[stosh]

I say an Ortho a couple of years back and they gave me a brace for my wrist. Later I got a bill from my Ins co for $20. I could have gotten the brace at Walgreen's for $17.95. The Ortho billed the Ins co $100 for the brace.

Nice!!!

Only Pvssys wear braces anyway.



j/k

 

[Toshi]

Healthcare overall WHO:

the WHO statistics are actually very interesting to browse. unfortunately, as you have failed to grasp, health care and outcomes cannot be reduced to a single variable and plotted nicely in terms of being #1, #2, etc.

here's the site where you can query their database:

http://www.who.int/whosis/database/core/core_select.cfm

furthermore, note that inequality (or equality) of outcomes does not necessarily imply lack of equivalent care, as the people of each country have fundamentally different lifestyles, access to care, etc. for example, americans being fat DOES have effects on health outcomes. who would have thought?



here are some outcomes between a few countries that i just queried up:

Healthy life expectancy (HALE) at birth (years) males ?
Country Value Latest Year
Canada 70.0 2002
China 63.0 2002
France 69.0 2002
Germany 70.0 2002
India 53.0 2002
Japan 72.0 2002
Mexico 63.0 2002
New Zealand 69.0 2002
United Kingdom 69.0 2002
United States of America 67.0 2002
Healthy life expectancy (HALE) at birth (years) females ?
Country Value Latest Year
Canada 74.0 2002
China 65.0 2002
France 75.0 2002
Germany 74.0 2002
India 54.0 2002
Japan 78.0 2002
Mexico 68.0 2002
New Zealand 72.0 2002
United Kingdom 72.0 2002
United States of America 71.0 2002

Probability of dying (per 1 000 population) between 15 and 60 years (adult mortality rate) males ?
Country Value Latest Year
Canada 90 2005
China 155 2005
France 128 2005
Germany 110 2005
India 280 2005
Japan 92 2005
Mexico 162 2005
New Zealand 92 2005
United Kingdom 101 2005
United States of America 137 2005
Probability of dying (per 1 000 population) between 15 and 60 years (adult mortality rate) females ?
Country Value Latest Year
Canada 56 2005
China 98 2005
France 58 2005
Germany 57 2005
India 207 2005
Japan 45 2005
Mexico 94 2005
New Zealand 61 2005
United Kingdom 62 2005
United States of America 81 2005

Probability of dying (per 1 000 live births) under five years of age (under-5 mortality rate) ?
Country Value Latest Year
Canada 6 2005
China 27 2005
France 5 2005
Germany 5 2005
India 74 2005
Japan 4 2005
Mexico 27 2005
New Zealand 6 2005
United Kingdom 6 2005
United States of America 8 2005
Infant mortality rate (per 1 000 live births) ?
Country Value Latest Year
Canada 5.0 2005
China 23.0 2005
France 4.0 2005
Germany 4.0 2005
India 56.0 2005
Japan 3.0 2005
Mexico 22.0 2005
New Zealand 5.0 2005
United Kingdom 5.0 2005
United States of America 7.0 2005
Neonatal mortality rate (per 1 000 live births) ?
Country Value Latest Year
Canada 3 2004
China 18 2004
France 2 2004
Germany 3 2004
India 39 2004
Japan 1 2004
Mexico 11 2004
New Zealand 3 2004
United Kingdom 3 2004
United States of America 4 2004
Maternal mortality ratio (per 100 000 live births) ?
Country Value Latest Year
Canada 5 2000
China 56 2000
France 17 2000
Germany 9 2000
India 540 2000
Japan 10 2000
Mexico 83 2000
New Zealand 7 2000
United Kingdom 11 2000
United States of America 14 2000

