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The US pays more money because it has more health care being provided, in many cases. It just so happens that more health care doesn't necessarily translate to

The US pays more money because it has more health care being provided, in many cases. It just so happens that more health care doesn't necessarily translate to measurably better outcomes (e.g. cancer screening helps reduce mortality for some cancers but not others). It also just so happens that it's very rare to study whether a particular care regimen actually improves overall outcomes as opposed to just the thing it's ostensibly aimed at treating. Continuing our cancer example, cancer screening helps reduce mortality from _cancer_ for almost all if not all cancers, but for some the increased mortality from operations and other cancer therapies cancels out the improvement. That's not to mention the fact that people in the US prefer to get care even if they know it'll likely make them worse than not getting care. I'll dig up the reference for this; I don't have it offhand.

pessimizer 16y ago
>The US pays more money because it has more health care being provided Reference for this, too, please.
bzbarsky 16y ago
Reference for the last part there: http://www.ncbi.nlm.nih.gov/pubmed/16282212 http://www.ncbi.nlm.nih.gov/pubmed/16282212
bzbarsky 16y ago
The first claim above is pretty broad; coming up with a single reference to support it would be hard, and coming up with a wide range of references time-consuming. But as examples: http://www.ncbi.nlm.nih.gov/pubmed/2268793 http://www.ncbi.nlm.nih.gov/pubmed/2268793 (2.5x more coronary artery bypasses per capita in the US than in Canada in 1988; admittedly somewhat dated). http://www.pillsforall.com/blog/cardiac-stents-are-used-twice-more-in-u-s-than-in-canada/ http://www.pillsforall.com/blog/cardiac-stents-are-used-twic... I realize that's pretty weak support; I don't have anything better off the top of my head, unfortunately.
dalke 16y ago
So we pay more money then other countries but don't get better outcomes? Could we save money and get the same outcomes? And since we get worse outcomes then they do, could we spend less and still get better outcomes? How do you defined "more health care?"
- bzbarsky 16y ago
  > So we pay more money then other countries but > don't get better outcomes? Yes, exactly. > Could we save money and get the same outcomes? That seems like an obvious corollary of the above... But yes, I think we could. > And since we get worse outcomes then they do Not necessarily worse; just not better. Measuring and comparing outcomes across different populations is hard enough that it's hard to say more than "our outcomes are not clearly better than theirs". > could we spend less and still get better outcomes? This question is based on a premise which doesn't seem to be true, so probably no. > How do you defined "more health care?" Number of procedures per capita per year for various procedures is a reasonable measurement (where procedures can be MRIs, surgeries of various sorts, etc, etc). Usually people focus on the expensive end of this, by the way; having more physical checkups won't necessarily blow up your healthcare costs the way that more invasive cancer surgeries will.
  - dalke 16y ago
    Your logic works both ways. If you say it's hard to measure then how do you know that get the same outcomes? "Number of procedures per capita per year" is a horrible measure. It assumes that procedures done is a good proxy for overall health, which it isn't. Public health (clean food and water, trash pickup, promoting exercise and outside activities, cutting down on smoking, etc) is also important. Here's a scenario. Country A and B are identical except that country A has pushed for potable water and B has not. As a result, 10% of the procedures in country B are from dysentery, cholera, and other water-borne diseases which are relatively cheap to treat (keep hydrated with a solution of salts and sugar). As a result, country B has more doctor visits per capita, and on average these costs are cheaper than in country A. Country B also has lower life-expectancy, more days sick per year, and other measurable outcomes. By your definition, country B has the better health care system but I think most people would prefer the overall health of country A. Therefore your measurement is not so useful as an indicator of overall health outcomes.

pessimizer 16y ago

>The US pays more money because it has more health care being provided Reference for this, too, please.

bzbarsky 16y ago

Reference for the last part there: http://www.ncbi.nlm.nih.gov/pubmed/16282212 http://www.ncbi.nlm.nih.gov/pubmed/16282212

bzbarsky 16y ago

The first claim above is pretty broad; coming up with a single reference to support it would be hard, and coming up with a wide range of references time-consuming. But as examples: http://www.ncbi.nlm.nih.gov/pubmed/2268793 http://www.ncbi.nlm.nih.gov/pubmed/2268793 (2.5x more coronary artery bypasses per capita in the US than in Canada in 1988; admittedly somewhat dated). http://www.pillsforall.com/blog/cardiac-stents-are-used-twice-more-in-u-s-than-in-canada/ http://www.pillsforall.com/blog/cardiac-stents-are-used-twic... I realize that's pretty weak support; I don't have anything better off the top of my head, unfortunately.

dalke 16y ago

So we pay more money then other countries but don't get better outcomes? Could we save money and get the same outcomes? And since we get worse outcomes then they do, could we spend less and still get better outcomes? How do you defined "more health care?"

bzbarsky 16y ago
> So we pay more money then other countries but > don't get better outcomes? Yes, exactly. > Could we save money and get the same outcomes? That seems like an obvious corollary of the above... But yes, I think we could. > And since we get worse outcomes then they do Not necessarily worse; just not better. Measuring and comparing outcomes across different populations is hard enough that it's hard to say more than "our outcomes are not clearly better than theirs". > could we spend less and still get better outcomes? This question is based on a premise which doesn't seem to be true, so probably no. > How do you defined "more health care?" Number of procedures per capita per year for various procedures is a reasonable measurement (where procedures can be MRIs, surgeries of various sorts, etc, etc). Usually people focus on the expensive end of this, by the way; having more physical checkups won't necessarily blow up your healthcare costs the way that more invasive cancer surgeries will.
- dalke 16y ago
  Your logic works both ways. If you say it's hard to measure then how do you know that get the same outcomes? "Number of procedures per capita per year" is a horrible measure. It assumes that procedures done is a good proxy for overall health, which it isn't. Public health (clean food and water, trash pickup, promoting exercise and outside activities, cutting down on smoking, etc) is also important. Here's a scenario. Country A and B are identical except that country A has pushed for potable water and B has not. As a result, 10% of the procedures in country B are from dysentery, cholera, and other water-borne diseases which are relatively cheap to treat (keep hydrated with a solution of salts and sugar). As a result, country B has more doctor visits per capita, and on average these costs are cheaper than in country A. Country B also has lower life-expectancy, more days sick per year, and other measurable outcomes. By your definition, country B has the better health care system but I think most people would prefer the overall health of country A. Therefore your measurement is not so useful as an indicator of overall health outcomes.