The Amazing Maze of US Health Care

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. Read the rest of this entry »

You have heard the arguments.

In the first corner:  “We have the best health care system in the world.  People travel to this country from all over the world to get the best health care.  the parking lots in hospitals bordering Canada are full of cars with Canadian license plates.”

In the second corner: “There are 100,000 deaths per year from hospital infections and a similar number from prescription drug errors, and an equally horrific number of people who need to be re-admitted to the hospital for complications.  And what about “Never Events”, those medical errors that are described as adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable.

And there is a voice in a third corner: “We have the most expensive health care system in the world yet the United States is not ranked among the top twenty nations in infant mortality, maternal mortality, longevity, or hospital admissions avoidable with access to health care.” Read the rest of this entry »

How often have you heard the phrase, “The United States has the best health care system in the world.”?

What is wrong with that statement is the word “system”.

We could rephrase it – The United States can deliver some of the best health care services in the world (to those who can pay for it).

We could even argue  – The United States has some of the best health care systems in the world: the Mayo Clinic, the Veteran’s Administration, the Department of Defense.

But to assert that we have a system or that Americans (all Americans) receive the best care in the world is a stretch.  Why?

Over the last two weeks I wrote about our fragmented health care system and the closely related fragmented payment system.

I wrote about how patients are equally fragmented, migrating during their lives through several health plans, what I call patient delivery systems.

Why does this matter?

In most measures of health system performance the United States ranks embarrassingly near the bottom or at the bottom among industrialized countries.  From 2000 to 2009 male life expectancy fell six slots to 24^th in the world and female life expectancy fell from 28^th to 35^th.  Some would counter that life style, diet, or poverty had more influence on those drops than health care.

Isn’t that fragmented thinking?  If we had a health care “system” then it would take comprehensive approach to population health.

What are the incentives for doctors and hospitals?  Just as sunflowers follow the sun, health care providers, like the rest of us, follow the money.  And the money is paid for doing stuff, surgeries and tests, for example.  It is not paid for talking with or listening to patients, giving them lifestyle or treatment compliance assistance.

What are the incentives for patients?

Patients often lack the freedom to choose just any doctor.  Their incentive is to change doctors to conform with their current health plan rules. Read the rest of this entry »