Age-standardized mortality rate for non-communicable diseases (per 100 000 population) ?
Country Value Latest Year
Canada 388.0 2002
China 665.0 2002
France 368.0 2002
Germany 444.0 2002
India 750.0 2002
Japan 287.0 2002
Mexico 503.0 2002
New Zealand 423.0 2002
United Kingdom 434.0 2002
United States of America 460.0 2002
Age-standardized mortality rate for cardiovascular diseases (per 100 000 population) ?
Country Value Latest Year
Canada 141.0 2002
China 291.0 2002
France 118.0 2002
Germany 211.0 2002
India 428.0 2002
Japan 106.0 2002
Mexico 163.0 2002
New Zealand 175.0 2002
United Kingdom 182.0 2002
United States of America 188.0 2002
Age-standardized mortality rate for cancer (per 100 000 population) ?
Country Value Latest Year
Canada 138.0 2002
China 148.0 2002
France 142.0 2002
Germany 141.0 2002
India 109.0 2002
Japan 119.0 2002
Mexico 88.0 2002
New Zealand 139.0 2002
United Kingdom 143.0 2002
United States of America 134.0 2002
Age-standardized mortality rate for injuries (per 100 000 population) ?
Country Value Latest Year
Canada 34.0 2002
China 79.0 2002
France 48.0 2002
Germany 29.0 2002
India 117.0 2002
Japan 39.0 2002
Mexico 58.0 2002
New Zealand 37.0 2002
United Kingdom 26.0 2002
United States of America 47.0 2002

of interest to the parents and prospective parents:

Deaths among children under five years of age due to neonatal causes (%) ?
Country Value Latest Year
Canada 58.5 2000
China 49.2 2000
France 52.6 2000
Germany 50.7 2000
India 45.2 2000
Japan 40.0 2000
Mexico 52.5 2000
New Zealand 48.3 2000
United Kingdom 59.1 2000
United States of America 56.9 2000

HIV prevalence among adults aged 15+ years (per 100 000 population) ?
Country Value Latest Year
Canada 222 2005
China 62 2005
France 263 2005
Germany 69 2005
India 747 2005
Japan <100 2005
Mexico 244 2005
New Zealand <100 2005
United Kingdom 137 2005
United States of America 508 2005

lest people think that stosh's story about unattended births is commonplace:

Births attended by skilled health personnel (%) ?
Country Value Latest Year
Canada 100.0 2004
China 83.0 2004
Germany 100.0 2006
India 48.0 2006
Japan 100.0 2004
Mexico 93.0 2003
New Zealand 97.0 2001
United Kingdom 99.0 1998
United States of America 99.0 2003

americans are fat:

Prevalence of adults (15 years and older) who are obese (%) males ?
Country Value Latest Year
Canada 15.9 2003
China 2.4 2002
Germany 13.6 2003
India 0.3 1998
Japan 2.9 2001
Mexico 18.6 2000
New Zealand 21.9 2003
United States of America 31.1 2004
Prevalence of adults (15 years and older) who are obese (%) females ?
Country Value Latest Year
Canada 13.9 2003
China 3.4 2002
Germany 12.3 2003
India 0.6 1998
Japan 3.3 2001
Mexico 28.1 2000
New Zealand 23.2 2003
United States of America 33.2 2004

countries vary widely in the number of doctors and nurses per capita:

Physicians (density per 1 000 population) ?
Country Value Latest Year
Canada 2.14 2003
China 1.06 2001
France 3.37 2004
Germany 3.37 2003
India 0.60 2004
Japan 1.98 2002
Mexico 1.98 2000
New Zealand 2.37 2001
United Kingdom 2.30 1997
United States of America 2.56 2000
Nurses (density per 1 000 population) ?
Country Value Latest Year
Canada 9.95 2003
China 1.05 2001
France 7.24 2004
Germany 9.72 2003
India 0.80 2004
Japan 7.79 2002
Mexico 0.90 2000
New Zealand 8.16 2001
United Kingdom 12.12 1997
United States of America 9.37 2000

here's how much we spend, and part of the reason why we spend so much (note that we have WAY more management and ancillary personnel than other countries):

