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Is US Health Really the Best in the World?

The Journal of the American Medical Association (JAMA) published in July 2000 possibly the best article in the published literature concerning the deficiencies of the traditional medicine as it is practiced in the U.S.

The author was Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health. Her article and key data are summarized below. A reprint of her entire article in PDF format with full references is available here.

INFORMATION CONCERNING THE DEFICIENCIES OF US MEDICAL CARE HAS BEEN ACCUMULATING. The fact that more than 40 million people have no health insurance is well known. The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care.

The fact is that the US population does not have anywhere near the best health in the world. Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. Countries in order of their average ranking on the health indicators (with the first being the best) are Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the United States, and Germany. Rankings of the United States on the separate indicators are:

• 13th (last) for low-birth-weight percentages
• 13th for neonatal mortality and infant mortality overall
• 11th for postneonatal mortality
• 13th for years of potential life lost (excluding external causes)
• 11th for life expectancy at 1 year for females, 12th for males
• 10th for life expectancy at 15 years for females, 12th for males
• 10thfor lifeexpectancyat40yearsfor females,9thformales
• 7th for life expectancy at 65 years for females, 7th for males
• 3rd for life expectancy at 80 years for females, 3rd for males
• 10th for age-adjusted mortality

Also, U.S. health care has about 250,000 iatrogenic (physician caused) deaths per year which makes it the third leading cause of death in the U.S. behind heart disease and cancer:


* 12,000 -- unnecessary surgery

* 7,000 -- medication errors in hospitals

* 20,000 -- other errors in hospitals

* 80,000 -- infections in hospitals

* 106,000 -- non-error, negative effects of drugs

Another analysis concluded that between 4% and 18% of consecutive patients experience negative effects in outpatient settings,with:

* 116 million extra physician visits

* 77 million extra prescriptions

* 17 million emergency department visits

* 8 million hospitalizations

* 3 million long-term admissions

* 199,000 additional deaths

* $77 billion in extra costs

The poor performance of the US was recently confirmed by a World Health Organization study, which used different data and ranked the United States as 15th among 25 industrialized countries.

There is a perception that the American public "behaves badly" by smoking, drinking, and perpetrating violence." However the data does not support this assertion:

* The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range is from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best).
* The US ranks fifth best for alcoholic beverage consumption.
* The US has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.

Lack of technology is certainly not a contributing factor to the US's low ranking:

* Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population.
* Japan, however, ranks highest on health, whereas the US ranks among the lowest.
* It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the US, high use of diagnostic technology may be linked to more treatment.
* Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among the countries ranked, whereas they are very low in Japan, far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.



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