A couple of comments about the Commonwealth Fund’s new report (PDF) that gave the U.S. a failing grade for its health care system.
First, here are four different stories (1, 2, 3, and 4) about the report. Can you find a single comment in any of them critical of the report? I can’t. Talk about bias. I guess it is just axiomatic among the press that the health care system in the U.S. is terrible.
So let me provide a bit of balance. When comparing our health care system to other nations, the Commonwealth Fund relies on infant mortality and preventable mortality. Infant mortality is measured too inconsistently across nations for it to be a reliable indicator of a health care system (see my writing on that here.) Preventable mortality is based on a measure called “amenable mortality” which includes “deaths before age 75 from diseases or conditions that are preventable or treatable with timely, effective medial care.” The measure comes from a 2003 article in the British Medical Journal. But unlike the folks at Commonwealth, the authors of the article were far more sanguine about the limits of that measure. They state that
amenable mortality has itself some limitations. The diagnostic categories and the age range used involve some choices that are inevitably arbitrary. A major limitation is that, for many conditions, death is the final event in a complex chain of processes that involve issues related to underlying social and economic factors, lifestyles, and preventive and curative health care. Partitioning deaths among the categories is an inexact science. The example of ischaemic heart disease is instructive. Accumulating evidence suggests that advances in health care have contributed to the fall in mortality from ischaemic heart disease in many countries, yet it is equally clear that large international differences in mortality are caused primarily by factors outside the healthcare sector.
In other words, preventable mortality is affected by many factors not related to a health care system, making it a pretty crude measure.
Finally, I’d note that many health statistics are collected inconsistently across nations, making international comparisons difficult if not impossible. The Commonwealth Fund itself has a cooperative project with the OECD that is trying to come up with better measures. Its initial report is here (PDF) and it lists the measures it is focusing on right now on page five. There are quite a few measures, but infant mortality and preventable mortality aren’t among them.
I’ll end with the following question: why did the Commonwealth Fund use measures in its report on the U.S. health care system that it did not use in its project on quality indicators?