!! History Commons Alert, Exciting News

Follow Us!

We are planning some big changes! Please follow us to stay updated and be part of our community.

Twitter Facebook

US Health Care System

Studies

Project: US Health Care System
Open-Content project managed by kuhan, mtuck

add event | references

For 16 available health indicators, the US ranks on average 12th out of 13 industrial countries. Ranking first is Japan followed by Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the United States, and Germany. For three of the indicators, the US ranks dead last: low-birth-weight percentages, overall neonatal and infant mortality, and years of potential life lost. Life expectancy in the US appears to improve with age. While the country ranks 11th and 12th for female and male one-year-olds, respectively, it ranks a high 3rd for life expectancy among 80-year-olds of both sexes. [Starfield, 1998; Starfield, 2000 pdf file]

Entity Tags: United States

Category Tags: Studies-Academic

1999: Health Care Costs Increase 7.3 Percent

According to the Mercer National Survey of Employer-Sponsored Health Plans, the average total health benefit cost rises 7.3 percent in 1999 [San Francisco Chronicle, 12/8/2003] compared to a 2.2 percent increase in the Consumer Price Index. [InflationDate(.com), 6/22/2006]

Category Tags: Studies-Academic

The authors of a paper on VIGOR, a clinical study on the drug Vioxx, submit two sets of corrections to the New England Journal of Science for the manuscript they submitted in May (see May 18, 2000). They do not correct the omission of three fatal heart attacks that occurred toward the end of the study (see March 2000) after a February 10 “cut-off” date (see Early February 2000). [National Public Radio, 6/8/2006]

Category Tags: Fraud, Manipulation of data, Vioxx, Studies-Academic

An new analysis of data from the VIGOR study (a clinical trial for Vioxx, see January 1999) along with data from a clinical trial of the drug Celebrex, and two smaller studies, raises concerns that COX-2 inhibitors may cause cardiovascular events. The study, published in the Journal of the American Medical Association, concludes that “it is mandatory to conduct a trial specifically assessing cardiovascular risk and benefit of these agents.” The authors are cardiologists Debabrata Mukherjee, Steven Nissen, and Eric Topol. [Mukherjee, Nissen, and Topol, 2001; National Public Radio, 6/8/2006]

Entity Tags: Steven Nissen, Eric Topol, Debabrata Mukherjee

Category Tags: Vioxx, Studies-Academic

An expert panel convened by the National Science Academy’s Institute of Medicine issues a report recommending a number of changes to how the FDA regulates the drug industry. The proposed changes are unanimously endorsed by the panel, comprised of 15 experts from academic and professional organizations. Some of the recommendations include:
bullet The FDA should implement a moratorium on direct consumer advertising of recently approved classes of drugs until enough aggregate data is available to confirm the drugs’ safety. Packaging for such medications should have a special symbol imprinted on them alerting consumers to the higher risk associated with new medications.
bullet The FDA should be required to reevaluate the safety and effectiveness of drugs at least once every five years after the drug has been approved. The agency’s current system for monitoring drug safety post-approval is far less effective than pre-approval testing. The report notes that there is a history of fierce disagreements between the FDA’s Office of Drug Safety and the agency’s Office of New Drugs.
bullet The FDA should be given new powers to impose fines, injunctions, and withdrawals when drug companies fail to complete the required safety studies.
bullet The agency should be given the authority to impose a wider range of restrictions on drugs it considers potentially unsafe.
bullet The government should require drug companies to register all clinical trials they sponsor in a government-run database so patients and physicians can review all studies. Currently, only those studies published in medical journals are accessible to the public, and these tend to be the studies that produce the most favorable results for the drug being tested.
bullet Expert advisory panels should not be loaded with industry-connected scientists. Most of the members making up these panels should be free of industry ties. “FDA’s credibility is its most crucial asset, and recent concerns about the independence of advisory committee members… have cast a shadow on the trustworthiness of the scientific advice received by the agency,” the report says. [Institute of Medicine, 9/22/2006; Washington Post, 9/23/2006; New York Times, 9/23/2006]

Entity Tags: US Food and Drug Administration, Institute of Medicine

Category Tags: Clinical drug studies, FDA advisory panels, Studies-Academic

A study conducted by Harvard University and the Canadian Institute for Health Information finds that administrative costs in America’s health care system are almost twice that of Canada. The study, published in the New England Journal of Medicine, reports that the US health bureaucracy consumes 31 percent of total health care spending. By comparison, Canada’s administrative expenses amount to only 16.7 percent. Steffie Woolhandler of Harvard, who led the team, says if the US were to adopt a single-payer health care system like Canada, the funds saved would be enough to provide insurance for the more than 41 million uninsured Americans. [Woolhandler, Campbell, and Himmelstein, 2003; Toronto Star, 8/21/2003]

