ON THE SUCCESS, COST AND EFFICIENCY OF MODERN MEDICINE - AN INTERNATIONAL COMPARISON

Objective. To study the success and cost of modern medicine in industr ialized, rich countries from 1980 to 1990. Design. Cost per capita and per cent of gross domestic product (GDP) spent on health was related to: (i) mortality in six diseases amenable to treatment by modern medi cine; (ii) the sum of those six diseases (avoidable disease); (iii) de ath due to other, unavoidable diseases; (iv) maternal and infant morta lity; (v) life expectancy at birth; (vi) renal dialysis and transplant ation rates. Efficiency was studied by comparing a country's avoidable mortality rates multiplied by expenses, to the mean for all countries . Results. During the 10 years, avoidable death rate decreased 38% but unavoidable death rate only 10%. Life expectancy increased 3%. Cost p er capita increased 107% but health expenditures, as per cent of GDP o nly 10%. There was a reasonable correlation between expenses and avoid able mortality but none between expenses and unavoidable death rate. I n 1990 avoidable mortality was lowest in Canada, and highest in Japan. Cost was lowest in New Zealand, and highest in the USA. The efficienc y index was highest for Australia, and lowest in the USA. Conclusion. Modern medicine as we have studied it is successful. Avoidable death r ate shows a steep uninterrupted decline over the last 50 years while u navoidable death rate shows only small decreases. Cost as per cent of GDP has increased only moderately. There is a correlation between expe nses and mortality from avoidable but not from unavoidable diseases, a nd a large variation in efficiency.