I know reports like these are a dime a dozen, especially in post-recession America, but it bears reaffirmation, if only because a fair number of Americans still seem to think that our system is vastly superior to any existing or hypothetical alternative — even though the social and economic costs are vast and growing.
Let us start with this chart, courtesy of i09, which comes from a new report by the Commonwealth Fund, a private U.S-based foundation that promotes a more efficient healthcare. It compares the results of an extensive survey of patients and physicians across ten developed countries, looking at several relevant metrics.
Notice that by all measures, the United States is either middle-of-the-road or dead last , despite spending the most per person by far — $8,508 compared runner up Norway at $5,669 (incidentally the latter also does not perform all that well). Canada, while comparatively more efficient at nearly half the cost, does not perform all that impressively either.
By contrast, the highest ranked country on average, the United Kingdom, spends just $3,405 per person on health care. Taken as a whole, it appears that per capita spending has little bearing on the overall quality and effectiveness of the healthcare system (something that has been noted in similar international studies). Another chart from the report confirms this:
Despite such astronomical spending, in both proportional and absolute terms, the report sums up the America’s performance thusly: “[the country] fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.”
The culprit for such inefficiency? The very fact that many Americans lack access to reliable health care (including those who are technically insured).
Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.
However, as i09 notes, the study’s conclusion points to more than just broadening access:
The authors believe that the problems inherent in the U.S. healthcare system are so pervasive that it will take more than better access and equity to solve them. According to Karen Davis, lead author of the study, overall improvement “is a matter of accountability, having information on your performance relative to your peers and being held accountable to achieving a kind of care that patients should expect to get.”
But it’s not an intractable problem. The U.K.’s excellent result can be attributed to a number of reforms, including the hiring of more specialists, allocating bonuses to family physicians who meet quality targets, and adopting health system information that allows physicians to easily share information about their patients. Moreover, every citizen (apparently) has a doctor.
If there is any silver-lining, it is that the U.S. is moving in the right direction, if ever so slowly. In addition to the flawed but still impactful Affordable Care Act:
The U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology. Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.
Indeed, all of this attention towards the inefficiency of our healthcare system is leading to changes in both the political and private spheres. However, it will take a lot more than this piecemeal and hodgepodge approach to rectify what is very clearly a failing system. The solutions, while often difficult to implement, are clear, and both the necessary capital and public will is available. When will that be enough to spur necessary change?