Access matters: U.S. lags behind in preventable deaths

by Kim Krisberg

Another study, another support beam in the argument that access to insurance coverage matters — a lot.

In a study published this month in the journal Health Affairs, researchers took a look at rates of amenable mortality deaths — in other words, deaths that shouldn't happen in the presence of timely and effective care — between the United States, France, Germany and the United Kingdom. Their conclusion? The U.S. — home to the world's highest rate of health care spending — is lagging behind.

Between 1999 and 2007, amenable mortality rates among men fell by 18.5 percent in the U.S., compared to falling nearly 37 percent in the United Kingdom. Among U.S. women, the rate declined by 17.5 percent compared to a decline of almost 32 percent in the United Kingdom. As of 2007, the U.S. had the highest amenable mortality rate among its counterparts in the study — a rate nearly twice that of France. Amenable death rates improved considerably in all four countries for residents older than 65 (the age at which Americans can tap into universal coverage via Medicare); but still, the U.S. lagged behind its counterparts. The study found that the U.S. lag is mainly driven by amenable death among those younger than 65.

Researchers Ellen Nolte, PhD, MPH, of RAND Europe and C. Martin McKee, MD, DSc, of the London School of Hygiene and Tropical Medicine noted that such preventable death accounts for 21 percent of mortality among men younger than 75 and 30 percent among women.

"Overall, our findings must be viewed in the context of differences in underlying disease incidence and severity of disease when a patient presents to a health care provider," they wrote. "However, severity is a function of health-seeking behavior and — although partly outside the scope of health services — reflects access to care. It is, therefore, partly amenable to changes in health system design."

Some other interesting findings in the Nolte and McKee study:

• Men and women ages 65 to 74 in the United Kingdom experienced the biggest improvement in amenable mortality.
• The slow progress in the U.S. was largely due to circulatory conditions other than heart disease, such as hypertension and cerebrovascular disease (a disease that affects the flow of blood to the brain).
• The good news is that mortality from treatable cancers fell at about the same rate in all four countries. In fact, the lowest mortality rates were among men and women in the United States. Researchers wrote: "This is consistent with findings that older Americans benefit from intensive screenings and treatment provided under Medicare, so that cancer survival does not decline markedly with increasing age in the United States, as it does in many European countries."
• Young Americans are struggling — "crucially, levels of amenable mortality among Americans under age 65 have fallen increasingly far behind their European counterparts during the past decade," the researchers wrote.
• Researchers also found that significant leaps in progress are possible: In 1999, rates of amenable mortality in the United Kingdom were 13 to 20 percentage points higher than those in the U.S. By 2007, the United Kingdom had progressed past the U.S., with a rate 2 to 5 percentage points lower.

And as with many of our most pressing health problems, the roots have little do with what happens once you get inside a doctor's office. In regard to the slowdown in amenable mortality improvements among older Americans, the authors write that the worrisome trend comes 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." They conclude that the impact of U.S. health care is tied to access.

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

For a copy of the Health Affairs study, click here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for the last decade.