15/3/20: Acute beds and hospital beds capacity

With Covid-19 cases worldwide reaching almost 143,000 worldwide, it is worth examining some of the data on healthcare systems' capacity to absorb the influx of patients in weeks to come.

Here is an interesting set of data from OECD comparing the numbers of hospital beds per 1,000 population across the range of countries (I highlight some interesting comparatives):

These are not ICU beds with specialized equipment, of course, but it is hard to imagine that the relationship between ICU beds and general counts of beds is non-linear. Some people on Twitter claimed that the U.S. has higher number of acute care beds, than, say Italy or S. Korea. Which is simply, factually, false. Here's OECD data:

U.S. has 2.44 acute care beds per 1,000 population, Italy has 2.62, while S. Korea has 7.14. For those who are interested, Ireland has 2.77 and the OECD average is 3.59, with the median of 3.23.

The reality is simple: no country is fully ready for the onset of the Covid pandemic at the scale of what has happened in more impacted countries, like Italy, Korea or China. But of all countries we have data for, the U.S. system of healthcare is probably the least capable of handling any large scale public health events, not only due to mediocre capacity, but due primarily to the lack of access to healthcare.

Consider the following facts:

• Over 40% of Americans cannot afford to cover a financial emergency of > $1,000 per annum;
• Average health insurance deductible in the U.S. was in excess of $4,578 in 2018 (see chart below: source https://www.ehealthinsurance.com/resources/individual-and-family/how-much-does-individual-health-insurance-cost); for workers covered by their employers, average deductible was $1,573 in 2018 (https://www.kff.org/health-costs/report/2018-employer-health-benefits-survey/);
• By the above two facts, average family in the U.S. simply cannot afford the deductibles they are contracted for;
• The U.S. 27.5 million people were uninsured in 2018, meaning they cannot afford any care;
• 10-12.5 million of undocumented immigrants residing in the U.S. have no insurance and cannot afford any care. 

Roughly-speaking, between 159 and 162 million people living in the U.S. either have no access to insurance or cannot afford their deductibles. Does anyone expect these people to be pro-active in accessing testing and treatment for Covid early on?

2/4/19: Spending your way into oblivion?

As Donald Trump talks about forcing UK NHS to pay higher prices for U.S. pharmaceutical companies' output, an amazing chart from the Our World in Data project (link to more interactive charts on health expenditure: https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus) plotting life expectancy against health expenditure for all OECD countries:

Source: https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus

This data is dire. The U.S. vastly outspends other countries in terms of health spending, yet it also vastly underperforms in terms of life expectancy. Yes, in part, the latter feature is down to violence (not ineffectiveness of healthcare), and in part it is down to horrific diets and sedentary life-styles of Americans. But controlling for all this, Americans still live shorter lives and get less preventative healthcare and lower quality medical interventions. All for a higher price.