What Can the US Learn from Other Countries' Health Care Systems?
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More Slides from Ed Dolan’s Econ Blog http://dolanecon.blogsp ot.com/ What Can the US Learn from Other Countries’ Health Care Systems? Posted February 27, 2011 Terms of Use: These slides are made available under Creative Commons License Attribution—Share Alike 3.0 . You are free to use these slides as a resource for your economics classes together with whatever textbook you are using. If you like the slides, you may also want to take a look at my textbook, Introduction to Economics , from BVT Publishers.
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According to public opinion polls, a plurality of Americans (and a 2/3 majority of Republicans) believe that the US has the world's best health care systems. This slideshow takes a critical look at international comparisons and finds that it is difficult to find evidence that supports the view of the US system as the world's best.
Transcript of What Can the US Learn from Other Countries' Health Care Systems?
More Slides fromEd Dolan’s Econ Blog
http://dolanecon.blogspot.com/
What Can the US Learnfrom Other Countries’ Health Care Systems?
Posted February 27, 2011
Terms of Use: These slides are made available under Creative Commons License Attribution—Share Alike 3.0 . You are free to use these slides as a resource for your economics
classes together with whatever textbook you are using. If you like the slides, you may also want to take a look at my textbook, Introduction to Economics, from BVT Publishers.
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Health Care at Center of US Politics
The Patient Protection and Affordable Care Act of 2010 (“Obamacare”) did not resolve the issue of health care policy for the United States
Issues of who is covered, who pays, and how services are provided, continue to be hot topics of political debate
It seems only reasonable to ask—what can we learn from other countries’ health care experience?
Photo source: Infrogmation, http://commons.wikimedia.org/wiki/File:YesNoTVCameraHealthcareProtestNOLA.JPG
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Opinion: Is the US Health Care System the Best?
A 2008 survey by the Harvard School of Public health found that a plurality of all Americans, and a majority of Republicans, think the United States has the best health care system in the world
Other surveys suggest that even many Americans who are critical of the system as a whole are satisfied with the health care they personally receive
Source: Harvard School of Public Health, Press Release, March 20, 2008http://www.hsph.harvard.edu/news/press-releases/2008-releases/republicans-democrats-disagree-us-health-care-system.html
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
WHO Ranking of World Health Care
One of the most widely cited international rankings of health care systems was published by the World Health Organization in 2000*
It ranked the United States 37th in overall health care system performance, just behind Costa Rica and just ahead of Slovenia and Cuba
France was No. 1 in the ranking, and Myanmar was last among 190 countries surveyed
*For the full survey, see WHO, http://www.who.int/whr/en/. A convenient summary of the main findings can be found at http://www.photius.com/rankings/healthranks.html
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Criticisms of the WHO Ranking
The WHO ranking comes in for criticism, in part, because it is based on a weighted average of data that measure average population health, distribution of health care, fairness of the financial burden, and efficiency
The WHO methodology is subject to several paradoxes: A country with uniformly bad care could score higher in terms of equality than a
country with good care for the poor and excellent care for the rich A country with very good results obtained at great expense could score higher in
terms of efficiency than a country with mediocre results obtained very cheaply A country with good health habits in areas like diet and tobacco use could score
higher in national health indicators than one with poor health habits, but a health care system that did a better job of treating the resulting medical conditions
These and other methodological problems of the WHO rankings are discussed in detail in a study by Glen Whitman, published by the Cato Institute. (See http://www.cato.org/pubs/bp/bp101.pdf )
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Amenable Mortality
A less subjective method of ranking health care systems is based on amenable mortality rates
The amenable mortality rate measures deaths among people under 75 from causes like infections, treatable cancer, diabetes, and heart disease that can be helped by timely prevention or medical care
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Amenable Mortality
The ranking in the table is based on data from a study by Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine
It shows that the United States ranked last among 19 OECD countries in 2002-03
It also showed that the US made the least improvement of any of the countries between 1997-98 and 2002-03
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Health Care Costs
The low rankings of the US health care system cannot be explained by failure to spend enough
Instead, the United States spends more on health care, both in absolute terms and as a share of GDP, than any other country
Countries with higher-ranked ranked health care systems, like France and Japan, spend much less but obtain better results
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Health Care Costs vs. Performance
Still another international comparison, this one from the Commonwealth Fund, ranks health care systems according to performance
The United States ranks last of the 7 countries studied, despite having the highest level of spending
The complete Commonwealth Fund report is available at http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
Efficiency
Two kinds of inefficiency, or a combination, might cause the US to have poor health care results despite high spending
1. The US production function (PF2) might be lower than those of other countries (PF1), indicating that more inputs are needed to produce a given health care result (point B instead of point A)
2. Perverse incentives might lead to too much spending, reaching a point like C where the extra spending has no positive effect on health care results
A paper by Alan Garber and Jonathan Skinner suggests that both kinds of inefficiency are found in the US health care system.(See http://www.aeaweb.org/articles.php?doi=10.1257/jep.22.4.27 )
Posted Feb. 27, 2011 on Ed Dolan’s Econ Blog http://dolanecon.blogspot.com
The Bottom Line
Different methods can be used to rank national health care systems, but regardless of the method used, it is hard to support the claim that the US has the world’s best
The world’s highest costs combined with good, but not outstanding, health care outcomes suggests substantial inefficiencies
Further posts in this series will look at what can be learned from the health care experience of individual countries
