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Despite comparative evidence that US healthcare is very expensive and not particularly good by international standards, Americans seem to love it as evidenced by the debate on Obamacare and questions like this: Is the US Newborn Mortality Rate higher than 40 Countries? and this: Is more than 30% of US healthcare spending waste? .

A recent paper points out that, despite their extent, medical errors are not listed alongside other major causes of death in "top ten" tables of mortality. As the article summarises:

Medical error has been reliably identified as among America’s leading causes of death. Yet it never appears in “top ten causes of death” charts that periodically appear in the literature

and

Accounting for medical error as among the leading causes of death would require these data sets be integrated in a way that would force error to appear in causal compilations. Including fatal medical error in “top ten causes of death” charts and disclosing it during public end-of-life informational presentations would be an act of participatory medicine on several counts: for medicine, ownership, transparency, and disclosure; which would offer citizens the opportunity to factor error into our risk/benefit calculations as we ponder what we must do to increase our likelihood of dying in peace.

I have two interlinked questions, one direct and one implied by the article: Is the key claim correct in saying that medical error is rarely reported alongside other causes of death? and would including it alter the US perception that they have an excellent healthcare system?

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matt_black
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  • The CBC broadcast on this topic yesterday (for Canada not the US). There's a corresponding website at http://www.cbc.ca/news/health/features/ratemyhospital/ which (today) has headlines like, "Hospitals slow to learn from own mistakes", "Provinces team up to block CBC's hospital data request", and others. – ChrisW Apr 25 '13 at 23:23
  • I don't have any of the old resources at hand, but this is an issue I used to work on politically - a lot of obfuscation of medical errors goes on, such that the reported cause of death tends not to reflect errors that are often at the root cause. (For instance, "Drug Overdose" is reported after a botched prescription is filed.) – LessPop_MoreFizz Apr 26 '13 at 00:47
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    Without wanting to defend any (alleged) nefariousness or obfuscation, I wonder if having a single cause of death is not a bit simplistic. For example, if a person enters a hospital with serious gunshot wounds, and has a 20% chance of surviving, and a doctor makes a suboptimal care decision that reduces that chance to 2%, and the patient dies, what was the cause of death? We have two separate problems that both need addressing. – Oddthinking Apr 26 '13 at 02:31
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    Also, the high cost of the system is in large part not due to medical expenses but legal expenses to defend against lawsuits. In other countries with similar medical budgets that cost is much lower. Lower the maximum payouts and put in stiff penalties for frivolous or fraudulent claims and you reduce that overhead, leaving a lot more money for medical care (which already is far superior to most countries, it's just the value for money that's poor because of those legal costs). – jwenting Apr 26 '13 at 06:03
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    @Oddthinking Good point, but worth looking at the detail. Many medical errors cause death when patients are admitted for minor treatments. Some analysis required. – matt_black Apr 26 '13 at 11:49
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    @jwenting You might be right, but I'm not convinced. While US legal bills are high, there are plenty of other factors that drive up cost compared to other systems. Maybe that deserves a separate question and some analysis? – matt_black Apr 26 '13 at 11:51
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    @matt_black also consider that the legal threat causes a lot of unnecessary or superfluous procedures, performed "just in case". Procedures that are costly and carry their own risk (e.g. the US performs far more CAT scans and similar diagnostic procedures per resident than other countries because doctors are mortified of being sued in case they miss something that a scan could possibly have shown, often leading to ghost images giving cause for invasive procedures including chemo and radiation therapy). That cost should be added to the legal burden. – jwenting Apr 26 '13 at 11:58
  • @matt_black - while the factual premise of the question is interesting, how is it related to obamacare in any way? (as jwenting noted, the cost of defensive medicine, insurance, and tort costs are the main related items, and none of them are addressed by ACA as far as I'm aware). – user5341 Apr 26 '13 at 18:20
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    @DVK I only meant to use the debate on Obamacare to illustrate the extent to which Americans tend to oppose changes to a system most outsiders think is broken and in need of much change. An outside judgement of the Obama changes would probably conclude that one of their major failings was the lack of mechanisms to lower cost or improve quality. – matt_black Apr 26 '13 at 22:54
  • @jwenting While the threat of legal action is a plausible hypothteis for why over-diagnosis and over-treatment are so common, it is not the only one and I would like to see actual evidence. For example, many medics make significant profits when they refer their patients for unnecessary scans and the profit motive might explain more than fear of litigation. We can debate plausible stories forever but we can only resolve which is true with evidence. – matt_black Apr 26 '13 at 22:58
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    Still picking up down votes. Anyone want to tell me why so we can improve the question? – matt_black Mar 05 '14 at 19:52
  • I did not downvote you, but my suspicion is that the "would this alter perception" bit is either seen as subjective or implying that people should really know that the healthcare system sucks and "why don't they know this?". – Sean Duggan Dec 25 '14 at 15:44
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    The problem with comparing these statistics is assuming that there is one over-all standard of health care in a given country. Imagine two groups like this: (8,8,8,1) vs. (7,7,7,7) - overall, the second group has a higher average - but 3/4ths of the first group would rather be in the first group than the second. They might be very vocal in their preference of an 8 over being given a 7. I wouldn't expect *individuals* to deeply care about the over-all statistics...they'd care about the experiences they personally have. An outsider is more likely to look at the average. – Rob P. Dec 30 '14 at 17:43
  • @RobP. Also, the civic-minded person in the (8,8,8,1) society feels the right approach is to fix what's causing the 1 rather than move to the (7,7,7,7) system. – Loren Pechtel Jun 12 '15 at 18:52

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