Is US Life Expectancy As Bad As Commonly Reported?

A slightly modified version of a comment I posted on the NY Times Freakonomics blog, "Why Does the U.S Rank 29th in Longevity?" by Stephen Dubner.

Countries have different homicide death and accidental injury death rates, such as due to auto accidents. When these and other non-health care related death rates are standardized so meaningful comparisons for health care related deaths can be made, the US ranks number one in life expectancy. See published studies by University of Iowa, Robert L. Ohsfeldt and John E. Schneider.

Additionally, there are differences in the treatment of premature and newborns that die at or shortly after birth. The US is one of the most inclusive in the use of infant death statistics and this lowers its reported life expectancy statistics.

In addition, the OECD fact book where most of the comparative international health cost statistics come from has a warning at the beginning that the numbers are not comparable. For example, some countries include long-term health care and others do not.

Furthermore, although not mentioned in the fact book, different countries have different reporting times for gathering data. While the US data is the most current available, some countries are reporting data that is a year older than the US's data as the current year's data. When costs are rising as they are in healthcare, it means the other country's data is older than the US numbers and therefore lower than it should be. In many cases, US health care costs should be compared to other countries' following years' costs, which will be higher by anywhere from 5-15 percent.

From OECD fact book, "Comparability:
OECD countries are at varying stages of reporting total expenditure on health according to the boundary of health care proposed in the OECD manual A System of Health Accounts (SHA). This means that data reported are at varying levels of comparability…. limitations do remain (even among those countries where total expenditure is fairly comparable), due to the fact that data reporting is connected to current administrative records of financing systems. For example, different practices regarding the inclusion of long-term care in health or social expenditure are a major factor affecting data comparability."

When corrections are made to the US health cost data to make it comparable to other countries' data, the US no longer looks as expensive nor are its health results as bad.

When life style differences are included, such as smoking, obesity, teenage pregnancies (of which the US has the highest developed world rate and which lead to more premature and low birth weight babies and to lifelong medical problems), the US has the best medical system in the world.

Health care researchers know these facts about international comparisons. The problem is that too often, politicians, those that align themselves with the politicians and the mass media use the unadjusted numbers to achieve political outcomes by making US healthcare look bad when it is not.

See my previous post, "US First In Life Expectancy; Better Than OECD Countries" of August 2, 2009.