Saturday, July 04, 2009

If it's not measured, it doesn't happen

There's a strategy currently in implementation at National Review's The Corner to cut and paste from whatever is the latest NHS horror story in the Daily Mail or Telegraph and ... what? Presumably it's meant as an implicit argument against "socialized medicine" of whatever variant Barack Obama's health plan will finally involve. Here are Jonah Goldberg and Mark Steyn in the last couple of days --

Basic hygiene accounts for a big chunk of physical well-being, but it's one of the first things to fall by the wayside in socialized systems, which is why they become hotbeds of C Difficile, MRSA, and the like ... Well, it seems there's more work to be done. From the BBC: Maggot infestation hunt continues

The obvious problem is that for this "argument" to have any scientific content, it should come with statistics showing that these problems are not significant in the US healthcare system. Which Steyn and Goldberg don't provide. Now one can't know whether they even looked, but as it happens, it's not easy. Centralized health systems, or at least those with centralized financing, produce centralized health statistics. Balkanized provisions systems like the US don't.

Now in fact, it's not very hard to produce anecdotal infection horror stories in the US -- just ask around among friends who've had surgery recently. But with some research, the concrete statistics are there --

[Link] Hospital-acquired infections with Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA) infections, are a major cause of illness and death and impose serious economic costs on patients and hospitals. However, the recent magnitude and trend of these infections have not been reported. We used national hospitalization and resistance data to estimate the annual number of hospitalizations and deaths associated with S. aureus and MRSA from 1999 through 2005. During this period, the estimated number of S. aureus–related hospitalizations increased 62%, from 294,570 to 477,927, and the estimated number of MRSA-related hospitalizations more than doubled, from 127,036 to 278,203.

[Link] US hospital discharges for which Clostridium difficile–associated disease (CDAD) was listed as any diagnosis doubled from 82,000 (95% confidence interval [CI] 71,000–94,000) or 31/100,000 population in 1996 to 178,000 (95% CI 151,000–205,000) or 61/100,000 in 2003; this increase was significant between 2000 and 2003 (slope of linear trend 9.48; 95% CI 6.16–12.80, p = 0.01). The overall rate during this period was severalfold higher in persons >65 years of age (228/100,000) than in the age group with the next highest rate, 45–64 years (40/100,000; p<0.001). CDAD appears to be increasing rapidly in the United States and is disproportionately affecting older persons.

So apparently a damning indictment of the US healthcare system would be available if newspapers just started writing up a few of these cases.

UPDATE: Paul O'Neill in the New York Times on the high cost of hospital-acquired infections in the USA.

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