PDF A new study by the Commonwealth Fund comes to an old conclusion.
The United States is still last in health system performance.
The 2010 version of Mirror Mirror updates comparative health system performance data from seven industrialized countries. The sad conclusion is that the United States is last or next to the last in five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. And they are last overall.
This conclusion is no different than that reached in previous versions of the report issued in 2004,2006, and 2007. This year’s update adds physician and patient survey data on care experiences and dimensions of care and also adds the Netherlands into the comparison.
The Netherlands – first; The US – last
The Netherlands may not have made it to number 1 in soccer, but they leaped to the head of pack in health system performance.
Those who consistently tout the US health care system as the best in the world clearly are not paying attention to this and similar studies. In fact, they are not listening to their neighbors, or at least to other Americans.
Although the U.S. spends more on health care than any other country and has the highest rate of specialist physicians per capita, survey findings indicate that from the patient’s perspective (emphasis added) , the quality of American health care is severely lacking. The nation’s substantial investment in health care is not yielding returns in terms of public satisfaction.
In addition:
Americans and higher-income Americans were more likely than their counterparts in other countries to report problems such as not getting recommended tests, treatments, or prescription drugs.18 This is undoubtedly a reflection of the lack of comprehensive health insurance coverage and the high out-of-pocket costs for care in the U.S., even among the insured and those with above-average incomes.
The study does not dwell on the cost of care, but instead focuses on its dimensions of a high performance health systems: quality, access, efficiency, equity, and long, healthy and productive lives.
Quality
For some, this is supposed to be the one area that the US excels in. Unfortunately, the only positive spin potential here is that this is the only dimension in the study that the US did not finish dead last in. The US finished behind Canada on quality. In fact, in one sub-dimension of quality we were number one – prevention.
Access
No surprise here. The US finished last. But one sub-dimension of access was timeliness of care. Even here we finished next to the last in a survey that included questions like time needed for medical attention and emergency room waiting time.
Efficiency
This is the one dimension that examined cost and cost as a percentage of GDP. But it also included re-admissions, duplicate tests and unnecessary trips to the ER. The US finished last in this category.
Equity
The U.S. ranks low on all access to care measures and, as a result, does poorly on all measures of equity. … almost half of lower-income adults in the U.S. said they went without needed care because of costs in the past year.
Among the higher-income population, U.S. respondents often were more likely than their counterparts in other countries to report difficulty obtaining needed care because of costs.
Long Healthy and Productive Lives
This should be the ultimate outcome measure for a health care system. This measure examines mortality that might be avoided with health care, infant mortality and healthy life expectancy. The US finished last.
There is a lot in this report that deserves further discussion, but it is a stark reminder that the United States has a long way to go to rank as a high performing health care system.
1 Response to “The US Last in Health System Performance”