The popular perception that the U.S. has the highest quality of medical care in the world has been proven entirely false by several public heath studies and reports over the past few years.
The prestigious Journal of the American Medical Association published a study by Dr. Barbara Starfield, a medical doctor with a Master’s degree in Public Health, in 2000 which revealed the extremely poor performance of the United States health care system when compared to other industrialized countries (Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium and Germany).
In fact, the U.S. is ranked last or near last in several significant health care indicators:
- 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)
- 12th for life expectancy at 1 year for males, 11th for females
- 12th for life expectancy at 15 years for males, 10th for females
The most shocking revelation of her report is that iatrogentic damage (defined as a state of ill health or adverse effect resulting from medical treatment) is the third leading cause of death in the U.S., after heart disease and cancer.
Let me pause while you take that in.
The combined effect of errors and adverse effects that occur because of iatrogenic damage includes:
- 12,000 deaths/year from unnecessary surgery
- 7,000 deaths/year from medication errors in hospitals
- 20,000 deaths/year from other errors in hospitals
- 80,000 deaths/year from nosocomial infections in hospitals
- 106,000 deaths a year from nonerror, adverse effects of medications
This amounts to a total of 225,000 deaths per year from iatrogenic causes. However, Starfield notes three important caveats in her study:
- Most of the data are derived from studies in hospitalized patients
- The estimates are for deaths only and do not include adverse effects associated with disability or discomfort
- The estimates of death due to error are lower than those in the Institute of Medicine Report (a previous report by the Institute of Medicine on the number of iatrogenic deaths in the U.S.)
If these caveats are considered, the deaths due to iatrogenic causes would range from 230,000 to 284,000.
Starfield and her colleagues performed an analysis which took the caveats above into consideration and included adverse effects other than death. Their analysis concluded that between 4% and 18% of consecutive patients experience adverse 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 (equivalent to the aggregate cost of care of patients with diabetes
The Institute of Medicine’s report (“To Err is Human”) which Starfied and her colleagues analyzed isn’t the only study to expose the failures of the U.S. health-care system. The World Health Organization issued a report in 2000, using different indicators than the IOM report, that ranked the U.S. as 15th among 25 industrialized countries.
As Starfied points out, the “real explanation for relatively poor health in the United States is undoubtedly complex and multifactorial.” Two significant causes of our poor standing is over-reliance on technology and a poorly developed primary care infrastructure. The United States is second only to Japan in the availability of technological procedures such as MRIs and CAT scans. However, this has not translated into a higher standard of care, and in fact may be linked to the “cascade effect” where diagnostic procedures lead to more treatment (which as we have seen can lead to more deaths).
Of the 7 countries in the top of the average health ranking, 5 have strong primary care infrastructures. Evidence indicates that the major benefit of health-care access accrues only when it facilitates receipt of primary care. (Starfield, 1998)
One might think that these sobering analyses of the U.S. health-care system would have lead to a public discussion and debate over how to address the shortcomings. Alas, both medical authorities and the general public alike are mostly unaware of this data, and we are no closer to a safe, accessible and effective health-care system today than we were eight years ago when these reports were published.