CSWE National Center for Gerontological Social Work Education

Class Discussion Exercise

The graph below shows the reductions in deaths from ischemic heart disease among 6 countries during the 5-year period between 1998 and 2003. Ischemic heart disease is a chronic health condition that is quite prevalent in old age and a leading cause of death (Miniño, Heron, Murphy, & Kochankek, 2007). It is also a disease considered highly amenable to timely and effective medical care (Nolte & McKee, 2008). Although U.S. health care spending is about 70% in excess of the average expenditures of the other countries used for comparison (OECD, 2005), it is clear that the U.S. lags considerably behind these other countries in reducing the incidence of preventable deaths due to ischemic heart disease.

Using the Policy Issues section (above) as a reference, identify at least 3 factors within the dominant paradigm in the American medical care system that might account for some of this lag in the U.S. health care system’s effectiveness.

Data Source: Nolte, E., & McKee, C. M. (2008). Measuring the health of nations: Updating an earlier analysis. Health Affairs, 27(1), 58-71, adapted from data displayed in Exhibit 2.

Miniño, A., Heron, M., Murphy, S., & Kochankek, K. (2007). Deaths: Final Data for 2004. National vital statistics reports: NCHS, 55(19), 1-10.

Organisation for Economic Cooperation and Development (OECD). (2005). Health care spending and resources. Paris, France: Author.