Health Outcomes vs. Health Care
By Arnold Kling
A New York Times story says,
Americans 55 and over are much sicker than their British counterparts even though the United States spends more than twice as much per person on health care as Britain, researchers said Tuesday.
…The researchers wrote that “health insurance cannot be the central reason for the better health outcomes in England because the top socioeconomic-status tier of the U.S. population have close to universal access but their health outcomes are often worse than those of their English counterparts.”
…the study found that “differences in socioeconomic groups between the two countries were so great that those in the top education and income level in the U.S. had similar rates of diabetes and heart disease as those in the bottom education and income level in England.”
I have not seen the study, so I cannot say how well they controlled for reverse causation. Someone could be equally sick in two countries but not know it in a country with less medical care.
But I find the results plausible. Most of the determinants of health outcomes are not related to health care spending.
As W. Edwards Deming pointed out, it is easier to remove defects early in a process than to “inspect quality in.” Suppose you design an automobile, then design the assembly line to build the automobile, then build the automobiles, and finally inspect the automobiles for defects. If you wait until the final step to do quality control, you will have a very expensive QC process. If instead you design the automobile in a way that fosters low-defect assembly, you get better quality at lower cost.
Think of the analogy with health.
One argument about U.S. health care spending is the argument that, “Hey, it’s great that we spend a lot of our GDP on health care. That’s a good thing.”
That’s like saying, “It’s great that we spend a lot of money on inspecting cars as they come off the line and fixing defects. That’s a good thing.”