US: Health System Outcomes – Health Systems Facts

Life Expectancy at Birth (2016)
– Male: 76.1; Female: 81.1; Both Genders: 78.6
Maternal Mortality Ratio (per 100,000 live births) (2015): 14
Neonatal Mortality Rate (per 1,000 live births) (2017): 4
Probability of Dying from any of Cardiovascular Disease, Cancer, Diabetes, Chronic Respiratory Diseases Between Age 30 and Exact Age 70 (%) (2017):
– Male: 17.5%; Female: 11.8%; Both Genders: 14.6%

Source: World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf
https://www.who.int/gho/publications/world_health_statistics/2019/en/

Neonatal Mortality Rate (Deaths Per 1,000 Live Births) (2018): 4
Infant Mortality Rate (Deaths Per 1,000 Live Births) (2018): 6
Under-5 Mortality Rate (Deaths Per 1,000 Live Births) (2018):
Male: 7; Female: 6

Note: “Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
“Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
“Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.”

Source: UNICEF (2019). The State of the World’s Children 2019. Children, Food and Nutrition: Growing well in a changing world. UNICEF, New York.
https://www.unicef.org/reports/state-of-worlds-children-2019
https://www.unicef.org/media/60806/file/SOWC-2019.pdf

General Mortality Rate Per 1,000 Population (2016):
Total: 4.9; Male: 5.9; Female: 4.0
Communicable Diseases Mortality Rate Per 100,000 (2016):
Total: 28.3; Male: 31.9; Female: 25.2
Noncommunicable Diseases Mortality Rate Per 100,000 Population (2016):
Total: 417.8; Male: 492.1; Female: 353.4
External Causes Mortality Rate Per 100,000 Population (2016):
Total: 46.5; Male: 68.1; Female: 25.3
Lung Cancer Mortality Rate Per 100,000 Population (2016):
Total: 27.8; Male: 33.4; Female: 23.2
Colorectal Cancer Mortality Rate Per 100,000 Population (2016):
Total: 11.4; Male: 13.6; Female: 9.5
Ischemic Heart Diseases Mortality Rate Per 100,000 Population (2016):
Total: 79.2; Male: 106.3; Female: 56.0

Source: Pan American Health Organization. Core Indicators 2019: Health Trends in the Americas. Washington, D.C.: PAHO; 2019.
https://www.paho.org/hq/index.php?option=com_content&view=article&id=15499:core-indicators-2019-health-trends-in-the-americas&Itemid=1894&lang=en
https://www.paho.org/hq/index.php?option=com_content&view=article&id=1245:paho-publications&Itemid=1497&lang=en

“The United States performs well on some measures of quality and outcomes from an international perspective, while it does not perform so well on others. It is important to stress, however, that these measures are skewed by the access problems discussed in section 7.2. To illustrate, even though overall hospitalization rates are lower in the United States than in most OECD countries, the rate for asthma is the second highest, exceeded only by the Slovak Republic (OECD, 2011). The high United States asthma rate may be due to several factors, including air quality in urban areas or even genetics. A major part of the explanation is that it is probably the result of poor access to primary care, especially among the uninsured, rather than of poor quality of primary care received on a timely basis. This is not to say that quality is not a problem; rather, it shows how quality closely interacts with access to care.”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2013; 15(3): 1– 431.
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/united-states-of-america-hit-2013

“Part of the explanation for the poor United States performance is probably related to problems associated with access to health care. But once a person has access to the United States system, how well does it perform? There is a divergence of opinion on this as well. Docteur and Berenson (2009), reviewing a variety of diseases, find that United States performance compares well internationally in some areas (e.g. cancer screening and survival) and worse in others (e.g. asthma, medical errors), and conclude that the “overall evidence is mixed, indicating that the United States has neither the best nor the worst quality of health care for particular conditions among high-income countries” (p.4).”

“There has been much publicity recently on amenable mortality, which is defined as “premature deaths from causes that should not occur in the presence of timely and effective health care” (Nolte & McKee, 2011). They used data from the World Health Organization’s mortality database to assess levels and changes in amenable mortality in 16 high-income countries between 1997/8 and 2006/7. Over 30 causes of death were defined as amenable to health-care interventions, which can be summarized as “childhood infections, treatable cancers, diabetes, cerebrovascular disease and hypertension, and complications of common surgical procedures”. In addition, the authors considered half the deaths from ischaemic heart disease as amenable. For most of these conditions, only deaths occurring before the age of 75 were considered, although in a few instances lower age thresholds were used (e.g. cervical cancer before the age of 45).

“Fig. 7.8, adopted from Nolte and McKee by the Commonwealth Fund (2011), summarizes the findings. In the 2006 /7 period, the United States had the highest rate among all countries, which was 75% higher than France, the country with the lowest figure. The United States rate was 16% higher than the United Kingdom, which was 15th of the 16 countries. As was the case for other measures of mortality noted above, the United States rate had decreased over the previous nine years – by 20% – but other countries’ rates declined more quickly. Ireland, which had rates higher than the United States in 1997/8, had the greatest decline (42%) among all of the countries.”