U.S. lags France, Germany and U.K. in preventing avoidable deaths

The United States has a higher rate of “amenable deaths” — deaths that could have been avoided if individuals had received timely and effective medical care — than France, Germany or the U.K, according to a new study published online Wednesday in the journal Health Affairs.

The study also found that most of the Americans who are dying as a result of this higher rate are under the age of 65.

In other words, people who are not eligible for Medicare.

In France, Germany, and the U.K., affordable, universal health-care coverage is available to everybody, regardless of age.

“Our findings indicate that younger Americans do not appear to benefit from health care to the same extent as do their older compatriots or Europeans,” concluded the study’s authors, Ellen Nolte, director of health and health care at RAND Europe, and Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine.

“These findings strengthen the case for reforms that will enable all Americans to receive timely and effective health care,” they added.

Specific findings

For the study, Nolte and McKee used 1999-2007 data from a World Health Organization database. They selected causes of death that are “amenable to health care,” such as certain childhood infections, treatable cancers, diabetes, heart disease, and complications from common surgical procedures. (They included only 50 percent of the database’s heart disease deaths. Other research has shown that medical intervention is responsible for no more than half of the drop in heart disease mortality that industrialized countries have experienced in recent decades. Most of the decline is due to changing lifestyle behaviors, especially less smoking.)

The data revealed that the rates of amenable (avoidable) deaths fell in all four countries, but the pace of the drop was much slower in the United States. (with one exception). Furthermore, the rate of amenable deaths was higher in the U.S. than in the other countries. Here are some of the specifics:

• Amenable deaths among men fell by 18.5 percent in the U.S. during the years of the study, but they fell twice as much (36.9 percent) in Britain. France and Germany also had more significant drops than the U.S., 27.7 percent and 24.3 percent, respectively.
• The pattern was similar, although less dramatic, among women: a drop of only 17.5 percent in the U.S, compared to 31.9 percent in the U.K., 23.4 percent in France, and 22.7 percent in Germany.
• In the U.S., the lag in improvement was most pronounced among people under the age of 65. By 2007, the amenable death rate for American men in that age group was 69 per 100,000. That’s much higher than in the U.K. (53), Germany (50) or France (37). The amenable death rate for American women under the age of 65 in 2007 was 56 per 100,000. That compared with 46 in the U.K., 40 in Germany, and 34 in France.
• For Americans over age 65, the U.S. amenable death rate was comparable to that of the three European countries, although the rate of improvement was slower in the U.S., especially when compared to the U.K.

Cancer was the only area in which Americans did better than the Europeans. Both U.S. men and women were less likely to die from treatable cancers, although by 2007, the last year of the study, the Europeans had considerably narrowed that gap.

But again, the Americans who most benefited from the United States’ cancer-treatment advantage were over the age of 65. The study’s authors suggest that this was due to the affordable and guaranteed medical care they receive under Medicare.

U.S. spends more, gets less

The findings do not reflect well on our current health-care system, particularly given the fact that we spend about twice as much per person each year on health care ($8,233 in 2010) than France, Germany or the U.K.

The news is particularly bad for Americans not old enough to receive Medicare.

“We show that the lagging progress of the United States compared to other countries, as measured by amenable mortality, is largely driven by elevated amenable mortality among those younger than age sixty-five,” write Nolte and McKee. “However, we also observed a slowing of improvement among older Americans, relative to their peers in the other countries we studied. These changes have taken place at a time when the average U.S. family did not see increases in income, because health care expenditures consumed a greater share of families’ resources.”

Minnesota singled out

Interestingly, Minnesota is singled out at the end of the study as a place in the United States that is doing things right:

The population of Minnesota has achieve outcomes that are as good as those in many European countries and a mortality rate from amenable causes that is less than half the rates of Mississippi and the District of Columbia. Factors in these different outcomes included receiving care according to guidelines and being treated adequately by primary care providers to reduce unnecessary hospital admissions.

These observations lead us to the conclusion that there is no reason why all Americans cannot benefit equally from living in a country with the most expensive health care system in the world.

The study, which was funded by the Commonwealth Fund, can be read in full on the Health Affairs website.