Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: The Special Communication by
Drs Herzlinger and Parsa-Parsi1 describes the
comparative expenditures, resources, and some clinical outcomes for the medical
systems in Switzerland and the United States, as well as selected states that
have demographic features that most resemble the Swiss population. Key differences
include far greater spending in the United States (per capita, as percentage
of income, and as percentage of gross domestic product), with fewer resources
in some areas (acute care beds, practicing physicians, computed tomography
scanners, magnetic resonance imaging units, and occupied inpatient beds).
Important health outcomes were worse in the United States compared with Switzerland
(eg, infant mortality was 26% higher in 1999 and mortality from cerebrovascular
disease was 43% higher in 1997). Dr Reinhardt, in his Commentary,2 notes that in 2000 the rate of avoidable premature
deaths in the United States was 5120 per 100 000 compared with 3400 per
100 000 in Switzerland, a relative excess of 51%.
Pfaff WW. Holes in the Swiss Health Care System. JAMA. 2005;293(19):2337-2341. doi:10.1001/jama.293.19.2338-a