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> Health spending is determined by income Whoa. That's eye-opening. If country X spends less than country Y, rather than surmise that country X is more effic

> Health spending is determined by income Whoa. That's eye-opening. If country X spends less than country Y, rather than surmise that country X is more efficient with their healthcare spending we might want to look at whether country X has less per-capita income than country Y. This makes sense, though it's very surprising. I've seen so much commentary here about how much better the Europeans are at dealing with healthcare than us Americans...

mullingitover 2y ago
You can look at the health outcomes to gauge the efficiency. Does the population in country X live longer? Are infant mortality rates higher? Preventable deaths? We know the US healthcare system is a ripoff exactly because while the spending as a percentage of GDP in the US is dramatically higher, the measurable outcomes are embarrassingly bad across the board.
- getnormality 2y ago
  Why would we assume that the health of a country is mainly determined by its healthcare system? I think the big drivers of worse American health outcomes are things like obesity, car-based lifestyles, and long working hours, all of which have nothing to do with our healthcare system. The healthiest countries succeed by rarely needing their healthcare system because people behave in healthy ways. Needing the system a lot means you've already failed.
  - mullingitover 2y ago
    I don't think lifestyle explains our problem with infant mortality rates. That's something where you, first thing in life, depend on the health care system before you even have a lifestyle. In addition, yes, I think we can blame obesity on (the lack of) healthcare. If people routinely met with a physician and got advice, they might be able to turn things around before merely being overweight becomes obesity. We're effectively in a shortage situation, and by design. If you don't get preventative care, that's considered a good thing by the healthcare system because they would honestly collapse if everyone got the recommended doctor visits. So we have people not getting preventative treatment and dying of preventable causes at depressingly high rates. This is generally considered fine, because the health care system is bursting at the seams with more money than it can count, so it's considered successful.
    - getnormality 2y ago
      I'm not sure the infant mortality has much of an impact on longevity, and while there may be things the US could do about obesity within the healthcare system, I doubt that the reason for the US-world gap is that the rest of the world does these things and the US doesn't. You can name things that are bad about US healthcare and could be improved but that's a different topic than why Americans are in relatively poor health compared to other developed countries.
      - mullingitover 2y ago
        > I'm not sure the infant mortality has much of an impact on longevity Infant mortality is a measurable performance indicator for the healthcare system regardless of overall population's longevity.
        getnormality 2y ago
        There's still the same problem of disentangling the population health from the efficacy of the system. Maybe mothers are less healthy in the US and that affects infant mortality. Not an expert by any means, just confused by the complexity of it all.
    - chiefalchemist 2y ago
      > If people routinely met with a physician and got advice, they might be able to turn things around before merely being overweight becomes obesity. Anecdotally, two stories: - A while back, I had dinner with two friends who do pharma research. At the time they were working on treatment for T2 diabetes. Naive me asked, "Why not just focus on prevention?" They said it's doesn't happen. Too few people are willing to change. - More recently I had a conversation with a doctor at a social event. A similar topic came up, again I suggest prevention. And again I was told the same, it just doesn't happen.
      - ninalanyon 2y ago
        I'm sure these anecdotes are true. But is it true because this behaviour is immutable or is it because there has been no serious attempt to change it? For instance why not teach how to be healthy in primary school and in society generally? The US and other countries have a high incidence of Type 2 diabetes largely because of over consumption of sugar. This is a social issue. I saw this very clearly when I took my family to the US for three months many years ago and we visited one om my colleagues for Thanksgiving. Our host's wife was astonished when my children asked for a drink of water, she asked them several times if they would not prefer a sweet fizzy drink. But my children were thirsty and knew that water was the best remedy.
- chiefalchemist 2y ago
  I'm not so sure that's the healthcare system. The USA doesn't do well in preventing that which is preventable. The System is only as healthy as the population it serves. In the USA demand is high, price naturally follows. Reduce demand, prices will fall. This link just happened to be what I found. I'm certain I've seen others. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...
- refurb 2y ago
  > You can look at the health outcomes to gauge the efficiency. Does the population in country X live longer? Are infant mortality rates higher? Preventable deaths? Those aren't great metrics as they are highly confounded by other factors that have nothing to do with a healthcare system.
avidiax 2y ago
I don't find this to be surprising. Healthcare services have inelastic demand. If you have a broken leg, and the average income is $X or $2X, clearly the hospital can charge twice as much in the second case and still mend legs. What is surprising is the third section: > The rising health share explained by rising quantities per capita (not prices!) I don't think the author really makes the point, however. They don't seem to claim that higher income people are getting more doctor's visits or more procedures done or taking more medicine (though this may all be true). Rather, they claim that the we are putting more resources into healthcare, a somewhat orthogonal claim.

