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Hospital death rates in England 45% higher than in US, report finds Hospital death rates in England 45% higher than in US, report finds
(about 1 hour later)
Brian Jarman is the Marmite professor of health statistics. You either love him or hate him and his controversial but influential index: the hospital standardised mortality ratio. Brian Jarman is the Marmite professor of health statistics. You either love him or hate him and his controversial but influential index: the hospital standardised mortality ratio (HSMR).
Jarman, a professor at London's Imperial College, co-founded Dr Foster, an organisation that provides comprehensive information on UK hospitals. The professor at London's Imperial College co-founded Dr Foster, an organisation that provides comprehensive information on UK hospitals.
In a Channel 4 report on Wednesday he said he had collected information from all over the world. He concluded in 2004 that the NHS had the worst death rate figures of seven nations including Canada, Holland, Japan and the US. In a Channel 4 report on Wednesday he said he had collected information from countries around the world. From that he found in 2004 that the NHS had the worst death rate figures of seven countries including Canada, Holland, Japan and the US. Once the death rate was adjusted to take into account the different health systems, England's level was 22% higher than the average of all seven countries and 58% higher than the best country.
Once the death rate was adjusted to take into account the different health systems, England's level was 22% higher than the average of all seven countries and 58% higher than the best country. When Jarman projected the figures forward to 2012, the hospital death rates in all seven countries had improved – England's faster than some. However, it is still among the worst on this issue and, by his methodology, has death rates 45% higher than the best performing country, the US. The US has lower life expectancy – two years less than that in the UK – and millions of uninsured people who struggle to find healthcare, so the finding was combustible.
When Jarman projected the figures forward to 2012, the hospital death rates in all seven countries had improved – England's faster than some. Critics claimed that Jarman, who has only just released his findings, had an agenda to denigrate the NHS, which he has refuted. He accepts that the US does badly on life expectancy but says his data only looks at hospital deaths, which account for just half of the total mortality.
However, the country is still among the worst on this issue and by his methodology has death rates 45% higher than the best performing country, the US. The US has lower life expectancy – two years less than that in the UK – and millions of uninsured people who struggle to find healthcare, so the finding was combustible. "There's no GP system in America, so life expectancy, infant mortality, is terrible in places like Harlem. But in the US you do pay twice as much for healthcare in hospitals so that might explain something."
Critics claimed that Jarman had an agenda to do down the NHS, which he has refuted. He accepts that the US does badly on life expectancy but says his data only looks at hospital deaths, which account for just half of the total mortality. The work has been attacked for not being peer reviewed. In an interview Jarman conceded this point but said it was because "three nations had not allowed him to publish the data". The data sets, he said, were also large. For the UK he had all the hospital episode data. For the US he had a 20% random sample from the hospitals.
"There's no GP system in America so life expectancy, infant mortality, is terrible in places like Harlem. But in the US you do pay twice as much for healthcare in hospitals so that might explain something." Comparisons between the countries were difficult. One potential error can lie in the way hospitals in the two countries code their treatments. The HSMR is extraordinarily sensitive to this. However, Jarman pointed out that the US and UK were particularly comparable since hospitals in both nations used the same definitions to code patients' treatment.
The work has been attacked for not being peer reviewed. In an interview Jarman conceded this point but said it was because "three nations had not allowed him to publish the data". The data sets, he says, are also large. In the UK he has all the hospital episode data. For the US he had 20% random sample from the hospitals.
Comparisons between the countries are difficult. One potential error can lie in the way hospitals in the two countries code their treatments. The Hospital Standardised Mortality Ratio is extraordinarily sensitive to this. However, Jarman points out that the US and UK are particularly comparable since hospitals in both nations use the same definitions to code patients' treatment.
Ben Dean, a doctor in Oxford, sent a tweet saying: "In the UK many people with underlying diagnosis of cancer are coded as 'pneumonia' or 'sepsis' death, while in US this doesn't happen." Jarman said he would be interested to see the data on that.Ben Dean, a doctor in Oxford, sent a tweet saying: "In the UK many people with underlying diagnosis of cancer are coded as 'pneumonia' or 'sepsis' death, while in US this doesn't happen." Jarman said he would be interested to see the data on that.
There is an additional issue that could affect the UK-US comparisons. In America people with insurance are often discharged to die at home or in a hospice as it is less expensive for the insurer. US hospital mortality data would not capture these individuals. Jarman accepts this but says it "would make only a small difference to the numbers". There is an additional issue that could affect the UK-US comparisons. In America people with insurance are often discharged to die at home or in a hospice as it is less expensive for the insurer. US hospital mortality data would not capture these cases. Jarman accepted this but said it "would make only a small difference to the numbers".
The debate about his HMSR has been contentious. Recently Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, was hired by the NHS to devise a new measure. He described death rates as a nonsense.The debate about his HMSR has been contentious. Recently Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, was hired by the NHS to devise a new measure. He described death rates as a nonsense.
But Jarman's work was partly vindicated by Robert Francis QC in his report into the appalling care provided by Mid Staffs NHS trust. Francis noted that "the methodology and significance of these statistics are subject to academic controversy" but also that "there is strong evidence to suggest that these figures mandated a serious investigation of the standards of care being delivered". This is HSMR's strongest defence: it is a smoke signal in the health system.But Jarman's work was partly vindicated by Robert Francis QC in his report into the appalling care provided by Mid Staffs NHS trust. Francis noted that "the methodology and significance of these statistics are subject to academic controversy" but also that "there is strong evidence to suggest that these figures mandated a serious investigation of the standards of care being delivered". This is HSMR's strongest defence: it is a smoke signal in the health system.
HSMR is used because it provides a simple, headline grabbing, way of conveying what is usually complex failure inside a hospital. Hence its attraction to politicians, a point not lost on Tory MPs, like Charlotte Leslie, who have used it to criticise the state system. HSMR is used because it provides a simple, headline-grabbing way of conveying what is usually complex failure inside a hospital. Hence its attraction to politicians, a point not lost on Tory MPs, such as Charlotte Leslie, who have used it to criticise the state system.
Jarman denies that he is bashing the NHS but argues that the index should be used to improve the health service. He points out: "[Of taxpayers] 5% provide 75% of tax income to the government so most people don't pay very much for health care in this country. In the states it is the other way round." Jarman denied that he was bashing the NHS but argued that the index should be used to improve the health service. "[Of taxpayers] 5% provide 75% of tax income to the government so most people don't pay very much for healthcare in this country. In the States it is the other way round."
Jarman says his comparison with the US should not come as a big surprise. "Apart from obesity the UK does worse than America on the availability of beds, doctors, scanning machines. Look at the World Health Organisation or the OECD comparisons and we do badly. So it should not surprise us." Jarman said his comparison with the US should not come as a big surprise. "Apart from obesity, the UK does worse than America on the availability of beds, doctors, scanning machines. Look at the World Health Organisation or the OECD [Organisation for Economic Co-operation and Development] comparisons and we do badly. So it should not surprise us."