Category Tags: Studies-Academic

The National Academy of Sciences issues a report calling for universal health insurance coverage by 2010. “It is time for our nation to extend coverage to everyone,” the report says. “Universal insurance coverage is an important and achievable goal for the country.” The report was drafted by a panel of 15 experts and is the product of three years of work.
Sampling of report's conclusions -
bullet People without insurance receive about half the medical care of those who have it. Consequently, they are on average sicker and tend to die sooner.
bullet Roughly 18,000 people die each year because they do not have insurance.
bullet In 2001, only half of uninsured children in the US visited a physician during 2001, compared with three-quarters of privately insured children.
bullet In 2001, taxpayers spent roughly $30 billion in unreimbursed medical care for uninsured Americans.
bullet The poorer health and premature deaths of uninsured people cost taxpayers between $65 billion to $130 billion a year.
Reaction in US government - Republican Senate majority leader Bill Frist of Tennessee—whose family owns HCA Inc., the largest for-profit hospital chain in the US—expresses concern that “the report may not focus enough on the reasons why health care costs continue to rise and how to pay for any reform.” Democratic Senator Tom Daschle of South Dakota supports the call. “It’s doable,” he says. “It’s essential. This is, I believe, the single most important domestic issue facing our country.” Tommy G. Thompson, secretary of health and human services, tells reporters the proposal is “not realistic.” [Institute of Medicine, 2004; National Academies, 1/14/2004; New York Times, 1/15/2004]

Category Tags: Studies-Academic, US Health Insurers

The British medical journal Lancet publishes a paper by FDA scientist David Graham suggesting that tens of thousands of Americans probably died from taking Vioxx, a painkiller that was recalled in September (see September 30, 2004). His study looked at data on 1.4 million Kaiser Permanente patients that took Vioxx, Celebrex, or another non-steroidal anti-inflammatory drug (NSDAID) between 1999 and 2003. The data showed that the risk of having a heart attack or dying from heart problems was 1.6 times higher for patients taking standard-dose Vioxx compared with those using Celebrex. The risk was 3.6 times higher for those on high doses. Graham notes that Vioxx’s potential impact on the patient population was likely severe. Using the risk factors from Merck-sponsored randomized clinical trials, and extrapolating these to the estimated 106.7 million Vioxx patients, Graham says that the drug may have caused cardiovascular problems for 88,000-140,000 Americans. It is estimated that 44 percent of acute myocardial infarction’s are fatal. [Graham et al., 2005 pdf file; London Times, 1/25/2005] In November, Graham told Congress that senior managers at the FDA’s Office of Drug Safety had delayed giving Graham permission to publish this study, even after it had been accepted by Lancet. [US Congress, 11/18/2004 pdf file]

Entity Tags: David Graham

Category Tags: Vioxx, Studies-Academic

A study conducted by the American Medical Association (AMA) finds that health insurance companies are becoming near-monopolies. Ninety-five percent of the 294 HMO/PPO metropolitan markets surveyed have a Herfindahl-Hirschman Index (HHI) above 1,800. The HHI is used to determine whether a company’s control of the market warrants antitrust concern. A market with a rating of 1,800 is considered by the Department of Justice to be “highly concentrated.” Sixty-five percent of the companies surveyed have a rating over 3,000. The concentration is apparently the product of a period of intense consolidation within the industry. According to the AMA, there were more than 400 mergers during the preceding ten years. [American Medical Association, 2006 pdf file; Associated Press, 4/18/2006] “Patients do not appear to be benefiting from the consolidation of health insurance markets,” says AMA board member Dr. J. James Rohack. “Health insurers are posting historically high profit margins, yet patient health insurance premiums continue to rise without an expansion of benefits.” [Consumer Affairs, 4/18/2006] The AMA has asked the Department of Justice to take up antitrust action. But the organization says that in spite of the extremely high market concentration, regulators seem uninterested. [Associated Press, 4/18/2006]

Entity Tags: US Department of Justice, J. James Rohack, American Medical Association

