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Despite high cost, U.S. health system lags behind — report

June 23, 2010 | By Michael McCarthy More

A study that compares the health systems of seven countries–Australia, Canada, Germany, the Netherlands, New Zealand, United Kingdom and the United States–finds the U.S. comes last or next to last in five performance: quality, access, efficiency, equity and health lives–and last overall.

This despite the fact that the “other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States,” the researchers note.

The study, which was conducted by the Commonwealth Fund, included surveys of patients and primary care physicians about their respective nations’ health systems.

The study’s findings confirm three previous studies conducted by the Fund comparing national health systems.

In overall rankings, the Netherlands came in 1st , followed closely by the U.K., 2nd and Australia, 3rd.. Germany came in 4th, New Zealand, 5th, Canada 6th, and U.S., 7th.

The U.S. led, however, on spending, which in 2007 equaled $7,290 per person. First-ranked Netherlands, on the other hand, spent far less: $3,837 per person. Health spending was lowest in fifth-ranked New Zealand, just $2,454 per person.

Among the report’s findings.

Quality:

Compared with the other six countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. However, its low scores on chronic care management and safe, coordinated care pull its overall quality score down. Other countries are further along than the U.S. in using information technology and managing chronic conditions. Information systems in countries like Australia, New Zealand, and the U.K. enhance the ability of physicians to identify and monitor patients with chronic conditions.

Access:

Americans with health problems were the most likely to say they had access issues related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services. In other countries, like the U.K. and Canada, patients have little to no financial burden, but experience wait times for such specialized services.

However, the authors note, it is not necessary to tradeoff cost for access.

There is a frequent misperception that such tradeoffs are inevitable; but patients in the Netherlands and Germany have quick access to specialty services and face little out-of-pocket costs.

Efficiency:

On indicators of efficiency, the U.S. ranks last among the seven countries, with the U.K. and Australia ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology, rehospitalization, and duplicative medical testing.

Equity:

The U.S. ranks a clear last on nearly all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment, or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs.

Long, healthy, and productive lives:

The U.S. ranks last overall with poor scores on all three indicators of long, healthy, and productive lives. The U.S. and U.K. had much higher death rates in 2003 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Canada and Australia. Overall, Australia ranks highest on healthy lives, scoring in the top three on all of the indicators.

The authors conclude that the recent enactment of health reform in the U.S., which provides for near universal access and promotes preventive and primary care, offers an opportunity for improvement:

Many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, but the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions.

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