How Effective is American Healthcare?

From Umair Haque at HarvardBusiness.org

Be sure to click link above to read it all and check out the charts.

Where does the United States stand compared to other countries? It loses the most potential years of life amongst developed countries. In the United States, 6397 years of life are lost per 100,000 males — compared to just 4574 in the United Kingdom, or 4018 in Italy.

The United States (the bright red line) has seen the smallest reductions in PYLL, by a wide margin. In fact, Korea — the bright blue line — now loses fewer potential years of life than the United States, and has done so since approximately 1999.

The United States gets the smallest bang for the buck in terms of life itself amongst developed countries: it realizes the lowest level of "life returns." The U.S. healthcare system returns the fewest life years for each dollar spent. The United States, for example, has invested an additional 8.3% of GDP in health since 1971. That investment yielded a PYLL reduction of 5157 years. America realized a return of 621 potential years of life gained for each additional percentage point of GDP invested in health.

The United Kingdom invested an additional 3.3% of GDP in health since 1971. That investment yielded gains of 4421 fewer potential years of life lost. The United Kingdom realized a return of 1340 potential years of life gained for each additional percentage point of GDP invested in health. The United Kingdom healthcare system delivers life returns more than twice those of the American healthcare system.

Canada, in contrast, has invested a marginal 2.6% of GDP in health since 1971. That investment yielded a PYLL reduction of 5393 years. Canada realized a return of 2074 years for each additional percentage point of GDP invested in health. The Canadian healthcare system delivers life returns more than three times greater than those of the American healthcare system.

Now, please take all this with a grain of salt. PYLL is an imperfect measure, and it doesn't capture all the richness of healthcare inequities and imperfections. Equating life years lost to life years gained might have methodological issues. Comparing PYLL over time might need statistical adjustment. This is a blog post, not a journal article, and I crunched these numbers on a Sunday afternoon over a quick coffee.

The point isn't that this is the best, only, or final measure of healthcare effectiveness. The point is this:

A more productive debate begins with assessments of effectiveness, so costs can be compared to benefits. Debate is the lifeblood of a democracy — but the current debate lacks those. And that, perhaps, is why it's so frustrating for both sides. I hope this post offers a measure of effectiveness that everyone can use to have a more productive debate.