Worst Health System Performance
of Industrialized Nations
According to a recently released report, the U.S. spends double the amount on healthcare that 6 other nations they studied do, yet it gets the worst results.
The U.S. ranked either last or next to last on the 5 dimensions studied: access, quality, equity, efficiency, and healthy lives—as reported by the New York-based Commonwealth Fund, a private foundation which focuses on health issues.
In 2007, U.S. healthcare spending was tabulated at $7,290 per person and was ranked last in quality of care while the Netherlands ranked first—at $3,837 per capita.
And as you would expect, the debate on the reliability of this study has begun.
There are 3 sides to every situation. Opinion, fact . . . and the reasons behind it all. Let’s examine this study and the debate a bit more closely.
What’s included in the cost?
First, there is the question of how this spending level was determined. Did it include insurance payments? The taxes that other nation’s citizens pay to fund universal healthcare? What about those who travel to the U.S. to get the care they can’t get in their own countries? And what about elective procedures such as cosmetic surgery? Were they included?
In short . . . just how were these expenditures calculated?
There is also the question of whether pharmaceutical costs were included. It’s well known that drug costs are exponentially higher in the U.S., de facto subsidizing lower costs for the rest of the world.
And it’s no secret that socialized medicine just doesn’t offer the same range of services you find in the U.S., making a head-to-head cost comparison more difficult.
The use of subjective measures
Parts of the report were based on surveys that had physicians and patients themselves ranking the health system . . . not exactly the most objective measure. Some in the media have pointed to the possibility that U.S. citizens could have higher expectations than those in the other nations studied.
Socialized medicine bias
The report only included 6 other nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—all of which have universal health coverage, meaning that all citizens have access to care.
In the U.S., those without health insurance often decide to put off needed care, which can make it more expensive to be treated later on. A diabetes check up is much less expensive than dealing with a serious complication, for example.
And just taking this one factor into account can skew every other result.
The timing
Some have even called into question the timing of this report—that is, following on the heels of highly controversial healthcare legislation.
In fact, in the overview of the report on the Commonwealth Fund’s website, it states, “Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.”
That remains to be seen. If something is supposedly broken, do you stretch it out to cover more individuals?
The scarecard
While opinion surveys are open for interpretation, cold hard facts are not.
You can’t argue with the fact that in the U.S. access to care is limited because of the swelling numbers of the uninsured. But if you accept that perhaps we aren’t as efficient as we could be or are the most expensive health system in the world for whatever the reason . . . at least we get it right when it matters, correct?
According to the report, absolutely not.
Thus the most disturbing aspect of the studies were the quality and healthy lives dimensions. Data was based on the 2008 scorecard (“Why Not the Best: Results from the National Scorecard on U.S. Health System Performance, 2008”).
The 2008 scorecard points to objective measurements of the quality of care delivered in the country.
And upon closer examination, it shows a mixed bag.
On the negative side: The U.S. fell to last place among 19 industrialized nations on mortality amenable to healthcare—deaths that might have been prevented with timely and effective care. Rates of visits for adverse drug effects were up by about 33% between 2001 and 2004.
Yet the scorecard shows gains in the control of diabetes and high blood pressure, an increase in the number of heart failure patients receiving hospital discharge instruction, and in hospitals’ compliance with heart failure, heart attack, and pneumonia treatment standards. Hospital standardized mortality ratios also improved 19% over the last scorecard in 2006.
One aspect of quality care, getting an appointment fast, was included within the quality instead of access section where it would arguably be a better fit.
The scorecard does reveal a lot of variation in the system. Case in point: Average rates of hospital readmissions within 30 days remained at 18%, and rates in the highest percentage regions were 50% more than those in the lowest regions were.
The scorecard suggests a number of underlying causes as to what ails the U.S. healthcare system. Among them: a lack of widespread adoption of electronic medical records leading to duplicate tests and other consequences, a ridiculous amount spent on insurance administrative costs versus the amount spent in other countries, and the fact that there are so many uninsured.
And, of course, it points to universal healthcare coverage as the answer. Again, that is something that remains to be seen. How the new legislation plays out in the years to come will tell the real story.
Overheard Thoughts