mullingitover 2y ago

You can look at the health outcomes to gauge the efficiency. Does the population in country X live longer? Are infant mortality rates higher? Preventable deaths? We know the US healthcare system is a ripoff exactly because while the spending as a percentage of GDP in the US is dramatically higher, the measurable outcomes are embarrassingly bad across the board.

getnormality 2y ago
Why would we assume that the health of a country is mainly determined by its healthcare system? I think the big drivers of worse American health outcomes are things like obesity, car-based lifestyles, and long working hours, all of which have nothing to do with our healthcare system. The healthiest countries succeed by rarely needing their healthcare system because people behave in healthy ways. Needing the system a lot means you've already failed.
- mullingitover 2y ago
  I don't think lifestyle explains our problem with infant mortality rates. That's something where you, first thing in life, depend on the health care system before you even have a lifestyle. In addition, yes, I think we can blame obesity on (the lack of) healthcare. If people routinely met with a physician and got advice, they might be able to turn things around before merely being overweight becomes obesity. We're effectively in a shortage situation, and by design. If you don't get preventative care, that's considered a good thing by the healthcare system because they would honestly collapse if everyone got the recommended doctor visits. So we have people not getting preventative treatment and dying of preventable causes at depressingly high rates. This is generally considered fine, because the health care system is bursting at the seams with more money than it can count, so it's considered successful.
  - getnormality 2y ago
    I'm not sure the infant mortality has much of an impact on longevity, and while there may be things the US could do about obesity within the healthcare system, I doubt that the reason for the US-world gap is that the rest of the world does these things and the US doesn't. You can name things that are bad about US healthcare and could be improved but that's a different topic than why Americans are in relatively poor health compared to other developed countries.
    - mullingitover 2y ago
      > I'm not sure the infant mortality has much of an impact on longevity Infant mortality is a measurable performance indicator for the healthcare system regardless of overall population's longevity.
      - getnormality 2y ago
        There's still the same problem of disentangling the population health from the efficacy of the system. Maybe mothers are less healthy in the US and that affects infant mortality. Not an expert by any means, just confused by the complexity of it all.
  - chiefalchemist 2y ago
    > If people routinely met with a physician and got advice, they might be able to turn things around before merely being overweight becomes obesity. Anecdotally, two stories: - A while back, I had dinner with two friends who do pharma research. At the time they were working on treatment for T2 diabetes. Naive me asked, "Why not just focus on prevention?" They said it's doesn't happen. Too few people are willing to change. - More recently I had a conversation with a doctor at a social event. A similar topic came up, again I suggest prevention. And again I was told the same, it just doesn't happen.
    - ninalanyon 2y ago
      I'm sure these anecdotes are true. But is it true because this behaviour is immutable or is it because there has been no serious attempt to change it? For instance why not teach how to be healthy in primary school and in society generally? The US and other countries have a high incidence of Type 2 diabetes largely because of over consumption of sugar. This is a social issue. I saw this very clearly when I took my family to the US for three months many years ago and we visited one om my colleagues for Thanksgiving. Our host's wife was astonished when my children asked for a drink of water, she asked them several times if they would not prefer a sweet fizzy drink. But my children were thirsty and knew that water was the best remedy.
chiefalchemist 2y ago
I'm not so sure that's the healthcare system. The USA doesn't do well in preventing that which is preventable. The System is only as healthy as the population it serves. In the USA demand is high, price naturally follows. Reduce demand, prices will fall. This link just happened to be what I found. I'm certain I've seen others. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...
refurb 2y ago
> You can look at the health outcomes to gauge the efficiency. Does the population in country X live longer? Are infant mortality rates higher? Preventable deaths? Those aren't great metrics as they are highly confounded by other factors that have nothing to do with a healthcare system.

avidiax 2y ago

I don't find this to be surprising. Healthcare services have inelastic demand. If you have a broken leg, and the average income is $X or $2X, clearly the hospital can charge twice as much in the second case and still mend legs. What is surprising is the third section: > The rising health share explained by rising quantities per capita (not prices!) I don't think the author really makes the point, however. They don't seem to claim that higher income people are getting more doctor's visits or more procedures done or taking more medicine (though this may all be true). Rather, they claim that the we are putting more resources into healthcare, a somewhat orthogonal claim.