Health care - administrative incompetence

Professor Yaffle said:
Do you know what proportion of deaths in the infant mortality rate of the US is comprised of such deaths (ie at 22 weeks that wouldn't be counted by other countries)? And how does the amount of spending on fertility treatments relate to infant mortality rates? [ETA - after a moment's thought, I presume this is something to do with increased numbers of multiple-foetus pregnancies?]

(these are not gotcha questions, I genuinely don't know the answers)
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Not yet, but do we know what is or is not included in infant deaths in other countries? I only know that apparently the US considers all infants who show signs of life after separation from their mother are counted, regardless of gestational age. We do not know that is true of other countries though. And yes, the fertility treatments result in multiple fetus pregnancies which result in premature babies and a higher IMR.
 
PDiGirolamo said:
Not yet, but do we know what is or is not included in infant deaths in other countries? I only know that apparently the US considers all infants who show signs of life after separation from their mother are counted, regardless of gestational age.
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So you are using it as an argument against the figures without knowing whether any differences might cause significant disparities?

And yes, the fertility treatments result in multiple fetus pregnancies which result in premature babies and a higher IMR.
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After a little bit of looking around, I found some sources suggesting that there is lower per capita utilisation of IVF in the USA than elsewhere:

The use of IVF is greater in countries that subsidize expenses. For example, in 1998, per capita use of IVF was about three times greater in France, the Netherlands, Norway and Sweden than in the US, and five times greater in Denmark, Finland, and Iceland.
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But you do pay more for it:

Recently, Collins estimated the median cost per IVF cycle in 2001 in the US to be $9,226, and the cost per live birth to be $56,419, whereas non-US costs were significantly lower, at $3,531 for IVF (based on data from 25 countries) and $20,522 per live birth (based on data from 8 countries)
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And you may very well have more multiple births (ETA - apparently you do for triplets and above - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447238/), but I suspect this to be a consequence of your health care system. Most countries with UHC reduced the number of embryos transferred more than the USA did:

In the US in 1998, three or more embryos were transferred in 80% of ART cycles and in 47% of cycles, four or more embryos were transferred. In contrast, three or more embryos were transferred in 51% of European cycles, and four or more were transferred in only 9% of cycles, although in practice there is wide variation. In 1998, the percentage of IVF births that were multiples was higher in the US than in Europe. Over one-third of the IVF births in the US were multiples (32% twins, 7% triplets or more), compared with 26% in Europe (24% twins, 2% triplets or more; see Fig. 2). Furthermore, in the US, 57% of children born from IVF were multiples, compared to 43% in Europe.
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http://www.nature.com/fertility/content/full/ncb-nm-fertilitys29.html
 
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PDiGirolamo said:
Not yet, but do we know what is or is not included in infant deaths in other countries? I only know that apparently the US considers all infants who show signs of life after separation from their mother are counted, regardless of gestational age. We do not know that is true of other countries though. And yes, the fertility treatments result in multiple fetus pregnancies which result in premature babies and a higher IMR.
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Infant mortality is death under 1 year of age. Child mortality is under 5.

The UK would class a child who draws one breath as not still borne but would count towards the infant mortality stats. AFAIK the UK requires registration of still borns over 24 weeks (from memory), but obviously if one breath taken, regarless of gestatation it counts towards infant mortality.

http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_rates
 
Delscottio said:
Infant mortality is death under 1 year of age. Child mortality is under 5.

The UK would class a child who draws one breath as not still borne but would count towards the infant mortality stats. AFAIK the UK requires registration of still borns over 24 weeks (from memory), but obviously if one breath taken, regarless of gestatation it counts towards infant mortality.

http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_rates
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Per your link:
However, the method of calculating IMR often varies widely between countries, and is based on how they define a live birth and how many premature infants are born in the country.

Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[5]

Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control (CDC) researchers, some other countries differ in these practices.

However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries.

Which is exactly what I was saying. It seems like we can't use IMR in comparisons between UHC countries and non-UHC countries.
 
PDiGirolamo said:
Many countries, including the United States, Sweden or Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States Centers for Disease Control (CDC) researchers, some other countries differ in these practices.
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How does your infant mortality rate compare with Sweden and Germany?

