Life Expectancy in the US: Falling Behind

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The current (2016) life expectancy from birth for the US as a whole is 79.8 years.(1) How does that compare with other countries? Countries where people live longer than in the US include

  • Andorra 82.8
  • Anquilla 81.4
  • Australia 82.2
  • Austria 81.5
  • Belgium 81.0
  • Bermuda 81.3
  • Canada 81.9
  • Cayman Islands 81.2
  • Faroe Islands 80.4
  • Finland 80.9
  • France 81.8
  • Greece 80.5
  • Guernsey 82.5
  • Hong Kong (China) 82.9
  • Iceland 83.0
  • Ireland 80.8
  • Isle of Man 81.2
  • Israel 82.4
  • Italy 82.2
  • Japan 85.0
  • Jersey 81.9
  • Korea, South 82.4
  • Liechtenstein 81.9
  • Luxembourg 82.3
  • Macau (China) 84.5
  • Malta 80.4
  • Monaco 89.5
  • Netherlands 81.3
  • New Zealand 81.2
  • Norway 81.8
  • Saint Pierre and Miquelon 80.5
  • San Marino 83.3
  • Singapore 85.0
  • Spain 81.7
  • Sweden 82.1
  • Taiwan 80.1
  • United Kingdom 80.7
  • Virgin Islands 80.0

Of course, the issue is that the US spends more per capita on healthcare than any of these other countries.  In many cases, far more.

What’s a year of life worth to you?

On top of that, the US is falling behind in growth in life expectancy.(2) Kontis et. al. forcast growth in life expectancy in industrialized countries, and the US ranks near the bottom of the list, with minimal improvement.  South Korea, which is already ahead of the US, ranks near the top in growth in longevity.

lifeexpectancychangeYou spend a lot on healthcare and health insurance.  What exactly are you getting for your money?

 


SourcesI

  1. CIA World Factbook. https://www.cia.gov/library/publications/the-world-factbook/fields/2102.html
  2. Vasilis Kontis, PhD, James E Bennett, PhD, Colin D Mathers, PhD, Guangquan Li, PhD, Kyle Foreman, PhD, Prof Majid Ezzati, FMedSc, “Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble,” The Lancet, 21 February 2017. http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/fulltext

 

States with Best Healthcare in US

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US News published a ranking of states on quality of healthcare.  The top 10 don’t necessarily mirror population migration patterns, but who wouldn’t want to live where the best healthcare is found?

Conversely, why are residents of states with inferior care apparently so complacent about it?  I grew up in Kentucky, which is a hotbed of cancer from smoking, and offers sub par healthcare.  Why?

1. Hawaii

2. Massachusetts

3. Minnesota

4. New Hampshire

5. Iowa

6. Vermont

7. Rhode Island

8. New Jersey

9. Washington

10. California

The 10 worst states are the usual suspects:

50. Arkansas

49. Mississippi

48. Oklahoma

47. Alabama

46. West Virginia

45. Louisiana

44. Kentucky

43. Wyoming

42. Tennessee

41. Indiana


Sources:

Hospital Costs by State

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Kaiser Health Facts has published the average per diem cost of a hospital stay.  Costs will vary between hospitals, but it is clear that some states are just more expensive than others.

Obvious question:  Why would anyone use a hospital in New Jersey when quality facilities in New York and Pennsylvania are so close?

The most recent year for which data are available is 2015.  Cost may have risen slightly over the last year in most or all states.

United States

  • State/local government hospitals — $2,013
  • Nonprofit hospitals — $2,413
  • For-profit hospitals — $1,831

Alabama

  • State/local government hospitals — $1,458
  • Nonprofit hospitals — $1,664
  • For-profit hospitals — $1,410

Alaska

  • State/local government hospitals — $1,274
  • Nonprofit hospitals — $2,332
  • For-profit hospitals — $2,724

Arizona

  • State/local government hospitals — $2,012
  • Nonprofit hospitals — $2,636
  • For-profit hospitals — $1,996

Arkansas

  • State/local government hospitals — $1,637
  • Nonprofit hospitals — $1,649
  • For-profit hospitals — $1,521

California

  • State/local government hospitals — $2,985
  • Nonprofit hospitals — $3,752
  • For-profit hospitals — $2,118

Colorado

  • State/local government hospitals — $2,248
  • Nonprofit hospitals — $2,922
  • For-profit hospitals — $2,746

Connecticut

  • State/local government hospitals — $3,426
  • Nonprofit hospitals — $2,581
  • For-profit hospitals — $2,547

