Purpose: To analyse how effective was the USA, compared to Other Western Countries (OWC) in reducing premature deaths 1989-2015.
Design: This population-based study is a cost-effective model of fiscal input into health related to clinical outputs, recognising socio-economic factors influence health outcomes. Using World Bank data for total % GDP-Expenditure-on-Health, and, WHO data for Child (0-4), Adult (55-74) and Age-Standardised-Death-Rates rates per million America is compared with OWC. Cost-Effective Ratios (CEF) are calculated and Confidence Intervals (95%) tests USA against each OWC. `Excess’ deaths are calculated between the most and least expensive health systems.
Setting: Twenty Other Western countries.
Patients: National populations.
Outcomes: USA highest current total %GDPEH 16.8% and highest average of 12.7% and UK lowest 7.1% over period.
USA Child (0-4) highest at 1249pm, OWC averaged 803pm. Fourteen countries had significantly bigger reductions than America.
USA Adult (55-74) mortality was highest at 12,554pm, OWC averaged 9,835pm. Fourteen countries had significantly bigger reductions than USA.
Excess Deaths: America failed to match UK total mortality rates yielding 488,273 excess deaths, of which 12,613 were children.
Cost-Effectiveness-Ratio: America had smallest CER 1:113, OWC averaged 1:270, an USA to OWC ratio of 1:239. UK CER was 1:323 producing a USA: UK ratio of 1:2.86.
Conclusion: America’s health system more expensive as Britain’s and significantly less effective than most OWC. The USA needs to change its socio-economic political mind set’ if it is to match the Neighbourhood National Health Service’.
Keymessages: Implications for Policy makers: 1. policy makers in the USA need to re-think their present configuration and funding of their health services.
2. should confront the question, can any nation continue spend 17.1% GDP on health bearing in mind the challenges posed by longevity, yet still have the poorest clinical outcomes of the 21 Western nations. Whilst at the same time the richest nation on earth has the widest relative poverty in the West.
3. examine the findings of the USA `excess deaths’, compared to the lowest- health funded country, the UK and challenge politicians to be less doctrinaire and react to the evidence.
4. recognising that the USA is a continent with incredible social variation, they need to think outside the box and reject isolationist stereotypical thinking, otherwise the inconsistencies in the USA will worsen and possibly destabilise.
Implication for General Public: 1. Democracy works best when citizens are well informed. This research shows the American public that compared to the rest of the Western world, despite USA health expenditure being the most costliest in the world they have the highest rate of child (0-4) and adult (55-74) mortality amongst Western countries - thus the American health care system is both relatively inefficient and ineffective and such results points the need for change.
2. A system based upon the American tradition of `neighbourliness’ could develop a reciprocal health care system which would ensure that the monies reach the patient at the point of need, and not be lost in the uneconomic profit-making insurance health model.
3. These evidenced-based recommendations could benefit the people of America significantly by reducing health costs, get a better return on money invested in health care, be more equitable, inclusive and contribute to a more cohesive society.
Published on: Feb 12, 2019 Pages: 15-23
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