Blog | Monday, August 12, 2013

Living longer but sicker: health care in the U.S.


I was interested to read the recent article in the Journal of the American Medical Association titled "The State of U.S. Health 1990-2010, the Burden of Diseases, Injuries and Risk Factors." It is a vast compilation of data from various surveys and data banks using the methods of the Global Burden of Diseases, which has been performed for 50 countries, allowing comparison on a variety of measures. The article is a clear presentation of that data, and I won't repeat that, at least not much.

In the last 10 years the U.S. has had a significant improvement in life expectancy, from 75.2 to 78.2 years. This is a good thing. Other countries, though, had more significant improvements, so we dropped in ranking among these countries from 20th to 27th, behind Chile and just ahead of Poland. We also spend much more money on health care than they do. We are the very top country in terms of percentage of gross domestic product spent on health care, at over 16%, and Chile spends about half that.

The years of life we spend with disability is actually about stable, at about 10.5 years, and we rank only sixth on that metric, which surprised me. I see so many patients treated with life sustaining, high-technology interventions toward the end of life that I thought this would mean that the U.S. would have a higher proportion of walking wounded than the rest of the world, but that isn't true (at least not as it is measured in this study). We have moved down a point from 1990, at which time we were in fifth place.

We die mostly of heart attacks. Our health is significantly worse because of increasing obesity, diabetes and inactivity since 1990, which increase heart attacks. These are things we could change without spending more on health care. It is interesting that we have figured out how to live longer even though we are less active and fatter. Medical science is full of miracles.

Janice Boughton, MD, ACP Member, practiced in the Seattle area for four years and in rural Idaho for 17 years before deciding to take a few years off to see more places, learn more about medicine and increase her knowledge base and perspective by practicing hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling. Disturbed by various aspects of the practice of medicine that make no sense and concerned about the cost of providing health care to every American, she blogs at Why is American Health Care So Expensive?, where this post originally appeared.