The Commonwealth Fund
January 2004
Mirror, Mirror on the Wall: Looking at the Quality of American Health
Care through the Patient’s Lens
By Karen Davis, Ph.D., et al
U.S. health care leaders often say that American health care is the best in the world. However, recent studies of medical outcomes and mortality and morbidity statistics suggest that the United States-despite spending more per capita on health care and devoting to it a greater percentage of its national income than any other country-is not getting commensurate value for its money. The Commonwealth Fund’s cross-national surveys of patients’ experiences in and views of their health care systems offer the opportunity to assess U.S. performance relative to other countries through the patients’ perspective-a dimension often missing from other international comparisons.
Using data from two recent surveys conducted in five English-speaking nations-Australia, Canada, New Zealand, the United Kingdom, and the United States-this report ranks the countries in terms of patients’ reports on care experiences and ratings on various dimensions of care.
Based on these surveys of patients, the U.S. rarely outperforms the other nations surveyed; on most measures of the quality of care, it ranked last or second-to-last. Among the five countries surveyed, the U.S. performed particularly poorly on measures of equity and meeting the health care needs of its vulnerable populations. The U.S. also ranked last on patient erceptions of safety, efficiency, and effectiveness (measured in terms of ability to adhere to recommended care). Only on timeliness for admission to hospitals or for elective surgery did the U.S. rank highest among the five nations. In terms of timeliness for other services, including ready access to physicians, the U.S. was not the leader. New Zealand outperformed the U.S. in terms of providing prompt access to primary care physicians and specialists.
These results indicate a consistent relationship between how a country performs in terms of equity and how patients then rate performance on other dimensions of quality: the lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it will be judged most harshly by its citizens. Rather than disregarding its performance on equity as a separate and lesser concern, the U.S. should devote far greater attention to seeing that the health system works well for all Americans. These findings raise fundamental questions about the current trend in the U.S. to increase patients’ out-of-pocket costs, and about the lack of action on the growing numbers of uninsured and underinsured. The U.S. needs to make a major commitment to improving health insurance coverage and quality of care.
If it fails to act, not only will the U.S. standing among health systems continue to erode, but there will be a predictable rise in public dissatisfaction and significant economic and human costs.
http://www.cmwf.org/programs/international/davis_mirrormirror_683.pdf
Comment: So we have “the best health care system in the world”… except for its performance. Well, at least we still rank first in one category…we spend the most.