Delaware

  • State/local government hospitals — N/A
  • Nonprofit hospitals — $2,828
  • For-profit hospitals — $1,468

District of Columbia

  • State/local government hospitals — N/A
  • Nonprofit hospitals — $2,717
  • For-profit hospitals — $1,976

Florida

  • State/local government hospitals — $2,095
  • Nonprofit hospitals — $2,347
  • For-profit hospitals — $1,667

Georgia

  • State/local government hospitals — $966
  • Nonprofit hospitals — $1,887
  • For-profit hospitals — $1,789

Hawaii

  • State/local government hospitals — $1,661
  • Nonprofit hospitals — $2,618
  • For-profit hospitals — N/A

Idaho

  • State/local government hospitals — $1,677
  • Nonprofit hospitals — $3,241
  • For-profit hospitals — $2,194

Illinois

  • State/local government hospitals — $2,956
  • Nonprofit hospitals — $2,422
  • For-profit hospitals — $1,546

Indiana

  • State/local government hospitals — $1,709
  • Nonprofit hospitals — $2,477
  • For-profit hospitals — $2,202

Iowa

  • State/local government hospitals — $1,454
  • Nonprofit hospitals — $1,481
  • For-profit hospitals — $1,547

Kansas

  • State/local government hospitals — $1,184
  • Nonprofit hospitals — $1,789
  • For-profit hospitals — $1,920

Kentucky

  • State/local government hospitals — $1,748
  • Nonprofit hospitals — $1,686
  • For-profit hospitals — $1,384

Louisiana

  • State/local government hospitals — $1,659
  • Nonprofit hospitals — $1,839
  • For-profit hospitals — $1,790

Maine

  • State/local government hospitals — $1,260
  • Nonprofit hospitals — $2,396
  • For-profit hospitals — $870

Maryland

  • State/local government hospitals — N/A
  • Nonprofit hospitals — $2,521
  • For-profit hospitals — $1,108

Massachusetts

  • State/local government hospitals — $1,916
  • Nonprofit hospitals — $2,965
  • For-profit hospitals — $1,773

Michigan

  • State/local government hospitals — $1,389
  • Nonprofit hospitals — $2,204
  • For-profit hospitals — $2,196

Minnesota

  • State/local government hospitals — $1,340
  • Nonprofit hospitals — $2,277
  • For-profit hospitals — N/A

Mississippi

  • State/local government hospitals — $1,214
  • Nonprofit hospitals — $1,391
  • For-profit hospitals — $1,667

Missouri

  • State/local government hospitals — $1,599
  • Nonprofit hospitals — $2,353
  • For-profit hospitals — $1,896

Montana

  • State/local government hospitals — $522
  • Nonprofit hospitals — $1,280
  • For-profit hospitals — $2,555

Nebraska

  • State/local government hospitals — $862
  • Nonprofit hospitals — $1,980
  • For-profit hospitals — $1,838

Nevada

  • State/local government hospitals — $2,073
  • Nonprofit hospitals — $2,163
  • For-profit hospitals — $1,701

New Hampshire

  • State/local government hospitals — N/A
  • Nonprofit hospitals — $2,361
  • For-profit hospitals — $1,942

New Jersey

  • State/local government hospitals — $4,569
  • Nonprofit hospitals — $2,635
  • For-profit hospitals — $1,499

New Mexico

  • State/local government hospitals — $3,011
  • Nonprofit hospitals — $2,373
  • For-profit hospitals — $2,170

New York

  • State/local government hospitals — $2,572
  • Nonprofit hospitals — $2,456
  • For-profit hospitals — N/A

North Carolina

  • State/local government hospitals — $1,962
  • Nonprofit hospitals — $2,069
  • For-profit hospitals — $1,568

North Dakota

  • State/local government hospitals — N/A
  • Nonprofit hospitals — $1,709
  • For-profit hospitals — $4,095

Ohio

  • State/local government hospitals — $2,617
  • Nonprofit hospitals — $2,611
  • For-profit hospitals — $2,538

Oklahoma

  • State/local government hospitals — $1,360
  • Nonprofit hospitals — $1,926
  • For-profit hospitals — $1,955

Oregon

  • State/local government hospitals — $3,360
  • Nonprofit hospitals — $3,397
  • For-profit hospitals — $2,520

Pennsylvania

  • State/local government hospitals — $767
  • Nonprofit hospitals — $2,377
  • For-profit hospitals — $1,826

Rhode Island

  • State/local government hospitals — N/A
  • Nonprofit hospitals — $2,809
  • For-profit hospitals — $1,857

South Carolina

  • State/local government hospitals — $1,916
  • Nonprofit hospitals — $2,086
  • For-profit hospitals — $1,650

