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Low Life Expectancy in the United States: Is the Health Care System at Fault?

Posted Sep 08 2009 10:08pm

Americans pay more for medical care than any other country and have one of the highest levels of income per capita of any country in the world. Despite its immense wealth and healthcare spending, the United States ranks 50th in life expectancy, worse than Jordan, South Korea, and Bosnia and Herzegovina. In a Commonwealth Fund report, the U.S. ranks last among 19 countries according to the criteria of “Mortality amenable to medical care.”

Despite these facts Preston and Ho (2009) claim that the American medical system is in fact very good. Instead of using overall life expectancy, Preston and Ho use more accurate measures of how well the American health care system operates. One could use the incidence rate of disease. However, effective diagnosis and early diagnosis will inflate statistics measuring incidence–since early stage disease is found in more patients–but also increases the probability a treatment is successful. For instance, “the United States has a higher prevalence than Europe of the major adult diseases, including cancer, heart disease, and diabetes ( Thorpe et al. 2007; Avendano et al. 2009 ). But higher prevalence could reflect higher incidence, better detection, or longer survival resulting from more successful treatment…Relatively high survival rates imply either that the disease has been detected unusually early or that treatment is unusually successful.”

The thesis of the paper is that the U.S. does a better job of screening patients for cancer as well as providing more aggressive treatment. The authors find:

“mortality reductions from prostate cancer and breast cancer have been exceptionally rapid in the United States relative to a set of peer countries. We have argued that these unusually rapid declines are attributable to wider screening and more aggressive treatment of these diseases in the US…5-year survival rates from all of the major cancers are very favorable; survival rates following heart attack and stroke are also favorable (although one-year survival rates following stroke are not above average); the proportion of people with elevated blood pressure or cholesterol levels who are receiving medication is well above European standards.”

This still leaves the question of why life expectancy is so low when the U.S. health care system is good. Likely the reasons are behavioral (e.g., smoking, obesity, stress) or public health related (e.g., clean drinking water, sanitation, pollution), and are not due to problems within the medical system. While the U.S. health care system is far from perfect, it is likely comparable or slightly superior to the medical care received in other developed countries.

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