Category Tags: Studies-Academic, US Health Insurers

Save the Children releases a report ranking the status of mothers and children in 125 countries. The report—based on 10 indicators pertaining to health and education—concludes that Sweden is the best country in the world for mothers and children to live. The US and United Kingdom are tied for tenth place. The US places much lower, however, in infant mortality, ranking second-to-last among 33 industrialized nations. It shares the spot with Hungary, Malta, Poland, and Slovakia with a death rate of nearly 5 per 1,000 babies. Save the Children’s data shows a remarkable difference in mortality rates between white and black infants. According to the report, black babies are twice as likely as white babies to be premature, have a low birth weight, or die at birth. The infant mortality rate among US blacks—9 per 1,000—is closer to the rates of developing nations. For example, in war-torn Colombia the mortality rate is 12 per 1,000. [Save the Children, 5/2006 pdf file; Save the Children, 5/9/2006; Associated Press, 5/10/2006]

Entity Tags: Save the Children

Category Tags: Studies-Academic

An article published in the journal Health Affairs reports that on average nonprofit nursing homes and hospitals provide better quality service than those operating for a profit. The authors of the report, whose conclusions are based on a review of 162 studies comparing nonprofit and for-profit health care providers, found that the evidence suggests that nonprofit hospitals have lower mortality rates. Eight of the studies surveyed by the authors concluded that nonprofits have lower death rates while only one study reported that for-profits have lower mortality rates. The article also reports that non-profit hospitals have lower expenses on average. For nursing homes, the opposite is true. The review says that evidence suggests for-profits tend to mark their prices up to improve the bottom line. There is also evidence that they receive more complaints. Sixteen percent of all hospitals are for-profit, a five percent increase since the early 1990s. [Reuters, 1/21/2006]

Category Tags: Studies-Academic

The Commonwealth Fund, a private organization founded to improve America’s health care system, releases a study that finds the US spends more on health care than any nation on earth, yet “consistently underperforms on most dimensions of performance, relative to other countries.” The report is based on a number of surveys conducted with patients along with information from primary care physicians. “The US spends twice what the average industrialized country spends on health care but we’re clearly not getting value for the money,” says Commonwealth Fund president Karen Davis. Compared with Australia, Canada, Germany, New Zealand, and Britain, “the US health care system ranks last or next-to-last on five dimensions of a high-performance health system: quality, access, efficiency, equity, and healthy lives. The US is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the US lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.” These findings are similar to those of studies conducted in 2004 and 2006. “The most notable way the US differs from other countries is the absence of universal health insurance coverage,” the study’s authors note. “Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term ‘medical home.’ It is not surprising, therefore, that the US substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.” The study’s executive summary concludes: “For all countries, responses indicate room for improvement. Yet, the other five countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the US health care system could do much better in achieving better value for the nation’s substantial investment in health.” Britain receives the highest overall ranking in the study, followed by Germany, and then by New Zealand and Australia, which tie for third. Canada is placed fourth. [Commonwealth Fund, 5/15/2007; Agence France-Presse, 5/15/2007]

Entity Tags: United Kingdom, Germany, United States, Karen Davis, New Zealand, Australia, Canada, Commonwealth Fund

Category Tags: Studies-Academic

The California Nurses Association (CNA) releases the results of a study which found “a national single-payer style health care reform system would provide a major stimulus for the US economy by creating 2.6 million new jobs, and infusing $317 billion in new business and public revenues, with another $100 billion in wages into the US economy.” The study was conducted by the Institute for Health & Socio-Economic Policy (IHSP), a “non-profit policy and research group” that is “the exclusive research arm of the California Nurses Association/National Nurses Organizing Committee.” In addition to the growth in jobs and revenues generated by covering the 47 million Americans who were uninsured as of 2006, the study also found that universal coverage “could be achieved for $63 billion beyond the current $2.1 trillion in direct health care spending,” according to the press release for the study, which also notes that this figure is “six times less than the federal bailout for CitiGroup, and less than half the federal bailout for AIG.” [CalNurses.org, 1/14/2009]

Entity Tags: Institute for Health & Socio-Economic Policy, California Nurses Association

Category Tags: Health Care Cost, Studies-Academic, History of US Health Care System, Obama Health Care Reform, Other health care systems, US Health Care Costs, US Health Care Problems

Ordering 

Time period


Email Updates

Receive weekly email updates summarizing what contributors have added to the History Commons database

 
Donate

Developing and maintaining this site is very labor intensive. If you find it useful, please give us a hand and donate what you can.
Donate Now

Volunteer

If you would like to help us with this effort, please contact us. We need help with programming (Java, JDO, mysql, and xml), design, networking, and publicity. If you want to contribute information to this site, click the register link at the top of the page, and start contributing.
Contact Us

Creative Commons License Except where otherwise noted, the textual content of each timeline is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike