You got questions, we got answers

Yes, we do requests.

A reader asks for specific international comparisons on spending for health care. The Organization for Economic Cooperation and Development -- an association of relatively affluent countries -- has this info.

Health Spending in Most OECD Countries Rises, with the U.S. far Outstripping all Others

03/06/2004 -

OECD Health Data 2004, the most comprehensive source of comparable statistics on health and health systems across the 30 member countries of the OECD, shows that U.S. health expenditure grew 2.3 times faster than GDP, rising from to 13% in 1997 to 14.6% in 2002. Across other OECD countries, health expenditure outpaced economic growth by 1.7 times. In the United States, health spending reached $5267 per capita in 2002, almost 140% above the OECD average of $2144 and around 10 times as more than Mexico and Turkey, which spent $553 and $446 respectively.

Full details here: OECD

Another reader asks about retail pharmacy economics. Does your corner drugstore (probably part of a huge chain, of course) make more money from generic than from brand name drugs? I haven't been able to find hard numbers on this (you probably need a Wall Street analyst type for that) but qualitatively, it makes sense. Pharmacy chains insist, and analysts seem to agree, that they have no price negotiating power with manufacturers of brand name drugs. The big purchasers -- health plans and state Medicaid programs -- do negotiate prices for brand name drugs, and the pharmacists then are allowed to tack on a fixed $2 or $3 to what they pay the wholesaler for filling the prescription. However, there is competition among manufacturers of generic drugs to sell to the chains, so the chains can do some dickering and probably improve their margins. Retail pharmacies prefer to sell generics, that much is clear. Of course, where the retailer does best is with OTC meds, where their margins are not restricted. Also, ironically, they charge whatever the market will bear to uninsured people buying prescription drugs, which is always more than what insurers reimburse.

Finally, a question about the possibility of a major killer flu epidemic (with a link in the comments to the previous post). There is an interesting article about this in the new Scientific American. Researchers have recovered samples of the 1918 killer flu virus and are determining the specific characteristics that made it so virulent. Their best guess about the origin of the 1918 virus is that genetic components of an avian flu virus recombined with strains more infectious to mammals in pigs. Particularly dangerous strains of flu can certainly arise in this way again. New strains of flu generally arise in Asia, where there are a lot of fowls, swine and humans in close proximity. Concerns about avian strains jumping to mammals happen every year. It's really a question of when, not if, but the smart people in the white coats are trying to learn more about what makes flu strains nasty before the next big one hits. That's about all anyone can say about it.

Note that influenza kills tens of thousands of people in the U.S. every year, as a matter of course. Most of them are old and frail, or already sick for some other reason. The 1918 flu, however, was different because it killed a lot of young, healthy people.

The news media generate tons of hype about West Nile Virus and Eastern Equine Encephalitis and other really trivial infectious diseases every year, just because they are novel or rare. Flu overwhelms these media darlings in importance, but we're accustomed to it so it doesn't get the attention. West Nile Virus is very close to nothing, by the way -- if you live in a place where it has become endemic, you've probably already had it, and you didn't even know it. Now you are immune for life. Don't worry about it, it's just an excuse to spray insecticides around, which do far more harm than WNV.