Inadequate Health Insurance: the Burden on Infants

I’ve discussed the shortcomings of the US’s current system of health insurance provision in great detail over the past year or so. But new evidence keeps emerging about how poorly the US’s system performs when it comes to health outcomes (see this post for some of my earlier evidence).

Last week it was this JAMA article, which provided statistical evidence that Americans are significantly less healthy than individuals in the UK, even after controlling for differences in demographics and lifestyle. (See Krugman’s piece about the study for more on this, as excerpted by Mark Thoma.)

This week new data about the relative performance of the US health care system is provided by Save the Children. In their annual report “The State of the World’s Mothers“, they examine infant mortality around the world. Marketwatch reports:

U.S. has high rate of newborn deaths

SAN FRANCISCO (MarketWatch) — Newborns in the United States have the second lowest survival rate in the industrialized world, according to a report released this week.

Babies in their first month of life have the best odds in Japan, which boasts the lowest newborn mortality rate of 1.8 deaths per 1,000 live births, according to a report from the nonprofit group Save the Children. Latvia had the highest mortality rate among the 33 industrialized nations surveyed, at six newborn deaths per 1,000 live births.

The U.S. ranked next to last and tied with Hungary, Malta, Poland and Slovakia, which all averaged five deaths per 1,000 live births. The U.S. newborn mortality rate is nearly three times higher than that of Finland, Iceland, Norway and Japan, the study found.

What do all of the countries that are most dangerous for infants have in common? They are all among the poorest countries in the industrialized world… except for the US. The US’s distinction is that it is the only country without universal health insurance.

To be fair, some of the US’s poor performance in infant mortality measures is due to differences in statistical definitions and standard medical practice. For example, doctors in the US tend to be more aggressive about attempting to resuscitate very premature newborns than doctors elsewhere, so extremely premature infants are more likely to be classified as live births – and their deaths more likely to be classified as infant deaths – than in countries with less aggressive resuscitation policies, where such instances would tend to be classified as fetal deaths instead.

However, it turns out that this is not a sufficient explanation for the US’s poor performance in infant mortality measures. Back in 1992 a CBO study called “Factors Contributing to the Infant Mortality Ranking of the US” explicitly tried to identify why infants in the US tend to die so much more often than infants in the rest of the developed world.

They examined the possibility that differences in medical practice and statistical definitions are to blame. And they found that, while they do make a bit of difference, the difference is small. The standard measure of infant mortality placed the US at #22 in the world. Using a modified measure that corrects for differences in definitions regarding extremely premature births did improve the US’s ranking slightly, but only slightly – to #19 in the world.

The CBO report concluded that the biggest culprit in the US’s poor infant mortality rates is the relative prevalence of low birthweight among newborns in the US. For some reason, more small, unhealthy babies are born in the US than in other rich countries. Since many other studies have repeatedly shown that the best way to prevent low birthweight babies is proper prenatal care, it seems a fair conclusion to say that insufficient prenatal care is probably the biggest single factor in explaining the US’s relatively poor infant survival rates.

Explaining the US’s poor infant mortality data therefore boils down to this question: why do so many women in the US seem to receive inadequate prenatal care? Clearly, insufficient health insurance coverage for prenatal health care must be considered the leading candidate to explain this problem.

So let’s chalk up another cost to the US’s patchwork system of inadequate or non-existent health insurance: thousands of preventable infant deaths every year.