subject: Productivity in Heart Attack Treatments #4 [print this page] Productivity in Heart Attack Treatments #4
Cross-country evidence
Although there appear to have been significant benefits from the technological change in heart
attack treatments, other practice patterns could have been even more effective and cheaper. One can better assess the optimality of treatment patterns by looking at the variation across countries. Figure 2 presents data from four different regions that are representative of cardiac care in the developed world: the U.S., Scotland, Finland, and Ontario, Canada; Panel A shows the percent of patients receiving bypass surgery with one year of a heart attack, Panel B shows the percent of patients receiving angioplasty within one year of a heart attack, and Panel C shows the percent of patients who die within one year of a heart attack.
The data are from the Technological Change in Health Care (TECH) project, an international collaboration of investigators from 17 countries, and are based on large, nationally representative samples of patients. Corresponding to the general trend of health expenditures, the U.S. has much higher rates of bypass and angioplasty than other countries: for instance, in 1997, the one-year bypass and angioplasty rates in the U.S. were 18.4% and 27.9%, respectively, while for Ontario, the rates were 10.4% and 10.0%.
But the differences in mortality rates for heart attack patients are much smaller: in 1996, Ontario had a one-year mortality rate of 24.1%, which is very similar to the United States rate of 24.2%; Scotland and Finland had higher mortality rates, but the difference of roughly 5 percentage points between their rates and the U.S. rate was much smaller than the differences in the rates of surgical treatments.
Note, however, that we measure only one outcome, patient death. It is possible that the surviving heart attack patients in the U.S. have a higher level of physical function, and hence a higher quality of life, as a result of more invasive surgery.
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