South Dakota

  • State/local government hospitals — $407
  • Nonprofit hospitals — $1,232
  • For-profit hospitals — $3,149

Tennessee

  • State/local government hospitals — $1,393
  • Nonprofit hospitals — $1,846
  • For-profit hospitals — $1,610

Texas

  • State/local government hospitals — $2,626
  • Nonprofit hospitals — $2,464
  • For-profit hospitals — $1,821

Utah

  • State/local government hospitals — $2,699
  • Nonprofit hospitals — $2,665
  • For-profit hospitals — $2,390

Vermont

  • State/local government hospitals — N/A
  • Nonprofit hospitals — $2,162
  • For-profit hospitals — N/A

Virginia

  • State/local government hospitals — $3,132
  • Nonprofit hospitals — $1,816
  • For-profit hospitals — $1,781

Washington

  • State/local government hospitals — $2,689
  • Nonprofit hospitals — $3,592
  • For-profit hospitals — $2,529

West Virginia

  • State/local government hospitals — $781
  • Nonprofit hospitals — $1,748
  • For-profit hospitals — $1,135

Wisconsin

  • State/local government hospitals — $2,532
  • Nonprofit hospitals — $2,271
  • For-profit hospitals — $2,687

Wyoming

  • State/local government hospitals — $1,405
  • Nonprofit hospitals — $2,036
  • For-profit hospitals — $2,146

My past research suggests that nonprofit hospitals are better at deploying new technology to support patients than are either for-profit or government facilities.  Nonprofits don’t have the limits on spending that profit margins or government budgets place on the other types of facilities.  Our choices about where to go for care are based in part on that.

What you need to know:

You need to shop around to determine where you prefer to be treated.  You can’t wait for an emergency to make that decision.  And if your local hospital is no better than a “band-aid station”, you need to know where you want to go.


Soources:

Choosing a Doctor, Revisited

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In an earlier blog, I reposted the report of a speech by a senior physician regarding how hedoctor-clip-art-doctor-clip-art-4 selected a specialist for his own treatment.  I added information in subsequent posts about issues to consider in selecting a doctor as that information became available.  It’s time to add to that knowledge again.

For some US residents, there is a stigma attached to a doctor who receives medical training outside the US.  Because offshore schools aren’t accredited by US institutions and typically cost much less to attend, there is a feeling that the training provided is not as good as that provided by US medical schools.

To test that theory, a team at Harvard conducted a statistical analysis of patient treatment and outcomes, comparing results between US-trained doctors and those trained outside the US and practice in the US.

The report on this research notes that

To practice in the US, international medical school graduates must pass two exams on medical knowledge and one assessment of clinical skills, and complete accredited residency training here. However, medical schools outside the US are not accredited by any domestic agency. In response to concerns about quality of care from internationally trained physicians, the Educational Commission for Foreign Medical Graduates will require accreditation of medical schools outside the US by 2023. [Lewis]

The study looked at hospital admissions under the care of a general internist between 2011 and 2014.  Data from 44,227 general internists were included in the research, of which 44% had graduated from medical schools in one of the following countries:  China, Egypt, India, Mexico, Nigeria, Pakistan, the Philippines, and Syria.  Graduates of schools in the Caribbean were excluded from the research, on the grounds that most of those are US citizens and the fact that they studied outside the US would not be obvious to a patient.

The only two statistically significant differences between US-educated and foreign-educated doctors were

  • The cost of care was slightly higher on average for those with offshore training ($47), and
  • There was a lower rate of death among patients of offshore-trained physicians.

(Hmm.  Which is more important to you, $47 or dying?)

The general conclusion from this research is that there is no difference in quality of care between physicians practicing in the US and who attended medical school in the US or in the listed countries.

______________

Sources:

 

What’s Best for the Patient?

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[Note: in all of my writing, I try to place personal opinion in blue italic font to separate it from what I am reporting from other sources.]

doctor-clip-art-doctor-clip-art-4There are a number of factors that can affect decisions that doctors make about patient care. What’s “objectively best” for the patient may be only one consideration.  Patients need to know this.  While you may not be a doctor, you bear the ultimate responsibility for your own care.  You’re the one who has to live with the results.

