Inefficiency Hurts U.S. In Ranking of Health Nicholas Bakalar New York Times November 29,

Life Expectancy By any measure, the United States spends more on health care than any other nation. Yet according to the World Fact Book (published by the Central Intelligence Agency), it ranks 49th in life expectancy. World Fact BookCentral Intelligence Agency Why? Researchers writing in the November issue of the journal Health Affairs say they know the answer. After citing statistical evidence showing that American patterns of obesity, smoking, traffic accidents and homicide are not the cause of lower life expectancy, they conclude that the problem is the health care system. Health Affairs

Comparison Peter A. Muennig and Sherry A. Gleid compared the performance of the United States and 12 other industrialized nations: Australia, Austria, Belgium, Britain, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden and Switzerland. In addition to health care expenditures in each country, they focused on two other important statistics: 15-year survival for people at 45 years and for those at 65 years.

Major Analysis In 1975 the US was “close to the average” in health care costs, and last in 15-year survival for 45-year-old men. By 2005 its costs had more than tripled, far surpassing increases elsewhere, but the survival number was still last — a little over 90%, compared with more than 94% for Swedes, Swiss and Australians. For women, it was 94% in the United States, versus 97% in Switzerland, Australia and Japan.

Look at inverse of slope. Why?

Basic Method The researchers first eliminated several other factors. Obesity and smoking are the most important behavior-related causes of death, but obesity increased more slowly in the United States than in the other countries and smoking declined more rapidly, so neither can explain the differences in survival rates. Homicide and traffic fatality rates have remained steady over time, and social, economic and educational factors do not vary greatly among these countries.

Controlling for Race

Not without criticism Samuel Preston: They “have no direct evidence about the health care system in this article,” he continued. “Their conclusion is extremely speculative.” Muennig responds: “Smoking and obesity are still major risk factors for an individual’s health,” he said. “But they are sapping life expectancy in all countries. Whereas in the U.S. we have a highly inefficient health system that’s taking away financial resources from other lifesaving programs.”