March 19, 2008

The Best Health Care in the World - Part Four: Do the Statistics Tell the Whole Truth?

We have seen that America spends more on health care than other developed democracies around the world for outcomes that, on the whole, are no better than those achieved by the average OECD country. Our health care "system" perpetuates ever-increasing spending without delivering results to justify the expense. Moreover, because of our country's isolation, both geographically and culturally, few Americans actually know about or appreciate this disparity. In the words of that eminent philosopher, Pogo, "We have met the enemy, and he is us."

But not all the news is gloom and doom. We lead the world in medical technological innovation, and we have chosen to target this expensive technology at some very thorny problems. Further, statistics don't always tell the whole or true story. Sometimes, one needs to lift up the rug and check what's lying underneath.

Take infant mortality, for example.

The best place to find infant mortality data is (drum roll): the US Central Intelligence Agency, which tracks the rate of infant deaths in 241 countries around the world in its World Facts Book.

Currently, the CIA shows Angola, with 184 deaths per 1,000 births, as having the highest infant mortality rate (IMR) in the world, 241st out of 241. That is, more than 18% of Angola’s infants die shortly after birth. In fact, with the exception of Afghanistan, the 24 countries with the world's highest infant mortality rates are all in Africa. It has long been known that IMR directly correlates with a nation's per capita GDP.

At the other end of the scale, Singapore, a high-GDP country, ranks first, with the world's lowest infant mortality rate – 2.3 deaths per 1,000 births, followed by Sweden, Japan, Hong Kong, Iceland and France.

And where in this mix is the United States you may ask. Well, with a rate of 6.37, we rank number 41 in the world.

Or do we? It all depends on how one treats the numbers, because not everyone defines infant mortality the same way. The most common definition is: the number of deaths of infants, one year or younger, per 1,000 live births. The question is – what is a live birth? The World Health Organization (WHO) defines a live birth as "any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat." However, the United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. And the US is far more aggressive and advanced in attacking and treating significant neonatal complications. Visit any major teaching hospital's neonatal ICU and you’ll see what I mean. The inference is that the US’s actual comparative infant mortality rate may actually be lower, perhaps much lower, than is statistically reported.

But those neonatal ICUs cost a lot of money. It’s an investment the US has chosen to make, unlike most other countries, and it is symptomatic of why we spend so much more than the rest of the world on health care.

Of course, if you spend a few minutes talking with a mother and father who have just brought a young child home, healthy and smiling, after six months, of so, in one of those expensive, neonatal ICUs, you might be excused for thinking, as they surely do, that the cost is worth every penny.

Prior entries in this series:
Part Three: What Do We Get for the Money?
Part Two - What does it cost?
Part One: The best Health Care Plan in America



Interesting piece, which raises several important issues, in a compact, concise way. Thank you.


I have just finished your four part series. I think part four says some things that need to be said about the rest of the healthcare system.

People who want to bash the system do so using statistics that are misleading (lies, damn lies and statistics, Benjamin Disraeli and Mark Twain) at best.

Having lived in other parts of the world (OECD countries and others) I feel that the healthcare in the US is the best in the world. There is much antidotal evidence to support that, contrary to Michael Moore and his propaganda machine. There are many places in the world including OECD countries if I come down ill I am going to invoke my emergency evacuation insurance policy and have a private jet take me to a truly wonderful American hospital. Cuba being one of those.

A truly independent peer reviewed and standardized study of health care, results and conditions would be fascinating. For instance occurrence of diabetes is higher in the US than in Japan because of diet, heredity, actual health care or some other reason. If we have higher and earlier deaths do to self inflicted diet induced diabetes does that really mean our life expectancy is truly less or our we driving it down due to wealth, affluence and lack of societal penalties for fat people.

There are some problems with access in this country no doubt. But less than many people believe. I live just outside of Dallas, Texas. Parkland hospital serves the indigent of Dallas County. It is a first class trauma center, it has incredible neo-natal facilities (also incredibly 1% of all live births in the United States many whose parents are not citizens which affects the infant mortality rate) and much more. Anyone, repeat anyone, from anywhere, repeat anywhere, who shows up is treated regardless, repeat regardless, of ability to pay. So Dallas County, Texas has universal heath care and universal access despite of what may be said.

The left owns the question and sets the tone. The left wants government to run everything. I think the debate and the result is too important to leave just to the left.

It is always nice to hear some reasoned voice though it is limited and among much other leftist rhetoric.



Charles J. Read

It'd be nice to see a parallel discussion on the effect of the trial bar on health economics, not only in the US but in the rest of the developing world. How do the countries rank in spending on malpractice premiums, court costs per capita, etc. This elephant in the room usually gets nary a mention from policy wonks. IMHO, the US will never get a handle on expenditures until the issue of adjudication of alleged malpractice is addressed.


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This page contains a single entry by Tom Lynch published on March 19, 2008 5:42 AM.

The Best Health Care in the World - Part Three: What Do We Get for the Money? was the previous entry in this blog.

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