We’re Number One

Which country produces the highest quality health care? In a sidewalk survey, the USA would probably come in first place. Among health policy wonks, however, the results would be very different. The Commonwealth Fund regularly produces studies showing that the US lags behind other countries by one measure or another. The World Health Organization (WHO) ranks the US system 37th in the world, even trailing Costa Rica. (Costa Rica? Yes, Costa Rica.)

On his way to get health care at the Cleveland clinic last year, Italian Prime Minister Silvio Burlusconi probably flew over a half dozen higher ranking countries, not to mention his own (rated number two!) or neighboring France (rated number 1!). What could he possibly have been thinking? Doesn't he read WHO reports?

A favorite statistic of critics is life expectancy at birth. The US rate is fair to middling among developed countries, despite our much higher health care spending. However, doctors don't control our overeating, overdrinking, overdosing, overspeeding and assault weapon shootouts in the hood.

A better, but far from perfect, measure is life expectancy for victims of cancer – a condition doctors can often do something about. A new, largest-ever international study confirms what ordinary people already think: patients do better in the US.

  • The study, published in Lancet Oncology, found that the five-year survival rate for all types of cancer among both men and women is higher in America than in any European country.
  • Further, US survival rates are higher than the European average for 13 of 16 specific cancer types.
  • In a separate NBER study, June and Dave O'Neill found that Canadian survival rates also lag behind the US rates.

Frankly, I'm surprised by these results. The reason: a big factor in cancer care is patients' compliance with their treatment regimens. I would have thought that northern European countries with small, homogeneous populations (and a lot less individualism) would knock the socks off of us. But apparently not.

Don't take too much comfort in these results. There are a lot of health policy wonks (probably most of them) who are still rooting for the other teams – with Michael Moore and Paul Krugman cheering them on.

For the Lancet Oncology study, go to http://www.thelancet.com/journals

Unfortunately, you must subscribe in order to retrieve the study or pay $30 per article.

For June O'Neill and Dave O'Neill's study, go to http://www.nber.org/papers/w13429.pdf

Betsy McCaughey reported on all this in a Wall Street Journal editorial that has been expanded into an NCPA Brief Analysis, which can be found at http://www.ncpa.org/pub/ba596/.

For an explanation of how better doctors produce better survival rates, see Peter Bach's Wall Street Journal editorial at http://online.wsj.com/public/article/SB119344360505573496.html 
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Comments (9)

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  1. Uwe Reinhardt says:

    With all due respect, John, picking on just one facet — cancer — on which we had declared war and spent huge amounts of money, as an indicator of a health system is not more honest than the horrible WHO report. I really mean that, John. Cancer is one dimension surely worth dwelling on, but to rank entire health systems by it strikes me as a bit looney.

  2. Sara Sue says:

    Really enjoyed this.

  3. John Gavras says:

    Well stated.

  4. Gerry Musgrave says:

    Look at the graph from this study. If you ran a regression of these data I think the economics would really dominate–especially for woman. Money matters. Countries do get a big benefit from spending–just what we have been saying for years!

  5. Anton Shufutinsky says:

    Perhaps a better statement could have been “weapons-related injuries”, “murder”, “gang violence,” or something along that line…not “shootouts in the hood.” It’s an embarrassment to see a nationwide health alert article use this stereotypical language…especially as sponsored by a well-educated and well-respected professional.

  6. Linda Gorman says:

    OK, let’s not just “pick on one facet” of the ways in which US health care produces better results. In addition to better cancer survival, Americans enjoy better population blood pressure control, higher access to lifesaving therapies like dialysis, less waiting for critical surgeries like hip replacement (with accompanying reduced mortality and morbidity) and longer longevity for bypass surgery over medical management for heart disease. Its population of diabetics have better blood sugar and blood pressure control. It has lower adverse event rates in its hospitals and better infection control. Its population has better access to newer drugs with the resultant reduction in side effects. Its newborns are more likely to survive, especially low birthweight infants. And its physicians can do more on a single visit than those at the NHS because they have more capital to work with.

    There’s more, but by now it should be clear that the superiority of the U.S. system of private medicine is not restricted to cancer.

  7. Rob Rutledge says:

    The US health care system works beautifully if you have wealth and are prepared to spend it. Wish the system works the same for the 40+ million Americans without health insurance. The US health care system mirrors the US economy where a significant divide exists between the rich and the poor and the divide is increasing.

    I suspect that residents of Beverly Hills have a different view of the United States than the residents of South Central Los Angeles, East St. Louis, South side of Chicago etc. And the US health care system is no different. If one has the financial position to access the best practioners in the US, there is not a better place to obtain health care. If not, the options are far less attractive. Based on this, is the US health care system really the number one system in the world?

  8. Good post. And yes, cancer is a good example, since it is one the critical point where medicine not only is the most needed, where medicine is literally lifesaving, but where also a tremendous amount of research, technology development, pharmacology as well as hospital performance, availability of cancer centers, of advanced technologies such as MRI for diagnosis and radiation for treatment have to come together in coordinated fashion. It is a very complex process that challenges everyone in medicine from the primary care physician, who has a suspicion to the specialist who establishes the diagnosis to teh subspecialist who performs the treatment. The all have to work together smoothly to reach the goal. Having the best cancer survival syas more than most other criteria about quality. Using cancer treatment and it’s success is an outstading parameter for the quality of helthcare.
    It is very suprising that Uwe Reinhardt would disagree with this, very surprising. I would love to see his response.

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