20090809

The Cost of Health Care


As part of the justification to "reform" the health care system in the US is predicated on the argument that the cost of health care in the US is too high. How do they know? It is because our the amount of money we spend on health care is higher than that of other industrialized nations without a better outcome? In these analysis, one such better outcome is typically measured as survival of some sort or another. I think survival measures are misleading for several reasons. Take infant survival for instance. Yes, as reported to the World Health Organization the US has higher infant mortality rates than most Western nations. Why is this? Partly because of how we calculate the mortality figure; what constitute a death is obvious but what constitute a birth is not always so obvious. The WHO specifies a birth as a "viable birth" but in some nations, if a live infant is born without meeting their ability to keep alive, it isn't considered a "viable birth".
Using mortality as a measure of health care outcome also doesn't show the whole picture. In the US we spend a significant amount of resources on palliation to improve quality of life without improving the over all survival. Medicare spends about 25-30% of its budget each year on the last year's of life. We typically do all we can to save a life and spends the resources to do so. But it isn't just in the last year of life. In Germany for instance, post operative analgesia are typically aspirins and ibuprofen, analgesics we can get over the counter here in the US. Here in the US, nearly all post operative analgesics are narcotic based, with pills for outpatient care and patient controlled intravenous injection of narcotics for inpatient recovery. These things cost money without extending longevity.
But for somethings longevity is better in the US. Take cancer survival for instance. But longevity also varies across the globe that has nothing to do with health care delivery. The US has a significantly higher population of obese patient and a higher incidence of heart disease, likely due to our diet.

The second motive to reform health care is to reign in health care inflation. I remember the same arguments a decade ago for Health Maintenance Organization (HMOs). For a few years, health care inflation was reigned in but afterward, it resume at previous rates of increase. The chart below is interesting in that this isn't just in the US but the health care inflation is on a similar projection in the UK as well as France.


What this graph signifies again is that there a cultural component the health care cost and health care inflation that is not being discussed. Western nations have rapidly rising health care cost, Japan does not. That there is cultural variation on what we spend money on should come as no surprise. For instance, most homes in the US has air conditioning and thus we have less consequences of heat waves. In France this isn't so.
All in all, we get what we pay for. In the US we spend more on palliative measures and this in actuality is a mark of our wealth. Health care isn't about survival in the US, health care is also about quality of life. This is a choice our society has decided on. Yes like any choice we can change our mind but we need to be cognizant what the debate should entails. I suspect some advocate for health care reforms knows this but also realize that a supposed cost saving argument is easier made than a cultural changing argument.

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