Population-Based Study Comparing the USA with Other Western Countries' Total Mortality 1989-91 V 2013-15 in Context of Health Expenditure: Plus Contrast of USA and UK Child (0-4) and Adult (55-74) and the 24 Who Global Diagnostic Mortality Rates

Abstract

Background: This population-based study examines how effective is the USA health system compared to twenty Other Western Countries (OWC) in reducing total mortality between 1989-91 and 2013-15 within the context of national fiscal health investment and directly compares current USA and UK children's (0-4) and adult (55-74) death rates, and, the 24 global WHO diagnostic categories mortality rates. Methodology: All mortality data is drawn from WHO, updated June 2018, using average world standard population the Age-Standardised-Death-Rates (ASDR) per million (pm).to examine total mortality of the USA and the OWC over the period. The fiscal context draws upon World Bank data, updated July 2018, which is the national percentage GDP-Expenditure-on-Health (%GDPEH). Findings: America had highest average %GDPEH at 13.39%, Britain the lowest at 7.60%. Every OWC had significantly greater reduced ASDR than USA over the period. If the USA had matched Britain's ASDR there would be 488,453 fewer deaths. UK child and adults rates at 855pm and 10,568pm, with America's 1,249pm and 12,544pm were 46% and 19% higher than UK. Of the 24 global diagnostic category deaths the USA had sixteen higher category mortalities than Britain, notable lower UK rates were for Circulatory Disease Deaths by 24%, Endocrine Disorders 70%, External Deaths 53%, Genitourinary 44%, Infectious Disease 65%, Neurological deaths 13% and Peri-natal deaths 34%. Conversely, America had lower rates than Britain for Neoplasms by 11%, Respiratory 12% and Digestive Disorder deaths 11%. Interpretation: America had the highest health expenditure but the highest total death rate. Direct comparison between the USA and the UK shows America achieved proportionally less with relatively more, whilst Britain achieved proportionally more with comparatively less. These results strongly indicate that America does not get a good return on its fiscal investment in health, which should be considered in current USA debate about health care. Funding: None. Declaration of Interest: The authors have no vested or other interest in the study.