Health management and support workers (density per 1 000 population) ?
Country Value Latest Year
China 0.83 2001
Mexico 4.17 2000
United Kingdom 12.77 1997
United States of America 24.76 2000
Total expenditure on health as percentage of gross domestic product ?
Country Value Latest Year
Canada 9.8 2004
China 4.7 2004
France 10.5 2004
Germany 10.6 2004
India 5.0 2004
Japan 7.8 2004
Mexico 6.5 2004
New Zealand 8.4 2004
United Kingdom 8.1 2004
United States of America 15.4 2004
Out-of-pocket expenditure as percentage of private expenditure on health ?
Country Value Latest Year
Canada 49.40 2004
China 86.50 2004
France 34.90 2004
Germany 57.50 2004
India 93.80 2004
Japan 94.90 2004
Mexico 94.40 2004
New Zealand 76.10 2004
United Kingdom 91.80 2004
United States of America 23.80 2004
Per capita total expenditure on health at average exchange rate (US$) ?
Country Value Latest Year
Canada 3037.6 2004
China 70.1 2004
France 3464.0 2004
Germany 3521.4 2004
India 31.4 2004
Japan 2823.2 2004
Mexico 424.3 2004
New Zealand 2039.6 2004
United Kingdom 2899.7 2004
United States of America 6096.2 2004
Per capita government expenditure on health at average exchange rate (US$) ?
Country Value Latest Year
Canada 2120.9 2004
China 26.6 2004
France 2714.6 2004
Germany 2709.1 2004
India 5.4 2004
Japan 2295.2 2004
Mexico 196.8 2004
New Zealand 1577.8 2004
United Kingdom 2501.8 2004
United States of America 2724.7 2004

hospital bed count:

Hospital beds (per 10 000 population)
Country Value Latest Year
Canada 36.0 2003
China 22.0 2003
France 75.0 2004
Germany 84.0 2005
India 7.0 2002
Japan 129.0 2001
Mexico 10.0 2004
New Zealand 60.0 2002
United Kingdom 39.0 2004
United States of America 33.0 2003

finally, per capita income:

Gross national income per capita (PPP international $)
Country Value Latest Year
Canada 32220 2005
China 6600 2005
France 30540 2005
Germany 29210 2005
India 3460 2005
Japan 31410 2005
Mexico 10030 2005
New Zealand 23030 2005
United Kingdom 32690 2005
United States of America 41950 2005

 

[syadasti]

health care and outcomes cannot be reduced to a single variable and plotted nicely

The rankings released by WHO were based on:

WHO&#8217;s assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system&#8217;s financial burden within the population (who pays the costs).

Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. The reason these are all advanced industrial nations is that a number of the elements of responsiveness depend strongly on the availability of resources. In addition, many of these countries were the first to begin addressing the responsiveness of their health systems to people&#8217;s needs.

Fairness of financial contribution: When WHO measured the fairness of financial contribution to health systems, countries lined up differently. The measurement is based on the fraction of a household&#8217;s capacity to spend (income minus food expenditure) that goes on health care (including tax payments, social insurance, private insurance and out of pocket payments). Colombia was the top-rated country in this category, followed by Luxembourg, Belgium, Djibouti, Denmark, Ireland, Germany, Norway, Japan and Finland.

Colombia achieved top rank because someone with a low income might pay the equivalent of one dollar per year for health care, while a high- income individual pays 7.6 dollars.

Countries judged to have the least fair financing of health systems include Sierra Leone, Myanmar, Brazil, China, Viet Nam, Nepal, Russian Federation, Peru and Cambodia.

Brazil, a middle-income nation, ranks low in this table because its people make high out-of-pocket payments for health care. This means a substantial number of households pay a large fraction of their income (after paying for food) on health care. The same explanation applies to the fairness of financing Peru&#8217;s health system. The reason why the Russian Federation ranks low is most likely related to the impact of the economic crisis in the 1990s. This has severely reduced government spending on health and led to increased out-of-pocket payment.

In North America, Canada rates as the country with the fairest mechanism for health system finance &#8211; ranked at 17-19, while the United States is at 54-55. Cuba is the highest among Latin American and Caribbean nations at 23-25.

The report indicates &#8211; clearly &#8211; the attributes of a good health system in relation to the elements of the performance measure, given below.

Overall Level of Health: A good health system, above all, contributes to good health. To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability- adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations. The report provides estimates for all countries of disability- adjusted life expectancy. DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability- adjusted life expectancy is estimated to be less than 40 years. Many of these are countries characterised by major epidemics of HIV/AIDS, among other causes.

