HEALTH CARE OUTCOMES
Though there are numerous health care outcomes that can be compared and analyzed, we have chosen to focus on the health care outcomes that are viewed as the most accurate indicators of the effectiveness of a country's health care system:
Infant Mortality
As can be seen in the graphic above, the United States has a higher infant mortality rate (IMR) than many comparable Western countries. IMR is a useful indicator of a country's level of health and development.
The high IMR is a reflection of two main failures in the US health care system:
- It costs approximately $14,000 to deliver a baby and pay for prenatal care
- A woman is expected to foot the bill for the costs associated with her pregnancy, unless she has insurance (personal or employer-based) or has a low enough income to qualify for Medicaid
- The average annual cost of individual health insurance is $4,242
Access:
- Health care in the United States is treated as a privilege and not a right. Women do not have access to necessary health care unless they can afford it
- In all of the other six OECD countries above, prenatal care is comprehensive, accessible, and either free or accompanied by financial assistance. Pregnant women are not excluded from prenatal care based on insurance status or income. Public prenatal clinics often coordinate maternity services and prenatal care for women
- None of the other six countries above have a significant percentage of uninsured women of childbearing age
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Other related areas in which United States does not fare well are:
- Percent of low-birth-weight infants
- Maternal mortality rates
- Percent of births delivered by cesarean section
- Preventive services (rates of pediatric immunization, high-risk pregnancy outreach, duration of maternity leave, and level of maternity financial support)
Mortality Amenable to Health Care
Although the United States spends the highest percentage of GDP on healthcare per year, our mortality amenable to healthcare - that is, the deaths before age 75 that are preventable with timely and appropriate medical care - is the highest compared to all other OECD countries.
In 1997-1998, mortality amenable to health care in 19 OECD countries accounted for 23% of total mortality for males and 32% among females. Between 1997/98 and 2002/03, the amenable mortality declined in all countries by an average of 16%. The United States was an outlier, with a decline of only 4 percent. If the United States could reduce amenable mortality to the average rate achieved in the three top-performing countries (France, Japan, and Australia), there would have been 101,000 fewer deaths per year.
The reason that mortality amenable to health care is important is because it reflects the number of deaths within a country that could have been prevented with adequate health care and/or medication. The standards (i.e. which conditions are considered treatable) do not change across industrialized countries.
Life Expectancy
Though the United States has by far the highest level of health care spending per capita in the world, we have one of the lowest life expectancies among developed nations (see graph below). Our life expectancy is lower than Italy, Spain and Cuba, and it is only slightly higher than the life expectancy of Chile, Costa Rica and Slovenia.
Life expectancy is affected by a number of factors, including the effectiveness of the health care system. There is a growing disparity in life expectancy between individuals with high and low income:
- In 1980, life expectancy at birth was 2.8 years more for the highest socioeconomic group than for the lowest6
- By 2000, that gap had risen to 4.5 years
6 See Gopal K. Singh and Mohammad Siahpush, "Widening Socioeconomic Inequalities in U.S. Life Expectancy, 1980-2000,"International Journal of Epidemiology, vol. 35, no. 4 (2006), pp. 969-979. Socioeconomic groups are defined using county-level indicators of education, occupation, unemployment, wealth, income, and housing conditions.