Arnold Kling  

Health Outcomes vs. Health Care

Bryan, Read Thyself... Cross-posting...

A New York Times story says,

Americans 55 and over are much sicker than their British counterparts even though the United States spends more than twice as much per person on health care as Britain, researchers said Tuesday.

...The researchers wrote that "health insurance cannot be the central reason for the better health outcomes in England because the top socioeconomic-status tier of the U.S. population have close to universal access but their health outcomes are often worse than those of their English counterparts."

...the study found that "differences in socioeconomic groups between the two countries were so great that those in the top education and income level in the U.S. had similar rates of diabetes and heart disease as those in the bottom education and income level in England."

I have not seen the study, so I cannot say how well they controlled for reverse causation. Someone could be equally sick in two countries but not know it in a country with less medical care.

But I find the results plausible. Most of the determinants of health outcomes are not related to health care spending.

As W. Edwards Deming pointed out, it is easier to remove defects early in a process than to "inspect quality in." Suppose you design an automobile, then design the assembly line to build the automobile, then build the automobiles, and finally inspect the automobiles for defects. If you wait until the final step to do quality control, you will have a very expensive QC process. If instead you design the automobile in a way that fosters low-defect assembly, you get better quality at lower cost.

Think of the analogy with health.

One argument about U.S. health care spending is the argument that, "Hey, it's great that we spend a lot of our GDP on health care. That's a good thing."

That's like saying, "It's great that we spend a lot of money on inspecting cars as they come off the line and fixing defects. That's a good thing."

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The author at The Glittering Eye in a related article titled NHS or BBC? writes:
    Quite a few people have linked to this story from the New York Times in which it’s reported that elderly Brits are healthier than elderly Americans.  There have been a wide variety of interesting takes on the story.  For example, Arnold Kling w... [Tracked on May 4, 2006 10:27 AM]
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josh R writes:

Yep, It is likely a garbage-in, garbage-out problem. When our diet is sugar water and fast food, our bodies don't have the resources they need to stay healthy. Doctors can't really cure us, they can only coach our bodies into curing themselves.

In our Drug happy culture, insurance may actually make our health worse, because we have a mentality that when we are sick, doctors should be able to give us something to fix the problem. In truth, if we are unhealthy, usually they can only give us something to mask the symptoms. If knew we couldn't afford to get sick, we likely would take better care of ourselves.

Robert Schwartz writes:

I am very skeptical about this study. Ever seen a middle aged Brit smile?

Robert Speirs writes:

We should eat more red meat. Lack of good solid protein is a health problem no one seems willing to address. Vegetables kill.

William writes:

I have refutted time and time again the notion (as have the authors of this study) that the US has the 'best health care system' in the world.


Ronnie Horesh writes:

I agree: as a society we should target health outcomes and subordinate all policy (not just health) to achieving them. These will be minimal outcomes applying especially to children and others who don't have the resources to make rational health choices. At the basic safety-net level, health policy is relatively easy: numerical indicators correlate well with societal wellbeing.

On my website I argue that all policy goals should be expressed in terms of outcomes that are meaningful to individuals. Not only would that be more efficient, transparent and stable then current policymaking; it would also bring more public participation and 'buy-in' to politics. Meaningful health targets would be a good place to start: as your post implies, much expenditure is squandered.

R.J. Lehmann writes:
One argument about U.S. health care spending is the argument that, "Hey, it's great that we spend a lot of our GDP on health care. That's a good thing."

That's like saying, "It's great that we spend a lot of money on inspecting cars as they come off the line and fixing defects. That's a good thing."

I'd have to disagree. It's perfectly acceptable to judge the quality of an auto assembly line in only one dimension -- by its net productivity. Not so the quality of a human life. And most of the "defects" that health care would address are the direct result of choices that provided that human with value: to smoke, to drink, to drive, to be idle, to eat high fat/high carb/low nutrition (but oh so tasty) foods. The sum of those benefits ought be factored in to the equation for the measurement to mean anything.

dearieme writes:

It's not just the British - surely a lot of the continental countries have higher life expectancies than the US? I don't understand the surprise, but I do like Robert's implication that it's too much dentistry that strikes you guys down.

I recently blogged about a similar issue. In short, it was pointed out that New Jersey spends less on the homeless than other states, while no mention was made of the success of our programs, nor the severity of any homeless problem in New Jersey.

It seems as if government programs have become a race to the top for funding.

JoshK writes:

I think the fact that food is so cheap here must come into play. Every time I work in London for more than a week or two I come back leaner. And I save every receipt to get reimbursed b/c of the cost....

Gordon Mohr writes:

Perhaps sick people in Britain are more likely to die before 55 -- making this a sampling oddity, a little like the low birth weight paradox.

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