 

Recent articles point to some of the issues that can impact treatment:

  • Doctor revenue.  Doctors can (and a few have been accused of this) maximize revenue by ordering unnecessary tests and performing unnecessary procedures.
    • A common example in the literature is the use of CT, MRI or X-ray in the first 30 days after reporting lower back pain.  Other systems besides back pain may require these test, but for lower back pain alone, no.
      • “One study found that people who got an MRI during the first month of their back pain were eight times more likely to have surgery than those who didn’t have an MRI — but they didn’t get relief any faster.” [Agnvall]
    • 61 doctors were among 301 people criminally charged earlier in 2016 with billing Medicare for care and prescriptions that weren’t medically necessary.
    • One of the current curiosities concerns rotator cuff surgery
      • Outpatient rotator cuff surgeries have increased by 272% in the last 5 years.  (Are we really that much more active??)
      • Rates of post surgery problems vary between surgery facilities from a low of 1/2% to 20%.  (If you need the work, are you having it done by the right doc?)
  • Measurements used in the current Federal “pay for performance” initiative.  “Pay for performance” is an effort to reward doctors and hospitals that delivery high quality care and penalize those that don’t.  The metrics include patient satisfaction questions, and some doctors argue that inclusion of those questions might cause doctors to cater more to what patients want than what is medically necessary.
    • That in turn raises two questions
      1. If docs pay more attention to what patients are saying, is that a bad thing?
      2. This criticism by surgeons seems similar to the complaints some teachers have about standardized testing.  In both situations, would the absence of any metrics make the situation better?
  • What insurance will cover, of course.
    • However, a dedicated physician can encourage the insurer to do the right thing.
    • My wife was injured, and the doctor felt she required a treatment the insurer was unwilling to approve.  His reaction was to hospitalize her (for which the insurer was committed to pay) until the insurer agreed to the treatment.  It worked.

What you need to do:

  • Learn how to search for information on your medical symptoms before you consult with a medical professional.  Be an informed patient.  If you don’t know, ask someone for help.
  • Prepare intelligent questions for your conversation with the doctor.
  • If tests are recommended, ask what they will accomplish.
  • If surgery is discussed, consult another doctor from a different medical practice who is unknown to the first doctor.  Conflicts of interest can be a problem, and you don’t want to go there.

Sources:

  1. Agnvall, Elizabeth, “10 Test to Avoid,” AARP Bulletin, 3 December 2015.  http://www.aarp.org/health/conditions-treatments/info-2014/choosing-wisely-medical-tests-to-avoid.html
  2. Cohen, Jessica Kim, “Outpatient rotator cuff repairs increase 272% in a decade — 5 facts on orthopedics in ASCs,” Becker’s ACS Review, 4 January 2017.  http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/outpatient-rotator-cuff-repairs-increase-272-in-a-decade-5-facts-on-orthopedics-in-ascs.html
  3. Frelick, Marcia, “Current Measures Flawed, Could Cause Problems, Surgeons Say,” Medscape.com, 6 January 2016.
  4. Gawande, Atul, “Overkill”, The New Yorker, 11 May 2015.  http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
  5. Haelle, Tara “Putting Tests to the Test: Many Medical Procedures Prove Unnecessary—and Risky,” Scientific American, 5 March 2013.  https://www.scientificamerican.com/article/medical-procedures-prove-unnecessary/
  6. Sandhu, Sarina, “40 common treatments and tests that doctors say aren’t necessary,” iNews, 24 October 2016.  https://inews.co.uk/essentials/news/health/40-treatments-doctors-saying-bring-little-benefit/
  7. Sun-Times Wire, “Skokie, Buffalo Grove doctors charged in Medicare fraud sweep,” Chicago Sun-Times, 23 June 2016.  http://chicago.suntimes.com/news/2-suburban-doctors-charged-with-medicare-fraud/

New Tools for Seeing Brain Injuries

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snyder-the-unseen-victims-of-traumatic-brain-injury-from-domestic-violence-1200One of the limitations on doctors ability to treat many diseases is the inability to see the disease.  That’s true with many cancers, where the exact boundaries of a cancer aren’t visible and isolated cell clusters can be missed entirely.  It’s especially true with brain injuries, where relatively subtle dislocations of neurons can have massive consequences on functioning, pain and quality of life.

It’s also been a complaint of trial lawyers in injury cases.  Juries can see wheelchairs and crutches.  Internal injuries, especially of the brain, often don’t exhibit outward signs and make it harder to prove injury to skeptical panels.

Now, researchers at a Canadian university (Simon Frasier University in British Columbia) have developed a new use for a high resolution brain scan technology in the identification of brain injuries.  This technique reportedly can identify injuries that are invisible to traditional CAT scans and MRIs cannot.

The technology is magnetoencephalography, or MEG. The method was pioneered at the University of Illinois in 1968 by physicist, David Cohen.  It’s use to date has been to understand and map brain activity and assess seizures in epilepsy. The strength of MEG is precision: it measures brain activity in much smaller time increments and measures electronic signals that are quite faint relative to the environment in which most people function.

