By Karen Davis, Ph.D., Cathy Schoen, M.S., Stephen C. Schoenbaum, M.D., M.P.H., Michelle M. Doty, Ph.D., M.P.H., Alyssa L. Holmgren, M.P.A., Jennifer L. Kriss, and Katherine K. Shea
The Commonwealth Fund
May 15, 2007
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report — an update to two earlier editions — includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries’ health systems. Compared with five other nations — Australia, Canada, Germany, New Zealand, the United Kingdom — the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
The findings indicate room for improvement across all of the countries, especially in the U.S. If the health care system is to perform according to patients’ expectations, the nation will need to remove financial barriers to care and improve the delivery of care. Disparities in terms of access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home.
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678&#doc482678
Full report:
http://www.commonwealthfund.org/usr_doc/Davis_mirrormirrorinternationalupdate_1027.pdf?section=4039
Comment:
By Don McCanne, MD
To really understand this report, you do need to read it in full. Based on the performance measures surveyed, of the six nations studied, the United States does have the least equitable and most expensive system, and places last in overall ranking. Clearly, the American health care system is NOT the best in the world.
The opponents of single payer national health insurance will be quick to point out that Canada’s ranking is next to last, drawing the spurious conclusion that single payer would be the worst model for us to adopt. That is why, if you wish to be prepared to respond to it, you should read the full report. Many of the deficiencies noted have little, if any, relationship to the method of financing health care.
No country could possibly have a perfect score on every parameter. But it is important for the stewards of each health care system to identify their deficiencies and then adopt policies that would rectify them.
More importantly, many of the major deficiencies noted in the United States are specifically due to our highly flawed system of financing health care. We will always be at the bottom until (1) we remove financial barriers to care by providing comprehensive health insurance for everyone, and (2) we reinforce our primary care infrastructure, ensuring an accessible medical home for everyone.
Then we really could have the best health care system in the world.