Mortality from Disease and the American Health Care System-Becker

Many Democratic Congressmen, member of the Obama administration, and others writing about American health care envy the 'European" health deliver system since they attribute Europe's lower mortality rates, despite much lower per capita spending on health care than by the US, partly to the European model of health care delivery. This model involves government domination of spending on medical care that involves extensive government regulation and rationing of access to medical care. Envy of the European model explains why the Democratic proposed "reforms" of the American system involve large increases in government involvement in health care, including a government-run health insurance plan. In evaluating whether envy of the European approach is justified, it is crucial to determine whether the higher mortality rates in the US than in many European countries is due to defects in the American health delivery system, or to other factors. Mortality rates are affected not only by health care, for they are also very much dependent on personal behavior, such as smoking, eating habits, exercise, stress, how carefully individuals follow the medical advise they receive, and many other kinds of behavior under the control of individuals rather than the medical profession. The US has relatively high incidences of obesity, partly because Americans consume lots of high fat and high cholesterol foods, and Americans were heavy smokers in the past, just to mention a few unhealthy forms of behavior. Perhaps then the higher US mortality rates are due much more to differences in personal habits and personal care than to defects in the US health delivery system? One way to separate health care from personal behavior is to consider survival from serious diseases, such as various cancers and cardiovascular diseases. In my post on health care on June 7 of this year I referred to a study published in Lancet in 2007 that compares five-year cancer survival rates for the US, the United Kingdom, and the European Union as a whole. The study examines early diagnosis, early treatment, and access to the best drugs, and finds that the United States does very well on all three criteria. As a result, five-year cancer survival rates are much better in the US: they are about 65% for both men and women, whereas they are much lower in these other countries, especially for men. Early diagnosis helps survival, but it may also distort comparisons of five or even ten-year survival rates since some cancers would be discovered at very early stages. An alternative that avoids this distortion is to compare age-adjusted mortality rates for different diseases. Early detection and other medical care that improved life prospects would show up as lower mortality rates. A recent excellent unpublished study by Samuel Preston and Jessica Ho of the University of Pennsylvania compare mortality rates for breast and prostate cancer. These are two of the most common and deadly forms of cancer-in the United States prostate cancer is the second leading cause of male cancer deaths, and breast cancer is the leading cause of female cancer deaths. These forms of cancer also appear to be less sensitive to known attributes of diet and other kinds of non-medical behavior than are lung cancer and many other cancers. These authors show that the fraction of men receiving a PSA test, which is a test developed about 25 years ago to detect the presence of prostate cancer, is far higher in the US than in Sweden, France, and other countries that are usually said to have better health delivery systems. Similarly, the fraction of women receiving a mammogram, a test developed about 30 years ago to detect breast cancer, is also much higher in the US. The US also more aggressively treats both these (and other) cancers with surgery, radiation, and chemotherapy than do other countries. Preston and Hu show that this more aggressive detection and treatment were apparently effective in producing a better bottom line since death rates from breast and prostate cancer declined during the past 20 by much more in the US than in 15 comparison countries of Europe and Japan. US death rate rates from prostate cancer went from about 7% above those of the comparison countries in 1990 to over 20 % below the average of these other countries in recent years, or almost a 30% greater fall in US rates. American death rates from breast cancer declined from about 10% above the average of these other countries in 1990 to slightly lower. These results suggest that the US health care system does deliver better control over serious diseases than systems in other advanced countries. Of course, American health care delivery is much more expensive, so a natural question would be whether the greater apparent benefits are sufficient to justify the greater cost? To get a very rough answer to this question, suppose generously that the American health care system adds 1 life year on average to persons above age 50 compared to what they would have with the average health care system in the 15 comparison countries used by Preston and Hu. Suppose also that people over age 50 value each additional life year by $120,00- since this is a ballpark figure often used for the average American, the dollar value may be lower (or higher!) for older persons. Given that about 4 million Americans reach age 50 each year, the aggregate value placed on these additional life years with these assumptions would be close to $500 billion. This is a little over 4% of American GDP, so this assumed improvement in mortality rates, even aside from improvements in the quality of life, could justify much of the additional spending by the US on health care compared to other wealthy countries. Of course, the assumption that the American health system produces one additional life year for each person over age 50 may be much too generous, and perhaps older people place a much smaller value on an additional year than $120,000. Still, these calculations suggest that America should hesitate without additional evidence of the type I have used before jumping on the European bandwagon, and conducting radical surgery on the American health care delivery system.

Comments

[Anonymous]

شات الخليج

دليل

[Anonymous]

Pervert! Let's get out of here. There are so many perverts here.So what? You are such a bad person Who's gonna like you? Tiffany Jewelry Don't mind him. Don't mind him. He's just playing. Forget him. He saw me steal the diamond. Tiffany Jewelry You're dreaming! In your dreams. Wake up and smell the coffee.Where'd you get it!Good idea.Think it over.You can never tell about this sort of thing.Take a closer l Wake up and smell the coffee.Where'd you get it!Good idea.Think it over.You can never tell about this sort of thing.Take a closer look.When did I say that!You have to be on time. Don't be late. ook.When did I say that!You have to be on time. Don't be late.

[Anonymous]

شات الرياض

شات كويت 29

[Anonymous]

شات بنت السعودية

ÿØÿ±ÿØÿ¥ÿ© ŸÇŸÑŸàÿ®

[Anonymous]

very thanks for article!

[Anonymous]

ahj

شات الملك

[Anonymous]

شات كتابي

دردشة كتابي

[Anonymous]

ÿØÿ±ÿØÿ¥ÿ© ÿØŸÑÿπ

دردشة الرياض

[Anonymous]

قوقل فيديو

ياهو فيديو

[Anonymous]

يوتوب

شات بنات الرياض

[Anonymous]

شات عسل

شات سارق القلوب

[Anonymous]

ÿ¥ÿßÿ™

ÿØÿ±ÿØÿ¥ÿ©

[Anonymous]

ترجمة قوقل

شات صوتي

[Anonymous]

شات الجنوب

شات مزنة

[Anonymous]

شات التحلية

شات الساهر

[Anonymous]

شات شبيك لبيك

شات همس الحب

[Anonymous]

Just love
tiffany
and
ugg boots,thanks!!

[xanax online]

Where are the tapes and photos of Becker head, crying on the health system? When he had his office a year ago. At least fake SOB had health insurance.

[pain relief]

I think this is one of the most significant information for me. And i am glad reading your article. But want to remark on some general things, The website style is perfect, the articles is really excellent : D. Good job, cheers

[Medical mask]

Great story! I'm not really a big hockey fan, but I sometimes have to pretend to be interested in it, because I have so many Canadian friends...

[crystal trophy]

Lovely, sensitive piece, Mary. Many of us, as kids, saw our parents as invulnerable, but when serious illness sets in, as it inevitable does, we see how human and vulnerable they really are.

[crystal products]

A really touching piece, Mary. Yeah...I remember the first time I saw my dad scared. I was still a teenager and it petrified me.

[beach umbrella]

Excellent tour, thanks very much! I feel the Keith Haring show would keep me enthralled for the day, and I would never get to the other galleries.

[children umbrella]

Treat yourself. Just pick a single chapter - maybe check out the easiest of allusions to the Odyssey and not bother to delve into the Irishness of it at first - just that, a single chapter - maybe the last one if nothing else.

[Steroids Sale]

food training contest competition sport increase generally high nutr form known build natural rate substance competitions size bodybuilder bodybuilding body.