What’s just as interesting is that Japan, the country that tops the overall life expectancy tables, finished in the middle of the pack on cancer survival.
He finds, as have others (John Goodman comes to mind), that the five-year cancer survival rates tend to be higher in the U.S. than in other countries. The one issue I would raise with this is that survival is measured from the point of diagnosis, so that if we diagnose cancer sooner (or diagnose more non-lethal cancers), then we would come out ahead on that measure.
Roy continues,
A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.
I think this study offers more reason to believe that the U.S. is really number 1 when it comes to health care outcomes. Still, it may not show that the U.S. is number 1 in terms of cost-effectiveness of health care. My guess is that comparing the additional amount that we spend on health care to the additional longevity we obtain would yield a very large cost per year of life saved.
I have long argued against using longevity statistics to judge what I once called the international health care Olympics. As I pointed out in that essay, it would lead policymakers to make some really perverse choices. But even if we are number 1 in terms of medically-treatable life expectancy, that is no reason to be complacent that our system is cost effective.
I’d be very dubious about international comparisons of cancer “survival” rates unless I was confident that there was some way of controlling for differential rates of early detection and monitoring.
The USA has a high breast cancer 5-year survival rate, and it has improved over time, but many people have pointed out that this could be largely an artifact of doing more early detection that sweeps in both: 1) early stage cases of DCIS that may never have been life-threatening in the first place, and 2) invasive cancer that still does kill women eventually, but since we caught it earlier, we get to count them as having “survived” for the 5 year period.
It’s not all early diagnosis; even if you compare cancers at similar stages, you see significant variation in survival rates. For example, http://www.cancerresearchuk.org/cancer-info/news/archive/pressrelease/2013-03-01-UK-late-stage-breast-cancer-survival-lower
Which is not to say that early-diagnosis of slow-growing cancers doesn’t play a role.
The text you link to makes no reference to the U.S.
That is true, but if you look at the paper referenced in the original post and its listed 5 year breast cancer survival rates, and compare the countries referenced in the UK article, you’ll see that the correction doesn’t change the rank ordered.
Sweden is second to the US for breast cancer (but not other cancers) in the first paper, and higher in the UK stage corrected study. The UK and Denmark scored the worst in both the Ohsfeldt and Schneider paper, and the UK stage corrected study.
Given that, it seems reasonable (but not definitive) to think that correcting for stages of discovery would not change the Ohsfeldt and Schneider results for the US as well.
Do you feel the same about how infant mortality rates are compiled across countries?
Here’s the best article I’ve seen on differences in infant mortality measures.
http://www.nationalreview.com/articles/276952/infant-mortality-deceptive-statistic-scott-w-atlas?pg=1
I guess life expectancy of women in the US would also climb up if you remove fatal injuries. Maybe by a smaller margin, as men tend to suffer more from “fatal injuries” – but that’s only an assumption.
However, from a cost-effiency point of view, these numbers tend to shaow that, indeed, the US healthcare systems is lagging behind west-euroean ones.
http://www.ladocumentationfrancaise.fr/dossiers/d000538-l-avenir-du-systeme-de-sante-en-france/des-depenses-de-sante-en-constante-augmentation
Also: While the U.S. has achieved gains in 15-year survival rates decade by decade between 1975 and 2005, the researchers discovered that other countries have experienced even greater gains, leading the U.S. to slip in country ranking, even as per capita health care spending in the U.S. increased at more than twice the rate of the comparison countries.
Finally, examining homicide and traffic fatalities, the researchers found that they have accounted for a stable share of U.S. deaths over time, and would not account for the significant change in 15-year life expectancy the study identified.
http://www.commonwealthfund.org/News/News-Releases/2010/Oct/Americans-Life-Expectancy.aspx
Statistics are indeed hell.
While that’s an interesting link I think the authors of that study are making a bit too strong of an argument for the information they provide. What they seem to be ignoring is that the faster gains in life expectancy could be explained by catch-up to US quality of health care rather than by actually superior care. Indeed the information that controlling for obesity/violent crime/accidents does lead to the US being highest ranked in OECD life expectancies implies that’s exactly what’s happening. And if the US is on the cutting edge of life expectancy expansion, we should expect that it would be more difficult for us to see gains than it would be for countries which are seeing gains through piggy-backing on effective US techniques and technologies.
It’s sort of like looking at the GDP growth rates in China and the United States and saying that China has a better functioning economy because their growth rate is so much higher than the US. If the US adopted Chinese economic policies, our growth rate would likely be hugely negative, they’re growing because they are in catch up and reforming their economy from a very bad starting point. If China actually passed the US in per capita GDP, then you would have a strong argument that the US could gain by adopting Chinese policies (one country that has managed to do this is Singapore, but there are few other examples that don’t involve large oil reserves). In the same vein, when the US begins slipping in rank adjusted for these non-healthcare concerns then that will be good evidence the US healthcare system has actually fallen behind in quality (not that we can’t still make it better, I doubt anyone thinks the current US healthcare system is ideal).
The Ohsfeldt and Schneider study is certainly provocative. But it would be better to try to systematically account for all of the factors that cause US and European Life expectancy numbers to differ. Maybe medical care isn’t the whole story; diet and lifestyle might possibly be more important. Without some sort of quantitative assessment, it is impossible to say how much value we are getting from expensive medical care.