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U.S. Ranks Last in Preventing Deaths from Treatable Conditions

By Caitlin Webber, CQ Staff

January 11, 2008 -- Although the United States is the global leader in health care spending, it ranks last among industrialized nations in preventing deaths from treatable conditions, according to a recent study from The Commonwealth Fund.

The study also found that the nation lagged behind developed nations in improving avoidable death rates. Between 75,000 and 100,000 lives could be spared annually, the study said, if the United States matched progress made by France, Japan, and Australia—the top-ranked nations.

"It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance," said Senior Vice President Cathy Schoen. "The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals, and efforts to improve health systems make a difference."

The study, published in the January/February issue of the journal Health Affairs, examined deaths before age 75 from conditions "amenable to health care" in the United States, Canada, Australia, New Zealand, and 14 European countries between 1997–1998 and 2002–2003. Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine focused on more than 30 conditions that could be effectively treated with health care, including appendicitis, bacterial infections, tuberculosis, thyroid disease, measles, epilepsy, diabetes, and certain cancers.

The United States placed fourth from the bottom in 1997–1998, but plunged to last place by 2002–2003 with 110 preventable deaths out of 100,000 people.

The study reveals an average 16 percent drop in preventable deaths among the 19 nations in the five years studied—the United States had only a 4 percent decline.

It's hard to ignore that the slow decline in U.S. preventable deaths "has coincided with an increase in the uninsured population, an issue that is now receiving renewed attention in several states and among presidential candidates from both parties," researchers said in a statement.

About 47 million Americans lacked health insurance in 2006, according to the U.S. Census Bureau.

According to the World Health Organization, America spends more on heath care, nearly $2.1 trillion annually, than any other nation in the world. The United States is the only country in the study without universal medical care.

The study found Ireland, where the preventable death rate fell 23 percent, along with Austria and the United Kingdom, to be the most improved countries. France had the lowest preventable morality rate, with 65 deaths per 100,000 people.

The study's authors said the rate of preventable deaths "is a valuable indicator of health care system performance" but should not be construed as a definitive measurement, but rather "as an indicator of potential weaknesses in health care that can then be investigated in more depth."

Catherine Hoffman, associate director at Kaiser Commission on Medicaid and the Uninsured, said in an interview that the study is "consistent with many international comparisons where the U.S. doesn't fare well."

While it is fair to compare health among economically developed countries, Hoffman said using averages masks "the racial, socioeconomic, and access disparities the U.S. deals with [that] drive differences in health outcomes."

If the study had compared preventable death rates among insured Americans, Hoffman said she expects "the U.S. would have done far better in its ranking."

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