But what Gottlieb omits is the crucial fact that, when the researchers went back and looked at “patients who survived the first post-transplant year,” they discovered that “patients who had suffered from chronic liver disease in the U.K. and Ireland had a lower overall risk-adjusted mortality” than patients in the U.S. In other words, survival rates for patients who had a chronic disease before the transplant were better in the U.K. and Ireland. As for patients suffering from acute liver disease, longer-term survival rates past one year were just as good in the U.K. and Ireland as in the U.S. Moreover, if you checked patients in the interval between 90 days and one year, outcomes were similar in the two health care systems.
So “equilibrated” wasn’t just a dodgy piece of jargon; it was inaccurate. When researchers checked on patients more than a year after they had the transplant, outcomes in the U.K/Ireland and the U.S. weren’t in perfect balance (or in equilibrium) with results in the U.S. Outcomes in the U.K./Ireland were just as good for one group and decidedly better for the second —assuming that if you go through the trauma of a liver transplant, the outcome you are hoping for is to live more than a year, rather than just 90 days.
Why is chronic care better in the U.K. in the years following surgery? Because the “primary care infrastructure” is stronger in the U.K. and Ireland, the article explains. Add in the fact that patients have “equal access” to health care and that the cost of care is “lower,” and this helps explain superior long-term results. As the researchers point out, “the 2002 Commonwealth Fund International Health Policy Survey found that sicker adults in the US are far more likely than those in the UK to forgo medical care and fail to comply with recommended follow-up and treatment because of costs. In the U.S., it seems, outcomes tend to turn on whether the patient has money.
Finally, what about outcomes after five years? What Gottlieb forgot to mention is that survival rates for patients who had originally suffered from chronic liver disease were similar in the two countries, while mortality rates for patients suffering from acute liver disease were higher in the U.K. and Ireland.
Thanks, Maggie!