Distribution of Health in the Populations: It is not sufficient to protect or improve the average health of the population, if - at the same time - inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health. The health system also has the responsibility to try to reduce inequalities by prioritizing actions to improve the health of the worse-off, wherever these inequalities are caused by conditions amenable to intervention. The objective of good health is really twofold: the best attainable average level &#8211; goodness &#8211; and the smallest feasible differences among individuals and groups &#8211; fairness. A gain in either one of these, with no change in the other, constitutes an improvement.

Responsiveness: Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider).

Distribution of Financing: There are good and bad ways to raise the resources for a health system, but they are more or less good primarily as they affect how fairly the financial burden is shared. Fair financing, as the name suggests, is only concerned with distribution. It is not related to the total resource bill, nor to how the funds are used. The objectives of the health system do not include any particular level of total spending, either absolutely or relative to income. This is because, at all levels of spending there are other possible uses for the resources devoted to health. The level of funding to allocate to the health system is a social choice &#8211; with no correct answer. Nonetheless, the report suggests that countries spending less than around 60 dollars per person per year on health find that their populations are unable to access health services from an adequately performing health system.

In order to reflect these attributes, health systems have to carry out certain functions. They build human resources through investment and training, they deliver services, they finance all these activities. They act as the overall stewards of the resources and powers entrusted to them. In focusing on these few universal functions of health systems, the report provides evidence to assist policy-makers as they make choices to improve health system performance.

The doctors reduced to a single ranking:

WHO Director-General Dr Gro Harlem Brundtland says: "The main message from this report is that the health and well-being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved."

Dr Christopher Murray, Director of WHO&#8217;s Global Programme on Evidence for Health Policy. says: "Although significant progress has been achieved in past decades, virtually all countries are underutilizing the resources that are available to them. This leads to large numbers of preventable deaths and disabilities; unnecessary suffering, injustice, inequality and denial of an individual&#8217;s basic rights to health."

The impact of failures in health systems is most severe on the poor everywhere, who are driven deeper into poverty by lack of financial protection against ill- health, the report says.

"The poor are treated with less respect, given less choice of service providers and offered lower- quality amenities," says Dr Brundtland. "In trying to buy health from their own pockets, they pay and become poorer."

The World Health Report says the main failings of many health systems are:

* Many health ministries focus on the public sector and often disregard the frequently much larger private sector health care.
* In many countries, some if not most physicians work simultaneously for the public sector and in private practice. This means the public sector ends up subsidizing unofficial private practice.
* Many governments fail to prevent a "black market" in health, where widespread corruption, bribery, "moonlighting" and other illegal practices flourish. The black markets, which themselves are caused by malfunctioning health systems, and low income of health workers, further undermine those systems.
* Many health ministries fail to enforce regulations that they themselves have created or are supposed to implement in the public interest.

Dr Julio Frenk, Executive Director for Evidence and Information for Policy at WHO, says: "By providing a comparative guide to what works and what doesn&#8217;t work, we can help countries to learn from each other and thereby improve the performance of their health systems."

Dr Philip Musgrove, editor-in-chief of the report, says: "The WHO study finds that it isn&#8217;t just how much you invest in total, or where you put facilities geographically, that matters. It&#8217;s the balance among inputs that counts &#8211; for example, you have to have the right number of nurses per doctor."

Most of the lowest placed countries are in sub-Saharan Africa where life expectancies are low. HIV and AIDS are major causes of ill-health. Because of the AIDS epidemic, healthy life expectancy for babies born in 2000 in many of these nations has dropped to 40 years or less.

One key recommendation from the report is for countries to extend health insurance to as large a percentage of the population as possible. WHO says that it is better to make "pre-payments" on health care as much as possible, whether in the form of insurance, taxes or social security.

While private health expenses in industrial countries now average only some 25 percent because of universal health coverage (except in the United States, where it is 56%), in India, families typically pay 80 percent of their health care costs as "out-of- pocket" expenses when they receive health care.

"It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance," says Dr Frenk. "Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich."

"In many countries without a health insurance safety net, many families have to pay more than 100 percent of their income for health care when hit with sudden emergencies. In other words, illness forces them into debt."

In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country&#8217;s system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country&#8217;s system has accomplished in comparison with those of other countries.