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Volume 13 Number 8 News: Quality Ranked on a list of 19 industrialized countries, the United States has the highest rate of deaths that could have been prevented through access to timely and effective health care, according to a study in the January/February 2008 issue of the health policy journal Health Affairs. The study, "Measuring the Health of Nations: Updating an Earlier Analysis," examined so-called "amenable mortality" rates for diseases such as bacterial infections, treatable cancers, diabetes, cardiovascular diseases, and complications from surgical procedures where death before age 75 can be avoided by prevention or treatment. As measured by the number of deaths per 100,000 people, the United States (109), Portugal (104), and Ireland (103) were the three countries with the highest amenable mortality rates during 2002-2003, the study said. France (64), Japan (71), and Australia (71) recorded the three lowest amenable mortality rates during that time period. The Commonwealth Fund, a nonprofit organization that works on health policy reforms, provided funding for the study looking at countries that are part of the Organization for Economic Cooperation and Development. The countries are Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom, and the United States. Avoidable Deaths Estimated If the United States had achieved the average rate of amenable deaths of the three top-performing countries, it would have prevented 101,000 deaths in 2002, according to study authors Ellen Nolte and C. Martin McKee, both with the London School of Hygiene and Tropical Medicine, Britain's national school of public health. They added that if the United States had achieved the average rate of all the other 18 OECD countries, it could have prevented a total of 75,000 deaths in 2002. "Thus, even the more conservative estimate of 75,000 deaths is almost twice the Institute of Medicine estimate of the number of deaths attributable to medical errors in the United States each year," the authors wrote. Slowed Improvement While the amenable mortality rates for the other countries declined an average of 16 percent between 1997-1998 and 2002-2003, the rate in the United States dropped 4 percent over that time period, according to the study. Consequently, the United States slipped from 15th place (114 deaths per 100,000) during the earlier 1997-1998 period to take the last place (109 deaths per 100,000) during the later 2002-2003 period, the authors wrote. In the earlier period, Finland, Portugal, the United Kingdom, and Ireland, respectively, had higher amenable mortality rates than the United States, but by 2002-2003, the U.S. rate was the highest among all the other countries in the study, they added. Link to Number of Uninsured While noting the importance of considering other policy factors, such as "tobacco and alcohol policies," in drawing conclusions about causes of high or low amenable mortality rates, the authors explained that "it is difficult to disregard the observation that the slow decline in U.S. amenable mortality has coincided with an increase in the uninsured population." Commonwealth Fund President Karen Davis said in a press release, "Cross-national studies conducted by The Commonwealth Fund indicate that our failure to cover all Americans results in financial barriers that are much more likely to prevent many U.S. adults from getting the care they need, compared with adults in other countries." She added that "while no one country provides a perfect model of care, there are many lessons to be learned from the strategies at work abroad." The study is available.
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