June 19, 2014

Low Scores for US Healthcare . . . Again; Is Help on the Way?

hospiceBy Gordon Schnell

The US healthcare system is the most expensive in the world.  Yet, it continues to rank poorly when compared to the healthcare systems of other developed countries.  In fact, when compared to the most developed countries around the globe, the state of our overall healthcare system comes in dead last.  At least that is the finding of the report issued this week by The Commonwealth Fund titled Mirror, Mirror on the Wall – How the Performance of the US Healthcare System Compares Internationally

The report ranked the healthcare systems of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.  That these other countries all bested the US in the overall ranking, and in most of the specific healthcare categories the report reviewed, is no doubt disconcerting.  Unfortunately, it is not all that surprising.  The US also ranked last in the previous studies the Commonwealth Fund conducted in 2004, 2006, 2007 and 2010.  It also had a dismal showing in the Institute of Medicine’s report last year — Shorter Lives, Poorer Health — on the health of the US population.

Here’s the breakdown of how the US fared in the specific dimensions of healthcare this newest study examined:

Quality.  This category measured the overall quality of the healthcare provided based on how safe and effective it is, how various courses of treatment are coordinated across multiple sites of care, and how “patient-centered” the care is in terms of giving priority to the specific needs and preferences of the patient.  The US scored highest in this category, coming in 5 overall, with individual rankings of 3 for effective care, 7 for safe care, 6 for coordinated care and 4 for patient-centered care.  The United Kingdom and Norway came in at the top and bottom spots, respectively, for this category.

Access.  This category measured the affordability and timeliness of receiving needed care.  The US scored 9 overall, with an 11 in affordability and a 5 in timeliness.  The bottom ranking in affordability is directly due to the lack of universal healthcare coverage.  The report found that 37 percent of the Americans surveyed did not get recommended care, fill a prescription or visit a doctor when they had a medical problem, all because of cost.  For the Netherlands, the next worst country in this measure, this percentage dropped to 22 percent.  For the UK and Sweden, which had the top spots in this category, only 4 and 6 percent respectively, reported going without recommended care because of cost.

Efficiency.  This category measured the quality of care and treatment outcomes based on the overall level of resources committed to the system.  Unsurprisingly, the US ranked last in this category in large part because of how much money is spent (and wasted) on healthcare in this country.  According to the Commonwealth Fund’s calculations, the overall per capita annual healthcare expenditure in the US of roughly $8,500 dwarfs that of every other country in the study (which ranged from a low of about $3,200 for New Zealand to a high of $5,700 for Norway and Sweden).  The UK and Sweden again shared the top spots in this category.

Equity.  The US ranked last in this category largely because so many low-income Americans lack access to adequate healthcare.  The study found that one-third or more of this population, a significantly higher percentage than in any other country studied, went without needed care simply because they could not afford it.  The UK, Sweden and Switzerland ranked the highest with small differences between their low-income and high-income populations when it comes to getting medical attention.

Healthy Lives.  The US ranked last in this category with bottom of the barrel scores in all three of the indicators measured — avoidable death rates, infant mortality and healthy life expectancy.  Interestingly, the UK came in at second-to-last here even though it ranked highest in virtually every other category.  France conversely, which ranked near the bottom overall as well as in most categories, came in at number one for healthy lives.  The Commonwealth Fund concluded from this apparent paradox that a country’s healthcare system is “just one of many factors, including social and economic well-being, that influence the health of a nation.”

So what does all this say about the state of US healthcare these days.  Obviously, we are in need of a serious fix.  But as upsetting as this newest ranking may be, the Commonwealth Fund had a rather rosy outlook on where US healthcare may be heading.  It was particularly sanguine about the impact the Affordable Care Act will have with its extension of insurance coverage to an estimated 26 million Americans (and the stability and security of coverage it will provide to scores of others).  It is this kind of focus on the underserved, on “building a health system that works well for all Americans” — particularly the most vulnerable — which the Commonwealth Fund concludes is the key to closing the significant healthcare chasm that continues to separate the US from the rest of the developed world.

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