TUESDAY, May 4, 2004 (HealthDayNews) -- The United States far outspends other English-speaking countries on health care, yet doesn't seem to be getting any better value for its dollars.
So says the first international comparison of health care quality indicators, released Tuesday by the Commonwealth Fund and appearing in a set of articles in the May/June issue of the journal Health Affairs.
The comparisons are intended to help health-care professionals and policy makers determine where to focus their efforts, according to the reports' authors.
"We think of it as a critically important demonstration project and hope that one day it will be replicated on an annual or biannual basis," Dr. Arnold Epstein, co-author of one of the reports and chairman of the department of health policy and management at the Harvard School of Public Health, said at a news teleconference Tuesday. "It represents an unprecedented international collaboration to allow countries to compare their performance with that of other countries, to permit benchmarking and to guide policy makers."
This is indeed the first time experts have even agreed on what measures to use when comparing health-care quality. Not surprisingly, it took five years to arrive at a consensus.
Out of an initial list of 1,000 possible indicators, 21 were agreed upon, including five-year cancer survival rates, 30-day heart attack death rates, breast cancer screening rates, and asthma mortality rates. In addition to the United States, the comparisons included Australia, New Zealand, Canada and England.
"None of the five countries is consistently the best or the worst on all 21 indicators," said co-author Gerard Anderson, director of the Bloomberg School of Public Health at Johns Hopkins University. The report did not explore the reasons or possible reasons for the discrepancies.
The United States, which spent $4,887 per capita on health care in 2001, had the best five-year survival rates for breast cancer, but the worst five-year survival rates for kidney transplants. On the plus side also, cervical cancer screening rates were very high.
But the United States was the only one of the five countries that showed asthma mortality rates on the rise.
Canada, whose per capita spending was $2,792, topped the charts for five-year survival after kidney and liver transplants, but scored the worst for 30-day heart attack survival rates. In general, cancer survival rates were average or above average and were particularly good for childhood leukemia. Stroke death rates were on the low side.
On the other hand, death from heart attacks, especially in older age brackets, was higher than in Canada than in Australia and New Zealand, the only two other countries measured in this category.
Australia, which spent $2,513 per capita, ranked the best for breast cancer screening rates, but was the worst in childhood five-year survival rates for leukemia. Other than this leukemia indicator, Australia had generally good cancer survival rates. It also had high breast cancer screening rates, low asthma mortality, and high rates of flu and polio vaccinations.
England, with a $1,991 per capita spending rate that reflected the entire United Kingdom, had the lowest suicide rates of the five countries, yet did poorly in five-year breast cancer survival rates, along with several other cancer indicators. (More recent data not included in this report indicated that England might be improving its breast cancer marks.) England also had the highest polio vaccination rates, but low cancer survival rates and low breast and cervical cancer screening rates.
New Zealand, with the lowest per capita rate of $1,710, outshone the other nations in five-year survival rates for colorectal cancer, yet it also had the highest suicide levels, especially among young people. Kiwis also had the highest colorectal cancer survival rates. But its influenza and polio vaccination rates were relatively low.
Smoking rates (measured as a percentage of the population) were the lowest in the two North American nations surveyed.
There were also many gaps in the data. "We don't have information on diabetes, Alzheimer's," Anderson said. "There are definite gaps in the future we would love to complete. It does give you a snapshot, but it does not give you the whole picture."
It's unclear how much of an effect this snapshot will have.
"My guess is that this will have a modest impact. People will be interested; it will raise awareness of quality of care internationally," Epstein said. "If this gets adopted by the OECD [Organization for Economic Development and Cooperation] and becomes an institutionalized report and comes out annually or bi-annually in the years ahead, I could see this having an enormous effect."
The OECD is, in fact, emulating and expanding the model. Quality of care will be the first topic discussed at a meeting next week, said Peter Scherer, counselor of OECD's employment and social affairs directorate. The organization is planning to do similar comparisons with 21 countries and more than 100 indicators.
"The bottom line is that the example that has come from this exercise had really inspired a lot of other countries with very diverse healthcare systems to join in a similar cooperative exercise," Scherer said.
More information
The Commonwealth Fund has the series of reports. The OECD also has information on health.
