Keeping candidates honest on health care

Northwestern's Institute for Policy Research News (PDF) is great for those of us without the time or train fare to attend all their briefings and symposia. The new (winter) issue includes a summary of health industry management prof David Dranove's December take on what presidential candidates aren't saying about cost containment, entitlement, and the role of technology.

I'm a sucker for people who are well enough informed to take a good whack at both sides. Here's DD on "the darling of Republican Party candidates," consumer-directed health plans. He says they're unlikely to have any impact because they target healthy well-educated individuals.

As for entitlements: "No one is promising a $300,000 house to homeless families. But many candidates are promising equal access to the world's most expensive and advanced healthcare system." That either means a big bill to pay, or a rationing system.

If you're a person of leisure, you can skip the newsletter and see the presenters' PowerPoint slides or watch a video of the event itself (46:45) -- and tell us about 'em in the comments.

US health care doesn't measure up

From a Commonwealth Fund summary of a study published in Health Affairs:

Between 1997–98 and 2002–03, amenable mortality fell by an average of 16 percent in all countries except the U.S., where the decline was only 4 percent. In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.

In case you're wondering,

The concept of amenable mortality was developed in the 1970s to assess the quality and performance of health systems and to track changes over time. For this study, the researchers used data from the World Health Organization on deaths from conditions considered amenable to health care, such as treatable cancers, diabetes, and cardiovascular disease.

By the authors' most conservative estimate, 75,000 people died in the US in 2002 who would have lived if we were merely up to the average of the other countries.

Note that this is not a case where our system is actually declining in absolute terms; it's simply improving more slowly than comparable systems. For those of us brought up on the idea that the US was ahead of everyone else and always would be, that's small comfort. But the sooner studies of this sort knock that notion out of our heads, the better.

Health care culture

Mary Beth Regan dredges up a number of interesting ideas about our health-care system in the Johns Hopkins Public Health magazine. Here's one, from JHU health policy prof Thomas A. LaVeist:

more tightly regimented treatment protocols to level the playing field. "The one place we don't find racial or ethnic disparities in health care is in the active-duty military," he says. "In the military you don't have black culture or white culture, you have 'green' culture," he says.

"When the lifestyles, health care access, and practice are similar, the outcomes are similar," he says. To LaVeist, U.S. experience shows that health care does not flourish when left to a free market. "There are public goods and services that are not optimally distributed by the free market—for example, police services, emergency services and national defense," he says. "Health care may also be one of them."

This reminds me of No Child Left Behind, for better or worse. Some teachers kick and scream because that law, or some small-minded implementations of it, have reduced their professional discretion. Medicine is both better organized and much more professional (in the sense of a learned profession) than education, so I don't know that this particular proposal is going anywhere.

But professionals -- in health care or education or whatever -- who abhor the idea of "more tightly regimented treatment protocols" might want to be involved in profession-based attempts to bridge cultural and economic gaps, rather than fighting efforts to correct them.

Insurance matters

A lack of health insurance can be a death sentence. A report published in CA: A Cancer Journal for Clinicians finds that

• For all cancer sites combined, patients who were uninsured were 1.6 times as likely to die in five years as those with private insurance.
• The relationship between access to care and cancer outcomes is particularly striking for several cancers which can be prevented or detected earlier by screening and for which there are effective treatments, including breast and colorectal cancer. At every level of education, individuals with health insurance were about twice as likely as those without health insurance to have had mammography or colorectal cancer screening. ...
• Women without health insurance are about half as likely as those with private health insurance to have received a mammogram in the past two years (38.1 percent of uninsured women versus 74.5 percent of insured women age 40-64), a pattern seen for all race/ethnicities studied (white, African American and Hispanic) at all levels of education.
  

I haven't found a link to the article itself, but EurekAlert has an extensive press release.

Health care: stay north to stay well

In the layoff season, a middle-aged person's fancy lightly turns to issues of health care. A good place to catch up on what looks to me like reality-based information is the Commonwealth Fund's ten top story list. Two caught my eye:

"4. ...A Commonwealth Fund survey of primary care physicians and patients in five other nations—Australia, Canada, Germany, New Zealand, and the United Kingdom—finds that the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. ...While no one country provided a perfect model of care, there are many lessons to be learned from the strategies at work abroad."

Even more interesting, unless you're already headed for Canada or South Korea:

"7. A state scorecard finds wide variations in health care exist across states.The Commonwealth Fund's first state scorecard found that health care quality, cost, and access vary widely across states, suggesting that where you live can make a big difference to your health."

In this ranking, Iowa was #2, Wisconsin #9, Michigan #16. (There are lots of details.) Moving down a tier, Missouri #37, Illinois #36, Indiana #38. Moving down one more tier: Arkansas #48, Kentucky #45. As far as this part of the Midwest goes, you're likely to get better health care the farther away you can get from areas settled by people from the South. Taking the "hospital" out of "hospitality," I guess.