[extropy-chat] Health data

[Rafal Smigrodzki]

On 6/17/06, Damien Sullivan <phoenix at ugcs.caltech.edu> wrote:
> On Sat, Jun 17, 2006 at 12:09:48AM -0400, Rafal Smigrodzki wrote:
>
> > of that and in their ethnic makeup. Instead, if you want to see real
> > differences relevant to healthcare spending levels, try to compare the
> > socialized medicine in Sweden with the socialized medicine in Russia,
> > or maybe North Korea, or maybe Saudi Arabia.
>
> Or the not-so-free market of the US with the free market of Mexico?
>
> Then there's Cuba.

### Yes, indeed, one can come with comparisons till the cows come home
but I doubt we have the means to statistically disentangle the
enormous number of confounding factors.

I'd rather think that the approach that is more likely to give useful
information on the relative efficiency of different systems of
healthcare delivery would be piecemeal.

First, identify a basket of specific life-saving interventions that
are likely to be equally needed in the countries under comparison,
like vaccinations, or appendectomy for appendicitis. You don't look at
country-specific treatments, like bariatric surgery in the US, and
Guinea worm treatment in the tropics.

Second, try to measure the actual cost of delivery of each of these
treatments, including the fraction of the overhead relevant to the
treatment, and normalize for differences in average incomes. You have
to normalize for incomes, since the same amount of labor may cost
differently in different countries.

Third, compare the costs of the basket of treatments between
countries. The more exhaustive is your sampling of useful treatments
in this basket, the better your idea of the actual impact of the
treatments on survival , and the cost of a year of life bought by a
given system.

Fourth, look at the remaining treatments, things that are likely to be
of little value for outcomes, subtract the cost of your basket from
the total of spending, and get an approximate estimate of the amount
of waste in the system.

The results would have little to do with the comparisons of average
survival between countries. I would expect that some of the poorer
countries with relatively short lifespans but highly unregulated
systems would outperform the usual poster children. India does
outperform the US and Europe in terms of surgery costs. The regulated
partially monopolistic system in the US would fare poorly in terms of
the fraction of waste, but overall well in terms of efficiency of
useful care delivery (actually, the cost of some useful surgeries was
compared between the US and Europe, and the comparison was favorable
for the US). The wholly regulated, monopolistic systems in Europe
would fare well in the fraction of waste measure, but middling to poor
in the efficiency of useful care delivery. These are my hunches, based
what I heard about medical tourism (which measures relative costs of
equal-quality care), and the partially unregulated, fee-for-service
areas of medicine, like cosmetic surgery, or infertility treatments.

As far as I know, the US should learn from Thailand, not Sweden.

Rafal