In a previous post we've addressed the areas where the United States appears to lag behind other developed countries, debunking some of the misconceptions surrounding those metrics - while also acknowledging places where the U.S. could improve its performance.
Now we turn our attention to those measures where the US takes a clear lead.
Breast Cancer Survival Rates
Breast cancer is the most common form of cancer among OECD countries, accounting for a full 30% of cancer incidence among women and 15% of all cancer mortality. Moreover, it is an important indicator of the quality of a country's health system. Of course, other factors like genetics play an important role in breast cancer survival rates - some people are naturally more resistant to cancer. However, it is hard to discount the importance of the quality and availability of detection and treatment regimens in saving breast cancer patients' lives.
There is reason to applaud, then, when we discover that the United States has the OECD's highest 5-year survival rate for breast cancer at 89.3 percent, with the average at 83.7 percent.
What factors, then, contribute to such a high survival rate in the United States compared to other countries? A recent study by the OECD concluded that total health expenditures, access to innovative drugs, and investment in technology are all strong predictors of cancer survival rates - the US either leads, or is close to leading in each of these indicators.
According to another study published this past April in Health Affairs, from 1983 to 1999, the US increased average cancer spending from $47,000 per case, to $70,000 per case. The authors peg the net value for all US cancer patients to have totaled nearly $600 billion. The authors find that "differences in US costs reflect more rapid uptake of new technologies that may lead to differences in survival." Simply put, we spend more and we get more. This further echoes the point that University of Chicago researchers made in 2006.
Good bang for your buck? Absolutely.
The quality of care in any health system is irrelevant if people can't see the doctor or are unable to get the surgery they need. Americans, on average, have much shorter waiting times for medical care than citizens of Canada and other OECD countries with more egalitarian healthcare arrangements. The numbers speak for themselves - in 2010, 25 percent of Canadians seeking elective surgery had to wait four months or more to receive it - compared with a mere 7 percent of Americans. In fact, the Fraser Institute found that 2011 marked the longest waiting times recorded in Canada:
"[D]espite high levels of health expenditure and provincial wait time strategies, it is clear that patients in Canada are waiting too long to receive treatment."
Not only do Americans wait less for elective surgery, they also wait less to see specialists - 20 percent in 2010 had a four week or longer waiting time, compared to 59 percent in Canada; 28 percent in the UK.
The numbers do show, however, that a number of countries - Switzerland, Germany, and the Netherlands have shorter waiting times than the US by 2010 estimates. The difference in waiting times, however, is much less pronounced than the difference between the US and countries like the UK and France.
Ultimately, it is hard to see the utility of a universal healthcare system in which patients have so much trouble seeing their doctors and getting the services they need.
Fatal Injury Adjusted Life Expectancy
The last piece of the US "outcome" puzzle is a little puzzling itself. Life expectancy is a very simple, easy to understand, and to an extent, useful measure of a country's broader health status - inextricably linked to the quality of the health system. When using raw figures, the US tends to lag behind other OECD countries in this measure. The raw figure, however, ignores the behavioral aspects that tend to get captured in the measure of life expectancy - homicide rates and fatal injury rates, for instance, will exaggerate the difference between the United States and France - the US has around four times the homicide rate of France. Because homicides and other injuries are unrelated to the quality of a country's health system, it makes sense to strip those differences out and build a new metric - the "Fatal Injury Adjusted Life Expectancy". Fortunately, two researchers from Texas A&M and the University of Iowa developed exactly such a measure using mean life expectancies from 1980-99 for OECD countries.
Source: How Does the U.S. HealthCare System Compare to Systems in Other Countries?
Using the fatal-injury adjusted mean, the United States leads the OECD in life expectancy. Yet another way that Americans get a good value for their money.
Do Americans spend a lot on healthcare? Without a doubt. Do we get a good return on our investment? When it comes to higher cancer survival rates, shorter waiting times, and longer life expectancy it's hard to argue that Americans don't see some significant returns on their investments.
None of this, however, deals with efficiency.
In our next post we will address some of the inefficiencies in the US system, their causes, and offer some suggestions for improvement.