Dear HE list:
I would agree with Needleman that the two positions are
complimentary.
A major difficulty with mortality rates is that they are all quite close
for developed countries. Thus one could realistically argue that "74.6
years" is actuall worse than Country B's "74.2 years" since there is this
that or the other quality of life improvement not accounted for.
Also, I think life expectancy after 1 or 5 years is a much better
indicator of "true" life expectancy because of persistent inconsistencies
in the measurment of births & perinatal death rates.
Given all that, my own position is that life expectancies (and in
particular, probabilities of living from say 25 to 65) are rather good
indicators of what we THINK we want the health system to do.
I suspect that the public vastly overestimates the impact of medical care
on their personal probablity of adverse outcomes. A great advantadge of
the mortality rate comparisons has been to give some leverage to those who
want to question the unmeasured benefits of large expansions in the number
of procedures (consider for example Ted MArmor's provocative comparisons
of surgical rates in the US and JApan).
Also, the sudden rise in russian mortality has certainly been useful to
those who think about the role of health systems and social disorder.
I was thinking of writing a brief piece arguing that the market "value" of
medical care advances may be declining as the raw mortality among
economically active persons declines--or rather that the willingness of
workers to pay for advances that mostly benefit non-workers may decline.
Does that seem sensible, or senseless, to anyone out there?
Tom Getzen, Temple U / iHEA
On Mon, 5 Oct 1998, Jack Needleman wrote:
> On Mon, 5 Oct 1998, Philip Clarke wrote:
>
> > Dear All,
> >
> > Following Bill Swan's recent contribution I'll raise an issue that could
> > generate some debate on this list...
> >
> > An editorial in the January 1998 edition of CHE News (from the Centre for
> > Health Economics, University of York) states: "International comparisons
> > of population health have often relied upon such indicators as life
> > expectancy or the infant mortality rate. The usefulness of these
> > indicators, and indeed the purpose of such comparisons is open to question-
> > after all, population health is influenced by many factors, perhaps most of
> > which lie outside the control of any health care system."
> >
> > The Economic Journal in the same month published an article by Amartya Sen
> > that takes a contrary view (Sen 1998). Sen urges economists to make greater
> > use of mortality statistics such as life expectancy. ("Mortality statistics
> > can form a major component of the informational base of economic
> > analysis"(p.23)). Further, comparisons of mortality (between nations, men
> > and women and different races) provide an important indicator of the
> > inequalities that exist in the world.
> >
> > Given this divergence of view I would be interested in finding out the
>
>
> I don't see the two views as divergent. The editorial argues that
> mortality statistics are influenced more by other aspects of social and
> economic organization than the health care system. Sen proposes using
> them as measures, not of the performance of the health care system, of
> economic inequality and the impact of the social and economic organization
> of a society. The two statements are complementary.
>
> Jack Needleman
> Harvard School of Public Health
>
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