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U.S. health care system given poor ranking (again)

We did well on “effective” and “patient-centered” care, but lousy in the categories of  access, equity and healthy lives.

The United States came in dead last against seven European countries (France, Germany, the Netherlands, Norway, Sweden, Switzerland and the United Kingdom), as well as Canada, Australia and New Zealand.
Courtesy of the Commonwealth Fund

A new report offers a comparative look at how some of the world’s wealthiest countries keep their citizens healthy.

And once again, the United States has been given a poor ranking.

In fact, in the report, released Tuesday by the Commonwealth Fund, the United States came in dead last against seven European countries (France, Germany, the Netherlands, Norway, Sweden, Switzerland and the United Kingdom), as well as Canada, Australia and New Zealand.

First place went to the U.K., with Switzerland a close second.

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The United States did do relatively well on two of the report’s criteria. We ranked 3rd on  “effective care,” defined in the report as “services that are effective and appropriate for preventing or treating a given condition and controlling chronic illness.” And we ranked 4th on “patient-centered care,” defined as “care delivered with the patient’s needs and preferences in mind.”

But we did lousy in most of the other categories, including “access” (the ability to receive affordable and timely health care), “equity” (care that doesn’t vary in quality due to gender, ethnicity, geographic location or socioeconomic status) and “healthy lives” (how well the medical care people receive keeps them healthy over the long term).

On the issue of access, for example, the report notes that 37 percent of Americans say that cost has kept them from visiting a doctor or clinic when they had a medical problem, or from receiving a recommended treatment, or from filling a prescription.

Only 4 percent of British citizens reported a similar problem.

And on the issue of long-term health, the report points out that “[t]he U.S. ranks last on mortality amenable to health care, last on infant mortality, and second-to-last on healthy life expectancy at age 60.”

First in expenditures

The United States did outscore the other 10 countries in one category: the amount of money spent on health care. We spent an average of $8,508 per person on health care in 2011, which is far and away more than any of the other countries in this report. Norway came in second with per capita health care expenditures of $5,669. New Zealand was the country with the lowest health care burden — $3,182 per person — although the U.K. was not far behind at $3,405.

“The United States health care system is the most expensive in the world, but this report and prior editions [2004, 2006, 2007, and 2010] consistently show the U.S. underperforms relative to other countries on most dimensions of performance,” write the authors of the report.

There is some hope, however. The data for this report is based on surveys of adults and primary care physicians taken in 2011-2013, before the Affordable Care Act became fully implemented. That law may lift our ranking in future reports, for it will increase the number of Americans with access to medical care.

“The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage,” write the Commonwealth Fund researchers. “Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes.”

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“With the enactment of health reform,” the researchers add, “the United States should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years.”

Criticism from the right

Commentators on the political right were quick to criticize the report. Philip Klein, a senior writer for the Washington Examiner, calls the study “deeply flawed” and “rigged to produce a result that favors socialized health care systems.”

Klein also makes the very curious comment that “[i]t’s an ideological decision to view equity as one of the most important factors in judging a health care system.”

As Michael Hiltzik, a business and public policy reporter for the Los Angeles Times, points out, Klein seems to be saying that “it doesn’t matter if a huge percentage of your citizens can’t get healthcare, as long as the people with access do all right.”

Klein also claims that the U.K. shouldn’t be ranked first because it falls behind the U.S. in several measurements of medical outcomes. Hiltzik does a good job of poking a hole in that argument:

This is a point made frequently by apologists for the American system, but it’s highly misleading. Typically, they rely on survival rates — the time after diagnosis that the patient remains alive.

Knowledgeable experts view survival rates as a poor substitute for the really important metric, mortality rates. That’s because survival rates are very sensitive to the lead time of a diagnosis — the earlier it’s made in the progress of a disease, the better the survival rate. But that often has no [e]ffect on mortality. 

The phenomenon can be viewed through statistics on breast cancer. American women have a 97% chance of surviving five years after a breast cancer diagnosis is made; British women only 85%.

That’s because American standards call for annual or biannual mammography tests beginning at age 40, while British doctors perform them every three years beginning at age 50. So American doctors will spot cancer at an earlier stage. But that has almost no measurable effect on a woman’s likelihood of dying from breast cancer. That figure is about 24.5 per 100,000 population in Britain, 22.6 in the U.S.

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You can download and read the Commonwealth Fund report, which is titled “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,” on the organization’s website.