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U.S. Found Lagging Behind Other Nations in Health Quality, Access

 |  By jsimmons@healthleadersmedia.com  
   June 24, 2010

While the U.S. healthcare system was shown to be the most expensive when compared with six other industrialized nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—it failed to achieve better health outcomes when compared to those countries, according to a new Commonwealth Fund updated report, Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally.

Overall, the U.S. stood 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. The U.S. had ranked last in value as well in the previous three Commonwealth Fund studies that compared it with the other countries.

"These findings are clearly disappointing for U.S. patients and their families. We're simply not getting commensurate return for a much higher investment in healthcare," said Commonwealth Fund President Karen Davis, PhD, in a telebriefing.

However, the new healthcare reform legislation may hold "substantial promise" for changing some of these results, Davis said. The Fund's analysis shows that investments in improved coverage, expanded health information technology, a stronger primary care foundation, and expanded quality and safety initiatives "could bear fruit in the upcoming decade," she said.

In response to questions that the American population may face different challenges because of higher rates of obesity, Davis said the other countries face other health issues such as higher rates of smoking. "Certainly those factors come into play," Davis said. "However, dimensions of care—such as, do you wind up in an emergency room for something that a doctor could have taken care of—are universal issues and quite independent of the specific disease profile."

Other countries may be challenged by an older population, said Cathy Schoen, a senior vice president with the Commonwealth Fund. For instance, Germany has a percentage of the population over age 65 that the U.S. has not yet experienced. "They're grappling with growing rates of chronic disease and frail elderly. But each country can claim a growing area of need."

But indicators that are being observed in the U.S., such as hearing about hospital readmissions or not getting care afterhours, is a "reflection of a healthcare system that is not organized . . . or well-coordinated around a patient, irrespective of what condition they have," Schoen said.

On quality, the U.S. stood out "particularly with symptoms of more fragmented, poorly coordinated care," Schoen said. In 2008, for instance, 14% of American adults with a chronic condition reported receiving the wrong medicine or the wrong drug dose in the past two years. "This was twice the rate of the lowest rate countries, Germany and the Netherlands," she said.

Also, 14% adults in the U.S. reported delays in being notified about abnormal test results or given the wrong results during the past two years. These rates were more than twice the rates as those countries with the lowest rates, Germany (7%) and the Netherlands (6%). "As a result, we rank last on safety, and do poorly on several dimensions of quality," Schoen said.

The U.S. scored the highest regarding cost-associated access problems. Over half (54%) of chronically ill surveyed in 2008 reported going without care because of costs in the past two years, compared with 7% in the Netherlands and 13% in the U.K. These problems included not filling a prescription or skipping doses; not getting recommended tests, treatments, or recommended follow-up; or not visiting a doctor when sick, Schoen said.

But looking at the insured in the surveys, "we also see very high rates of going without care because of costs and very high rates of spending $1,000 or more," Schoen said. "Our insurance benefits have been declining as premiums have gone up, exposing more to being underinsured."

Other findings are:

  • Chronically ill patients in the U.S. were the least likely to report having a regular physician (82%) while those in the Netherlands are most likely to have this connection (99%).
  • For patient centeredness, or "care delivered with the patient’s needs and preferences in mind," the U.S. was in the middle of the pack, ranking fourth.
  • For effective care overall, the U.S. was fourth, performing well on prevention but average on quality chronic care management. The U.K. and Australia scored first and second place, respectively.
  • For continuity and feedback, the U.S. scored in the midrange. Only slightly more than half (53%) of U.S. respondents said they had been with the same doctor for five years or more, compared with more than three quarters (79%) of respondents in the Netherlands.
  • The U.S. was third among the seven countries in terms of physicians routinely receiving data on patient satisfaction and experiences with care: 55% of American physicians receive such data. However, in the U.K., 96% of physicians received patient satisfaction data.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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