U.S. Health Care Ranks Low Among Developed Nations: Report

Despite high cost, it delivers too little to patients, Commonwealth Fund says

Steven Reinberg

Steven Reinberg

Published on June 23, 2010

WEDNESDAY, June 23 (HealthDay News) -- Compared with six other industrialized nations, the United States ranks last when it comes to many measures of quality health care, a new report concludes.

Despite having the costliest health care system in the world, the United States is last or next-to-last in quality, efficiency, access to care, equity and the ability of its citizens to lead long, healthy, productive lives, according to a new report from the Commonwealth Fund, a Washington, D.C.-based private foundation focused on improving health care.

"On many measures of health system performance, the U.S. has a long way to go to perform as well as other countries that spend far less than we do on healthcare, yet cover everyone," the Commonwealth Fund's president, Karen Davis, said during a Tuesday morning teleconference.

"It is disappointing, but not surprising, that despite our significant investment in health care, the U.S. continues to lag behind other countries," she added.

However, Davis believes new health care reform legislation -- when fully enacted in 2014 -- will go a long way to improving the current system. "Our hope and expectation is that when the law is fully enacted, we will match and even exceed the performance of other countries," she said.

The report compares the performance of the American health care system with those of Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom.

According to 2007 data included in the report, the U.S. spends the most on health care, at $7,290 per capita per year. That's almost twice the amount spent in Canada and nearly three times the rate of New Zealand, which spends the least.

The Netherlands, which has the highest-ranked health care system on the Commonwealth Fund list, spends only $3,837 per capita.

Despite higher spending, the U.S. ranks last or next to last in all categories, Davis said, and scored "particularly poorly on measures of access, efficiency, equity and long, healthy and productive lives."

The U.S. ranks in the middle of the pack in measures of effective and patient-centered care, she added.

Overall, the Netherlands came in first on the list, followed by the United Kingdom and Australia. Canada and the United States ranked sixth and seventh, Davis noted.

Speaking at the teleconference, Cathy Schoen, senior vice president at the Commonwealth Fund, pointed out that in 2008, 14 percent of U.S. patients with chronic conditions had been given the wrong medication or the wrong dose. That's twice the error rate observed in Germany and the Netherlands, she noted.

"Adults in the United States [also] reported delays in being notified about abnormal test results or given the wrong results at relatively high rates," Schoen said. "Indeed, the rates were three times higher than in Germany and the Netherlands."

"As a result we rank last in safety and do poorly on several dimensions of quality," Schoen said.

In addition, many Americans are still going without medical care because of cost, she said. "We also do surprisingly poorly on access to primary care and access to after hours care given our overall resources and spending," Schoen said.

In fact, 54 percent of people with chronic conditions reported going without needed care in 2008, compared with 13 percent in Great Britain and 7 percent in the Netherlands, she said.

The United States also ranked last in efficiency, Schoen said. There are too many duplicate tests, too much paperwork, high administrative costs and too many patients using emergency rooms as doctor's offices. In addition, poverty appears to be a big factor in whether Americans have access to care, the report found.

The United States also performed worst in terms of the number of people who die early, in levels of infant mortality, and for healthy life expectancy among older adults, Schoen said.

Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine, commented that "as a physician and public health practitioner, I have routinely spoken out in favor of health care reform in the U.S. The responses evoked have not always been kind. Prominent among the counterarguments has been: 'You should see what health care is like in other countries.'"

"This report utterly belies the notion that the former status quo for health care delivery in the U.S. was as good as it gets. Others have been doing better and we can, and should, too," he said.

However, at least one expert doesn't believe that health care reform, as it now stands, will solve these problems.

Dr. Steffie Woolhandler, a professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program, said that "the U.S. has the worst health care system among the seven countries studied, and arguably the worst in the developed world."

"Unfortunately, the U.S. will almost certainly continue in last place, since the recently passed health reform will leave 23 million Americans without coverage while enlarging the role of the private insurance industry, which obstructs care and drives up costs," she said.

More information

To see the full report, visit the Commonwealth Fund.

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