A matter of interpetation


Statistics don't tell the whole truth when it comes to health care
David R. Henderson takes a closer look at the Commonwealth Fund international survey.

"One-third of patients with health problems in the U.S. report experiencing medical, medication, or test errors, the highest rate of any nation in a new Commonwealth Fund international survey." So reads the opening line of a November 3 press release from the Commonwealth Fund. When you read that, you would think that the U.S. health care system is seriously worse than any other country's health system, right? Read a little further, though, and you learn that "any" means any of five other countries surveyed: Australia, Canada, Germany, New Zealand, and Britain. More important, a close examination of all the survey data tells a very different story from the picture this press release paints. Actually, as the late statistician W. Allen Wallis often said, "Data never tell a story; they must be interpreted." And interpreting the survey's data leads to the conclusion that, in ways that are very important to patients, the U.S. health-care system is superior to that of the other countries surveyed.

Consider, first, waiting times. The press release points out that 30% or fewer of American and Canadian patients were able to get needed medical care the same day, whereas for New Zealand, Germany, Australia, and Britain, the numbers were much higher: 58%, 56%, 49%, and 45%. What the 6-page-long Commonwealth press release does not report are the data on longer waits. Asked whether they had to wait more than 4 weeks for an appointment with a specialist doctor, only 23% of the Americans surveyed said yes, virtually a tie with Germany's 22%, whereas 40% of New Zealand patients, 46% of Australian, 57% of Canadian, and 60% of British patients said yes. Asked whether they had to wait more than 4 months for elective surgery, only 8% of Americans and 6% of Germans said yes, contrasted with 19% for Australia, 20% for New Zealand, 33% for Canada, and a whopping 41% for Britain.
 
These data square with what health economists have long known about socialized medicine. All the other five countries have various degrees of socialized medicine, with Germany -- interestingly, given the numbers above -- having a hybrid of government and private. (The least socialized, the United States, is also a hybrid, with government spending almost half of health care dollars, mostly on Medicare and Medicaid.) When governments run medical systems, they systematically overprovide services of general practitioners and underprovide specialists' services. That way, they can look good to the majority of citizens, who are healthy and who judge the system by whether they can get a doctor's appointment, not by whether they must wait 40 weeks from referral by a general practitioner to surgery by an orthopedist. This last number is not random: the Fraser Institute, a Canadian think tank, reported in Waiting Your Turn: Hospital Waiting Lists in Canada, 15th ed., 2005, that this was the median number of weeks my fellow Canadians waited for that particular treatment.

Interesting what people can get numbers to say.

— NeoWayland

Posted: Fri - November 18, 2005 at 04:51 AM  Tag


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