ETA: I looked at the CDC report and while it does say that a lot of the difference in IM is due to the US having a high rate of preterm birth (which might also have to do with healthcare - lack of antenatal care in some cases?), they also say:

The United States compares favorably with European countries in infant mortality rates for preterm, but not for term infants.
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If we look only at infants born at 37 weeks or more (full term) here are the figures:

United States 2.4
Austria 1.5
Denmark 2.3
England and Wales 1.8
Finland 1.4
Northern Ireland 1.6
Norway 1.5
Poland 2.3
Scotland 1.7
Sweden 1.5

http://www.cdc.gov/nchs/data/databriefs/db23.htm
 
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Professor Yaffle said:
So you are using it as an argument against the figures without knowing whether any differences might cause significant disparities?
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I have not yet found how it affects the figures but the fact that differences exist indicate the statistics are affected. I'm just saying we probably should not use Infant Mortality Rates when comparing the countries in the debate about UHC.
 
PDiGirolamo said:
I have not yet found how it affects the figures but the fact that differences exist indicate the statistics are affected. I'm just saying we probably should not use Infant Mortality Rates when comparing the countries in the debate about UHC.
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How about full term IM rates (see my ETA on previous post).
 
Professor Yaffle said:
How about full term IM rates (see my ETA on previous post).
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Interestingly everything I can find states it is due to Sudden Infant Death Syndrome, accidents, assaults, and homicides.

The high rate of preterm infants is discussed in terms of healthcare but healthcare is not even mentioned as it relates to full term IM rates. I guess once they're born we manage to kill them off via accident or homicide, if they don't die from SIDS.
 
PDiGirolamo said:
Interestingly everything I can find states it is due to Sudden Infant Death Syndrome, accidents, assaults, and homicides.

The high rate of preterm infants is discussed in terms of healthcare but healthcare is not even mentioned as it relates to full term IM rates. I guess once they're born we manage to kill them off via accident or homicide, if they don't die from SIDS.
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So it's our entire society that's uniquely deadly for infants compared to the rest of the (more progressive) developed world??

:confused:

I'm not opposed to that interpretation, as I see our unique lack of UHC as a symptom of a deeper ideological cause, but still.

Also, do accidents and murders, etc account for the whole difference? If so, can I get a link?
 
American society is not "uniquely deadly" for infants. The US is slightly worse than other developed countries, but a whole lot better than others. There are specific reasons why the US has a slightly higher IMR (and lower LE for that matter) than other countries and they are social in nature and have little to do with the healthcare system.
 
The thing is, nobody has been trying to argue that the US has much worse results than the rest of the developed world. The claim is that you spend way more than other countries for broadly comparable outcomes.
 
xjx388 said:
American society is not "uniquely deadly" for infants. The US is slightly worse than other developed countries, but a whole lot better than others.
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I said "compared to the rest of the (more progressive) developed world".

I know we're doing better than the Congo, Tanzania, and other developing nations.

But still.

Jesus.
 
PDiGirolamo said:
I have not yet found how it affects the figures but the fact that differences exist indicate the statistics are affected. I'm just saying we probably should not use Infant Mortality Rates when comparing the countries in the debate about UHC.
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I think that we're saying that no-one has suggested an alternative measure which can cover the broad spectrum of the healthcare system/population, rather than proposing IM and LE as ideal.

Take the debate on cancer rates, where assessment gets tied up in a statistical analysis that makes your eyes water.

This in turn takes us back to the point that no-one is saying that your clinical outcomes such, rather that you get broadly comparable results for 50-100% more than the rest of us spend.
 
Architect said:
...snip...

This in turn takes us back to the point that no-one is saying that your clinical outcomes such, rather that you get broadly comparable results for 50-100% more than the rest of us spend.
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I would say that there has been nothing demonstrated that indicates that the USA is somehow either very or uniquely different to other developed countries, therefore even if it didn't spend one extra cent on healthcare it is possible for it to have the best healthcare system in the world for all citizens.
 
Darat said:
I would say that there has been nothing demonstrated that indicates that the USA is somehow either very or uniquely different to other developed countries, therefore even if it didn't spend one extra cent on healthcare it is possible for it to have the best healthcare system in the world for all citizens.
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Doesn't the USA have the highest levels of inequality amongst developed countries?

Perhaps the USA has crossed a tipping point and cannot implement a UHC system because inequality is too entrenched in its society.

I only hope the UK hasn't gone past the point of no return yet.
 
Incidentally "such" in my post should, of course, read "suck". If a Mod wishes to fix it then I'd be grateful.....
 
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