The use  use of MEG to assess brain injury is new.  This approach maps the passing of electronic signals between different regions of the brain.  Changes in these patterns can identify injury when actual damage is too subtle to detect.  Statistical modeling allows the doctor to determine the location of injury.

Why does  this matter?  We’ve seen how brain injuries can affect quality of life and even the ability to follow commands and make critical decisions in crisis situations.  We’ve also heard testimony from people who have been injured and been accused of “faking it.”  Now we may have the ability to prove injury in the absence of outward physical signs and make better decisions about what to do with people with real hurt.

MEG, like other leading technologies, is not readily accessible to people in all parts of the US.  That makes the case for supplement insurance (e.g., the Aflac Accident Policy) to pay for travel that may be required for state-of-the-art treatment.


Sources:

 

The Unexpected Costs of Beating Cancer

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Cancer is a scary word for most people.  The C-word — some refuse to say its name — in the past has meant lengthy treatment with poisons and uncertain results.  If identified later in development, its often a death sentence.  The side effects of treatment (radiation and chemotherapy) are at best unpleasant.

We have a new class of drugs to treat cancer.  The class is called hypnotherapy, and it works by enabling the body’s own immune system to attack and destroy cancer cells.  Immune system cells (T-cells) see cancer cells as “normal.”  Immunotherapy changes the system by which T-cells identify alien cells to attack, allowing them to go after cancer cells.  For a lot of patients, this can be very effective in eliminating cancer.

The problem, as discussed in a New York Times story today, is that changing how T-cells identify targets can also allow them to attack cells that are truly normal and useful to the body — cells that make up the liver, lungs, pancreas and heart.  For some of the new drugs in this class, side effects can occur between 30% and 50% of the time and can range from mild to lethal.

Typical side effects can include:

  • Fatigue
  • Chills
  • Nausea
  • Reaction at the infusion site

More advanced reactions can include:

  • Pneumonitis (inflammation of the lungs resulting in cough and difficulty breathing)
  • Colitis (inflammation of the large bowel leading to diarrhea)
  • Hepatitis and pancreatitis
  • Skin rashes
  • Endocrine disorders including thyroid abnormalities and adrenal insufficiency (1)

People who survive the treatment have been known to develop a late-life version of Type I diabetes, requiring daily administration of insulin.  In one clinical trial, five health individuals who received the immunotherapy drug died.

The risk is greater for patients outside major urban medical research centers.  Doctors in these areas are unlikely to have seen the side effects from these drugs and may misdiagnose or delay treatment — and that can be life threatening.  Because some of the symptoms resemble flu, it can be easy for inexperienced doctors to fail to recognize either the urgency or the required treatment.  (Inexperienced in this can can refer to veteran doctors who simply have limited or no experience with these drugs and their side effects.)

Bottom line:

  1. With any cancer therapy, the patient needs to understand that there may be impacts on quality of life and make a conscious choice as to how much risk/impact he or she is willing to accept.
  2. The best course of action is behavioral change and early detection.  That means looking at diet and exercise and learning the early warning signs and how to self-examine.
    • One oncologist I know swears by a concoction that he drinks once per day made up of 2 cups of kale or spinach, a one-inch slice of pineapple and one green apple (e.g., granny smith).  There are other docs with other suggestions.
    • Pets have been known to sense cancer in owners.  If you pet changes behavior, and starts nuzzling part of your body, it’s worth exploring why.
    • Regular doctor visits and screenings.

Anything can be relatively quick and easy to beat at Stage 1.  The length of treatment, cost, and potential for a bad outcome rise with each Stage.

If you’re not going to take care of yourself, then make sure you have your will done.  No reason to create problems for your heirs.


Sources:

  1. Dana Farber Cancer Center, “What Are the Side Effects of Immunotherapy?”, 8 March 2016.  http://blog.dana-farber.org/insight/2016/02/what-are-the-side-effects-of-immunotherapy/
  2. Hackethal, Veronica, MD, “How to Treat Side Effects of New Cancer Immunotherapies”, Medscape, 6 May 2015.  http://www.medscape.com/viewarticle/844264
  3. National Cancer Institute, “Immunotherapy”.  https://www.cancer.gov/about-cancer/treatment/types/immunotherapy
  4. Richtel, Matt, “Immune System, Unleashed by Cancer Therapies, Can Attack Organs”, The New York Times, 3 December 2016.  http://www.nytimes.com/2016/12/03/health/immunotherapy-cancer.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0