Health Care Outcomes
I’ve argued in the past that health care outcomes like infant mortality and life expectancies are not really very good measures of a country’s health care services since such outcomes are also a function of variables that are outside the control of health care services. A person who is morbidly obese and refuses to change their behavior irrespective of medical advice is going to have a shorter life span that a person who does not. Then there are other factors like accidental deaths, homicide rates, and so forth that also influence life expectancies, but are pretty much outside the realm of health care. For example, if you fall of your roof and die, what does that have to do with cancer treatments, low infant birth weights, etc. Are accidental deaths and homicide rate distributions uniform across countries? If not, then they could be factors that need to be controlled.
Now at the National Bureau of Economic Research we have this part of their Program Report on Health Economics,
June E. O’Neill and Dave M. O’Neill address the NHI issue by comparing Canada’s publicly funded, single-payer health care system to the multi-payer heavily private U.S. system. They argue that differences between the United States and Canada in infant mortality and life expectancy — the two indicators most commonly used as evidence of better health outcomes in Canada — cannot be attributed to differences in the effectiveness of the two health care systems because they are strongly influenced by differences in cultural and behavioral factors, such as the relatively high U.S. incidence of obesity and of accidents and homicides. Direct measures of the effectiveness of medical care show that five-year relative survival rates for individuals diagnosed with various types of cancer are higher in the United States than in Canada, as are infant survival rates of low-birthweight babies. These successes are consistent with the greater U.S. availability of high level technology, higher rates of screening for cancers, and higher treatment rates of the chronically ill. The need to ration when care is delivered “free” ultimately leads to long waits. The health-income gradient is at least as prominent in Canada as it is in the United States.
In other words, when one looks at specific instances of U.S. vs. Canadian health care outcomes the U.S. does come out ahead. Does that justify the considerably higher costs? I don’t know, but it is something to consider. After all, getting a better outcome in terms of survivability for low birth weight babies might have a rather steep cost curve…or not.
This doesn’t mean that the U.S. system is better or that we don’t have to reform our health care system, we clearly need to. In fact, in reforming it we might have to accept lower survivability rates for both cancer patients and low birth weight babies.