World Health Organization

The US Health Care System and Lagging Life Expectancy: A Case Study Life expectancy in the United States fares poorly in international comparisons. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral factors. This paper compares mortality trends from prostate cancer in the United States to those in other developed countries. Prostate cancer is chosen because it can be detected at an early stage, because effective treatments are available, and because it is less heavily influenced by behavioral factors than most other chronic diseases. We find that, after the introduction of the PSA screening test for prostate cancer, mortality from the disease declined significantly faster in the United States than in the set of comparison countries. Trends in incidence and survival rates support the interpretation that the US health care system has worked very effectively to reduce mortality from this important disease. A brief consideration of breast cancer suggests that similar processes may have been a