02 May 2006

Health and Wealth

The Journal of American Medical Association (JAMA) has published a study which started with the fact that Americans spend more money on health than the British do.  The hypothesis is that more money spent equals better health.  I'm sure you can see where this is going, but bear with me please.

In self-reported surveys, data which measure health, income, and education were matched.  To control for racial/ethnic differences (such as health issues related to black and/or latino populations and the population percentage found in each society), only non-hispanic whites' data were used.  The focus remained on the age 40 to 70 segment of our populations.  All this is to control for as many variables as possible.

Mainly the variables under analysis were markers of biological diseases.

The results are:  "The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer....

The conclusions are:  "Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES (socioeconomic status=occupational prestige, education, and income) distribution....

Now, here's the thing:  it isn't the wealth of the populace that makes the difference.  It probably doesn't even have much to do with priorities, as in preventive care.  I would bet that the nations' states of health have more to do with the delivery system of health care.

I haven't conducted a study of the magnetude that this one reflects, but I do have a little knowledge of medical sociology, particularly when taken into account cultural differences in belief systems and practices dealing with medical and health related matters.  The single most important factor when examining health status across societies is the manner in which services, equipment, and medication is delivered.

Delivery systems entail factors such as how practioners are paid, who pays them, and in what amounts.  Our system is FOR-PROFIT.  This means that everyone is acting as a capitalist, from the doctors' offices to hospitals, to insurance companies, to pharmaceuticals, to pharmacies, to ....

Our practicioners and institutions are often paid per procedure, so every little anything is documented and billable.  What motivation do we have, from a business perspective, to encourage our citizens to take preventative measures, to not indulge in risky behaviors, to be well, to be health?  Medicine is a huge industry here, in ways I haven't even touched upon.

If memory serves correct, I think that most other industrial countries approach health care through a more socialist means.  Everyone chips in (taxes) and pays to the fund so that every one receives equal opportunity to access the needed, appropriate health care.  Practicioners are not paid per procedure.  There is a different sort of base-rate payout from the government to health care providers.  Doctors have much prestige in those countries, but the income is not even close to what we have here, although education (but not cost of education) is remarkably comparable.

So I contend that the prime motivator for health care delivery systems is a matter of wealth of the medical industry itself.  As the potential profit of the health care system increases, the health of the populace decreases.  As the motivation for profit is removed from the system, societal health status increases.

That's a hypothesis for a study that I'd like to see gain wide-spread press and attention.

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