Friday, May 25, 2012

Why Life Expectancy Is a Faulty Health Care Quality Indicator

I was playing around with OECD data from its Better Life Index. My attention was brought to the Health indicator, which had two sub-indicators: life expectancy and self-reported health, the latter of which is a citizen-based perception index. Like with any other perception indexes, my main criticism is that they do not measure actuality. Although perception indexes have their roles, they do not automatically measure in an accurate fashion, which is why I will bring my attention to life expectancy. If we were to use life expectancy as the sole qualifier of health care quality, OECD data would rank American health care 27th out of the 36 countries measured. Considering that "the greatest nation in the world" has a life expectancy below the OECD average, it demands pondering. If a given country were to claim to have superior health care, then it should be able to keep its citizens alive longer. With that logic, American health care would have to be deemed inferior. If that were the case, I would be ashamed to receive American health care. Per contra, as indicated by the divergence of the OECD's self-reported health indicator that would rank America as first in health care quality, everything may not be what it seems.

In order to figure out what is taking place, we need to ask ourselves what factors play into the average life expectancy. We have to ask ourselves the question of "how do people die?" This question is important because it helps determine causal mechanisms for a given life expectancy. A look at CDC data provides further insight (See Tables on p. 31 and 43 with preliminary 2010 data, as well as detailed tables from 2009 data). Let's take a look at some of the larger contributors to mortality in America.  

OECD data for mortality rates can provide reasoning for the life expectancy gap, especially when the United States has a higher mortality rate per 100,000 for enough causes of death to make an impact. Here are some things to consider. Except for Denmark and Hungary, the rate of malignant neoplasms for the lung (i.e., lung cancer) for the United States is highest amongst OECD countries. The United States also has a high incident rate for diabetes, which is another sizable killer in America. Another significant factor of the life expectancy gap is obesity. The OECD published a study in 2010 on obesity and showed that amongst the OECD countries, the United States has the highest rate of obesity, which means Americans are more prone to health care problems. The CDC points out that one in five deaths in America are caused by smoking. Note how they didn't blame it on the ineptness of the health care system, but the conscious choice that Americans make when they choose to smoke. Alcohol causes about another 40,000 American deaths per annum. Although other diseases can be looked at, the point I want to illustrate here is that a good amount of health care issues are based on one's lifestyle. If one has a poor diet, doesn't really exercise, drinks heavily, or smokes cigarettes, they increase their risk of being exposed to fatal diseases. Having some or all of these behaviors is overall more prevalent in America than it is in other countries. Such lifestyle decisions decrease life expectancy and do not have influence on the quality of health care.

It's not simply a matter of people making poor health choices. The number one cause of accidental deaths in America are transport-based (e.g., car accident or plane crash). According to World Health Organization (WHO) data (Table A.2 in the Appendix section), America's estimated road traffic death rate per 100,000 population is 13.9. This number exceeds that of many of the other OECD countries whose road traffic death rate is well in the single-digits realm. Homicides are another example. The UN Office on Drugs and Crime (UNODC) published a study on homicide rates (Table 8.1). The OECD data also confirm the UNODC data. The United States has a homicide rate higher than most other OECD countries. Countries such as Russia, Mexico, and Brazil all have higher homicide rates, and also have a lower average life expectancy. Both accidental deaths and homicides are external forces that have nothing to do with health care quality.

A study done by Drs. June and David O'Neill looks at the life expectancy disparity between the United States and Canada. What they found is that America's health care quality can hardly explain this disparity. The point I have been conveying here is that life expectancy reflects a myriad of factors that have nothing to do with health care quality, including, but not limited to culture, dietary trends, genetics, the aforementioned external forces of accidents and homicides, lifestyle, and level of education. To take these factors into consideration would decrease the gap to the extent where it would not cause such criticism of the American health care system.

Furthermore, there are better health care quality indicators than life expectancy. How about cancer survival rates? Can we look at the waiting time for certain procedures to see if expediency plays a role in better health care? How responsive are doctors and/or medicine being? How important is the quality of preventative care? Are certain external factors, such as government regulations, impeding doctors from providing sufficient health care? If the patient-to-doctor ratio is high, how does that affect availability or quality? How important is the progress of the medical technology, and would a higher price tag for that technology be worthwhile, even if it causes some disparities in terms of access? Is there a way to measure accountability of the system? Is there a way to have indicators to be consistent across borders so that health care quality can be accurately compared on an international level? In our quest for determining a framework for what constitutes quality health care, such questions are important to answer. Using life expectancy to determine such quality, however, is not.

No comments:

Post a Comment