Facts, Facts, Facts: What Is a Physician to Do?
Authors: Robert H. Brook
Journal: JAMA (2011)

IT IS A CLICHE TO OBSERVE THAT EVERYONE LIVES IN A GLOBAL economy. Anyone who travels internationally can see how rapidly the world is becoming similar in terms of shops, goods, and services. Perhaps it is timely to reengage physicians in thediscussion of international comparativedata about health care and to ask why the United States is so provincial in designing the systems by which care is delivered. Recently the Organisation for Economic Co-operation and Development (OECD) published Health at a Glance 2009, the annual compilation of health statistics from 30 countries. Even though most of the data are from 2007, these statistics provide revealing snapshots of various aspects of health and health systems, especially when comparing several US statistics to comparable statistics from other countries. Seventeen comparisons were selected to be representative of the different concepts (health status, nonmedical determinants of health, health work force, health care activities, quality of care, and health expenditures) that are covered in the OECD report. The comparisons (reported as United States; another country) are as follows. 1. Life expectancy in the United States is 78.1 years; in Switzerland, it is 81.9 years. 2. Years of life lost before age 70 per 100 000 men is 6291; in Italy, it is 3605. 3. The age-standardized ischemic heart mortality rate per 100 000 males is 145; in France, it is 54. 4. The percentage of newborns weighing less than 2500 g is 8.3%; in Ireland, it is 5%. 5. The percentage of children aged 11 to 15 years who are overweight or obese is 29.8%; in Belgium, it is 10.5%. 6. The number of practicing physicians per 1000 population is 2.4; in Belgium, it is 4.0. 7. The percentage of US physicians who are non-US trained is 25.9%; in the Netherlands, the percentage of non-Netherlands−trained physicians is 6.3%. 8. The ratio of the self-employed specialist’s average salary to the average salary of a full-time employee is 5.6:1; in Germany, the ratio is 4.1:1. For a selfemployed general practitioner, the comparable ratio is 3.7:1; in Canada, it is 3.1:1. 9. The number of physician consultations per capita is 3.8; in Germany, it is 7.5, and in Japan, it is 13.6. 10. The number of consultations per physician per year (data are from administrative sources and include visits in physician offices, hospital outpatient clinics, or patient homes) is 1570; in Korea, it is 7251 and in Canada, it is 3335 (fee-for-service visits only). 11. The number of magnetic resonance imaging (MRI) machines per 1 000 000 of population is 25.9; in Japan, it is 40.1; in Canada, it is 6.7. 12. The number of MRI examinations per 1000 population is 91.2; in Canada, the number is 31.2. 13. The hospital discharge rate is 126 per 1000; in France, it is 274. 14. The coronary revascularization rate is 521 per 100 000; in Switzerland, it is 144 and in Ireland, it is 128. 15. The number of patients treated for end-stage renal failureis169per100 000population; intheNetherlands, it is 77. 16. The age-sex standardized in-hospital death rate for acute myocardial infarction is 5.1%; in Sweden, it is 2.9%. 17. Health expenditures are 16.0% of gross domestic product; in France, 11% and in Ireland, 7.6%.