15 August 2009

Under 5 mortality rates

There are various ways of measuring the performance of a country's healthcare services. One good one is the under 5 mortality rate. There is not much argument about it. If you are dead you are dead. The data are unambiguous.

In the US they spend 16% of their GDP on healthcare. In England we spend just 8.3%. You cannot expect to get as good results if you spend half the amount. So, with that warning preamble, what are the under 5 mortality rates for the US and for England? The answer is that out of every 1000 live births in the United States there will be 9 deaths before the age of 5. In England out of every 1000 live births just 6 children will die before the age of 5.

It has been alleged that in England we do not look after the elderly or disabled. So how long do we in England live compared with the average American? The answer is that in the US your life expectancy is 77 and in England it is 78. Not bad given that we spend relatively so little.


subrosa said...

I did some research today about GDP and European countries. The figures I got for UK were just short of 10% on healthcare with Germany being similar.

My comparisons were with Europe rather than the US which has a completely different system compared with European countries. ie healthcare is mainly provided through employers in the US.

Dr Grumble said...

Of course spending in the UK has gone up recently. To be fair you need the spending in the same year as the other relevant figures which is not straightforward at all. The Grumble data comes from a table in the paper version of yesterday's Guardian. I could not find the same table online. I think the message is essentially correct.

Of course there are all sorts of problems with such comparisons. Death rates from many diseases do not have much to do with healthcare. And even the Guardian, in another article, failed to explain why Americans live so much longer with prostate cancer. They semed to accept this as a major failing of the NHS which is not necessarily at all the case. (For those that don't know the main reason is that in America you tend to get on the train at an earlier station (or lead time bias to give it the proper terminology).

Michael said...

Slightly dated, but in 2005, according to the WHO, this was the per capita spend by the government on healthcare:

United Kingdom $2261.0
United States of America $2862.0

Even with only 25% of Americans covered by government healthcare they are spending more tax dollars per person than we are.

Anyone who ever claims the NHS is inefficient just needs to see those figures.

Michael said...

Here's some padding on the above numbers:


Andy Cowper said...

The quality and insight of the non-debate about comarisons between the NHS and US healthcare has been very disappointing. Nick Timmins' commentary in the FT makes most of the salient points.

Dr Grumble said...

Thanks Andy. Agreed the FT article is better than most but these comparisons are difficult.

Even the FT implies that the fact that the UK has a lower dialysis rate for kidney disease than the US must mean that care in the US is better but it has been claimed that for-profit dialysis results in unnecessary treatment and racial differences are said to account for 50% of the difference. And, interestingly, it has also been claimed (supported by data) that mortality is worse in private for-profit centers.

Of course the attack on the NHS is ludicrous as an NHS-like system is not even being considered. I don't think it would even be possible given their starting point which is quite different from ours 40 years ago.

TomTom said...

Highest cause of death among black males <30 is gunshot wounds followed by HIV. If you restrict your death rates to natural causes you get a different result.

Further if you standardise the figures to exclude illegals and look at it state-by-state you will find infant mortality higher in Southern States among blacks than average; and probably higher among single mothers.

Why such criteria are used to make the English feel smug about the NHS beats me. It is vastly under-resourced in terms of specialist consultants and has terrible delays in diagnosing cancers, and has failed to fund properly in cities with high proportion of ethnic groups utilising health care disproportionately and resultant long lead times for diagnostic investigations.

Britain rations health care by letting men die before their cancers are treated; and by deliberately delaying investigation of cancers so as to to have a waiting list for treatments.

The British are smug and complacent with over-priced private health care in both dentistry and medicine; and have turned the NHS into a MASH unit leaving many people to a miserable existence with death as a release

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