Thinking stuffs

Chris asked me to post my final term paper I did for my Population and Society class. Maybe it's because he wants to get mileage out of my tuition fees. But more likely it's because we're pretty pro-healthy babies around here and want to share the info.

How Universal Healthcare Affects Infant Mortality

Infant mortality, which is measured in number of infant deaths per 1,000 live births, is a very important indicator of the health of a nation. This indication of a nation’s well being has been well documented with research. The leading causes of infant deaths are congenital malformations, pre-maturity, sudden infant death syndrome, respiratory distress syndrome, infections and accidents (OECD 2009). The current healthcare system in the United States lacks coverage and support for its newest citizens. In analyzing data from similar countries with universal healthcare it is found that with full health coverage the rates of infant mortality can be greatly reduced.

Data compiled indicates that the United States falls surprisingly low on the infant mortality charts for a high income country. In a recent study conducted in 2009, of 224 countries surveyed the United States ranked number 180. Angola ranked number 1 as the country with the worst infant mortality rate of 180.2 infant deaths per 1,000 live births. As indicated in the chart above, 44 other countries have lower infant mortality rates than the United States, such as Cuba, Hungary and the Czech Republic (CIA 2009). Surprisingly, all of these countries have one thing in common that the United States does not, universal healthcare. “….some nations ranked high in part because they offer free health services for pregnant women and babies, while the United States suffers from disparities in access to health care.” (Green 2006)

Lack of public healthcare is not the only factor in the United States’ poor infant mortality ranking. Educational attainment, family income and race of the mother also play a big part in the mortality of the child. "In 2001, infants born of black mothers were dying at a rate of 14.2 per thousand. That's a Third World figure, comparable to Russia's." (Dressel 2006) Other areas that have an influence on the health of the infant are female education, having a trained attendant at the birth and availability and use of family planning services (Green 2006).

United States and Canada can easily be compared as two countries whose overall survival and mortality rates were almost identical in 1971. At this time Canada switched to universal healthcare while the United States continued with private care. The similarities in the countries has provided excellent data regarding the effectiveness of private or public healthcare. Data has shown that Canada has emerged clearly the winner in the health and longevity of its citizens. More Canadian babies survive their first year and live longer lives. "If the U.S. infant mortality rate were the same as Canada's, almost 15,000 more babies would survive in the United States every year." (Dressel 2006)

The amount spent on health care in Canada and the United States is vastly different. According to the Organisation for Economic and Co-operative Development (OECD), in 1998 Canada spent only $2,312 per person on health care, compared to the U.S. $4,178 per person. Canada’s infant mortality rate is 5.2 deaths per 1,000 births, compared to the U.S. rate of 6.9. Spending more money on health care certainly does not lead to more lives saved. “High cost of health care in the United States can be attributed to a number of factors, ranging from the rising costs of medical technology and prescription drugs to the high administrative costs resulting the complex multiple payer system in the U.S. For example, it has been estimated that between 19.3 and 24.1 percent of the total dollars spent on health care in the U.S. is spent simply on administrative costs.” (University of Maine, 2001)

France, also a highly developed country with universal healthcare, has an excellent system in place for prenatal and early childhood care. France has thousands of healthcare facilities in operation to ensure that every mother and child in the country receives basic preventative care. Mothers receive a financial incentive for attending pre-natal and post-natal visits. If a child misses a check-up, social workers will be dispatched to locate that child. With France’s infant death rate at 3.9 per 1,000 live births, it is far exceeding the infant mortality rate in the United States (Capell 2007).

The availability of health care currently in the United States is inadequate. Pre-existing conditions, cost, eligibility and availability prevent many citizens from obtaining private health insurance. To have insurance easily available only to the employed and healthy seems counter-intuitive.

Of all of the OECD nations in 1997, the United States had the largest percentage of citizens without government-assured health insurance coverage. Only 33 percent of the U.S. population had health insurance coverage assured by the government - those with Medicare, Medicaid, Indian Health Service, civil service, or military coverage. In 1997 an estimated forty-three million Americans were uninsured. (Anderson et all, 1999)

The high proportion of people who are uninsured in the United States greatly contributes to expensive health care because conditions that could have been treated in the early stages often develop into a health crisis. The uninsured are also a population of people who are unable to pay their medical bills, leading to rising insurance costs for the insured. Bankruptcy is a very common byproduct of expensive healthcare. “Today, over half the family bankruptcies filed every year in the United States are directly related to medical expenses, and a recent study shows that 75 percent of those are filed by people with health insurance.” (Dressel 2006) The failures of the healthcare system are felt most sharply by the poor. They are driven deeper into poverty by exorbitant medical bills that they have no hope of ever paying.

“Research on 38 million adult patients in 26,000 U.S. hospitals revealed that death rates in for-profit hospitals are significantly higher than in nonprofit hospitals: for-profit patients have a 2 percent higher change of dying in the hospital or within 30 days of discharge." (Dressel 2006) This phenomenon can be explained by the cost-cutting measures that for-profit hospitals must make to pay their high administrative fees and doctors salaries. Countries with universal healthcare have state run hospitals, which benefit from lower administrative costs and standardized procedures and costs.

"One topic under discussion in the United States is the appropriate length-of-stay following normal childbirth. Mexico had the shortest length-of-stay (1.4 days), and the United States had the second-shortest (1.5 days). (Anderson et al, 1999) The length of stay in the hospital after giving birth is another area where countries with and without universal healthcare differ. In the United States, with private care the mother and baby are at the mercy of the insurance company. Within a short time, usually 48 hours, a deemed healthy mother and child will be escorted out of the hospital, regardless of their comfort level. In France a hospital stay is three to five days with follow up visits from a midwife. The longer stay allows babies to recover from jaundice, which is the most common reason for hospital re-admittance of a newborn.

Under President Obama’s healthcare reform the United States now has a universal healthcare option. Within his plan are many measures being taken to help lower the infant mortality rate in the United States. Free preventative care is offered under Medicare and private plans. This will provide contraception and education for appropriate family planning purposes. Community health centers will receive increased funding, allowing for preventative and pre-natal care. The number of primary care practitioners, nurses and physician assistants will be increased, providing additional opportunity for pregnant women to be seen by a medical professional.

Another measure being taken by health care reform is allowing children to remain on their parent's insurance until the age of 26. Currently, at the age of 18 children are generally removed from a parents policy, unless they are students. By extending the age to 26, this segment of often at-risk pregnant young women will be able to receive health care where it was previously not available.

Despite the efforts of insurance companies and managed care companies to limit the range of political choices in health care reforms, there appears to be growing broad-based support in the U.S. for a single payer system which would greatly resolve some of the most serious problems of cost, access and fairness. Furthermore, recent studies have shown that a single payer plan would not only be economically feasible, but would be an enormous improvement over what we have. In 1991, for example, the U.S. General Accounting Office and the Congressional Budgeting Office issued reports stating that a single payer system similar to that of Canada’s would more than pay for itself, due to reduced administrative costs, as well as having universal access to health care, especially preventative care. (University of Maine, 2001)

There are many factors to infant mortality rates and not all of them can be addressed by universal healthcare, but data from similar countries show that a public healthcare option is extremely beneficial. Women are provided with pre-natal care. They stay in the hospital longer at birth and are educated on the nutritional and safety needs of their infant. With public healthcare this important segment of the population is seen by a healthcare provider on a regular basis. In addition to increased quality and frequency of care for the mother to be, a universal healthcare plan allows for the mother to shift her focus from the cost of birth to the health of her baby. The United States could benefit from adopting some of the policies taken by other countries in an effort to provide quality care to all of its citizens.