The U.S. healthcare system comes in last for performance among seven industrialized nations, despite spending the most, according to a new Commonwealth Fund report. The researchers note that healthcare reform and uptake of health information technology hold promise for the future.
Despite having the most expensive healthcare system, the United States ranked last overall compared to Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom.
The research measured five performance areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.
While there is room for improvement in every country, the United States stands out for not getting good value for its healthcare dollars, ranking last despite spending $7,290 per capita on healthcare in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first overall.
Provisions in the Affordable Care Act that could extend health insurance coverage to 32 million uninsured Americans have the potential to promote improvements to the United States' standing when it comes to access to care and equity, according to "Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update," by Commonwealth Fund researchers Karen Davis, Cathy Schoen, and Kristof Stremikis.
The low marks in the quality and efficiency dimensions for the United States demonstrate the need to quickly implement provisions in the new health reform law and stimulus legislation that focus on realigning incentives to reward higher quality and greater value, investment in preventive care, and expanding the use of health information technology.
"It is disappointing, but not surprising that, despite our significant investment in health care, the U.S. continues to lag behind other countries," said Commonwealth Fund president and lead author Karen Davis. "With enactment of the Affordable Care Act, however, we have entered a new era in American healthcare. We will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high quality, efficient health care."
Earlier editions of the report, produced in 2004, 2006 and 2007, showed similar results. This year's version incorporates data from patient and physician surveys conducted in seven countries in 2007, 2008 and 2009.
Key findings from the study are on the next page.
Key findings include:
- On measures of quality the United States ranked 6th out of seven countries.
- On two of four measures of quality – effective care and patient-centered care-the U.S. ranks in the middle (4th of seven countries).
- The U.S. ranks last when it comes to providing safe care, and next to last on coordinated care.
- U.S. patients with chronic conditions are the most likely to report being given the wrong medication or the wrong dose of their medication, and experiencing delays in being notified about an abnormal test result.
- On measures of efficiency, the U.S ranked last due to low marks when it comes to spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing. Nineteen percent of U.S. adults with chronic conditions reported they visited an emergency department for a condition that could have been treated by a regular doctor, had one been available, more than three times the rate of patients in Germany or the Netherlands (6 percent).
- On measures of access to care, people in the United States have the hardest time affording the healthcare they need-with the United States, ranking last on every measure of cost-related access problems. For example, 54 percent of adults with chronic conditions reported problems getting a recommended test, treatment or follow-up care because of cost. In the Netherlands, which ranked first on this measure, only 7 percent of adults with chronic conditions reported this problem.
- On measures of healthy lives, the United States does poorly, ranking last when it comes to infant mortality and deaths before age 75 that were potentially preventable with timely access to effective healthcare, and second to last on healthy life expectancy at age 60.
- On measures of equity, the United States ranks last. Among adults with chronic conditions almost half (45 percent) with below average incomes in the United States reported they went without needed care in the past year because of costs, compared with just 4 percent in the Netherlands. Lower-income U.S. adults with chronic conditions were significantly more likely than those in the six other countries surveyed to report not going to the doctor when they're sick, not filling a prescription, or not getting recommended follow-up care because of costs.
