Think America has the world’s best health care system? You won’t after seeing this chart.

January 7

This, from Austin Frakt over at the Incidental Economist, is a terrifying chart. It shows potential years of life lost to different diseases, from circulatory issues to congenital defects, in the United States compared with other OECD countries.

The bubbles with numbers greater than one mean the United States is losing more life to a particular condition than the average member country in the Organization for Economic Cooperation and Development. A bubble with a number less than one means Americans are losing fewer years of life, although you don't see many of those, because, in every category measured in 2008, the United States did worse than than average.

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Americans lose three times as many years of life to infectious diseases as the average OECD country and loses twice as many years to metabolic diseases. There are some categories in which America used to lose fewer years of life than other countries back a few decades ago. But, ever since the 1980s, that hasn't happened.

How did we end up here? Here's the JAMA authors' attempt at an explanation, via Carroll, which lays blame at the very fragmented structure of the American health-care system:

Possible causes of this departure from international norms were highlighted in a 2013 Institute of Medicine report and have been ascribed to many factors, only some of which are attributed to medical care financing or delivery. These include differences in cultural norms that affect healthy behaviors (gun ownership, unprotected sex, drug use, seat belts), obesity, and risk of trauma. Others are directly or indirectly attributable to differences in care, such as delays in treatment due to lack of insurance and fragmentation of care between different physicians and hospitals. Some have also suggested that unfavorable US performance is explained by higher risk of iatrogenic disease, drug toxicity, hospital-acquired infection, and a cultural preference to “do more,” with a bias toward new technology, for which risks are understated and benefits are unknown. However, the breadth and consistency of the US underperformance across disease categories suggests that the United States pays a penalty for its extreme fragmentation, financial incentives that favor procedures over comprehensive longitudinal care, and absence of organizational strategy at the individual system level.

 

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Neil Irwin · January 7