiveness distribution."
All politics is national.