nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, July 1, 2010

Breaking The Code On Why The Commonwealth Fund Ranks US Health Care Last

The new report from the Commonwealth Fund contains no objective data, just opinions from surveys.

Last week I wrote briefly about the Commonwealth Fund's new report on health care quality in seven nations (US, Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom), ranking the US last overall.

At the time I had only scanned secondary reports, and could comment only on my previous experience of these comparison studies and their faulty methodologies.

I've had a chance to look more closely at the report and can provide some feedback.

But first, let me ask you something.  Do these scathing attacks on US health care really pass the common sense test for you?  We know that people stream to the US for care (recall the press accounts of the Canadian provincial governor who came to the US for his cardiac surgery).  We know that the US accounts for almost 90%  of all medical advances in research, equipment, testing, and procedures.   Many of the most beneficial new treatments take years to get to other countries, the delay sometimes just a matter of slow adaptation to breakthrough therapies...but also, sometimes the delay is an intentional denial of care if it's expensive and their governmental systems don't want to fund it (until forced to by public outcry). 

Some new US products and advances are not a substantial improvement.  That's a legitimate criticism and something we have to work on through public transparency of medical information, and doctors continuing to assess what works best.

But many of those advances the US develops are breakthroughs in care.  Diseases, particularly some cancers, are now treatable, and curable, that were hopeless only a few decades ago, largely due to American science.

By contrast, when we read about other countries' health care systems, we see long waiting times, policy decisions to deny care based on money, and substandard quality with cancer survival and cure rates that don't come near ours..  Remember Michael Moore's movie called Sicko, where he praised Cuban universal care?  Just last year over two dozen Cuban hospital patients died of hypothermia in one their hospitals--a credible story because the source was the Cuban government, who was investigating the tragedy.

So, something's not right. 

Either, (1) these other countries cook the data--as I've demonstrated in the past on the question of longevity and infant mortality, by including death rates that have nothing to do with health care delivery (like auto accident rates) or by defining some post-natal deaths as having not come from a "live" birth (ie, not "live" even though moving and breathing if under 24 weeks, or less than 30cm long, etc). 

Or, (2) the advocacy groups that do these studies ranking US health care poorly are disingenuous, and falsely critical in order to force their own vision of how America should be on the rest of us.  I've heard people accuse these groups of "hating" their own country.  I can see how they would think that, but I disagree.  I think humans have blind spots in how we form beliefs, and conform our thinking to meet those beliefs.  There are a number of popular science works on human cognition that show we tend to maintain our assumptions and beliefs in the face of contradictory data, rather than modifying our belief.

Putting this together, what's not right is...both of the above.  Advocates selectively analyze data to support their position, and other countries naturally try to make themselves look good. 

Very odd.  They try to look better and we try to look worse.

Back to the Commonwealth Fund's assessment of US health care.  It turns out they collected NO data on actual objective measures based on statistics of any kind.  It was all surveys of "perceptions" of care by patients and doctors (instead of infection rates, re-admission rates, etc)

That explains it.  Ask any trial lawyer about how people see, remember, and report something they witness.  Notoriously, no two people describe things the same.  Surveys of quality are subject to so many confounding factors I can't list them all (you thought care was poor because the doctor's waiting room was full, etc).

So, we can basically throw out the Commonwealth Fund's efforts;  in one part of the summary they claim that the problems they identify will be largely improved by ObamaCare.  So, I get it. 

My assessment is, those other countries who rate themselves higher, have great health care systems, unless you're sick.

Doc D

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