One thing I haven’t heard much in this latest health care debate is that the United States has the best health system in the world. That’s different from the last two times around.
We’ve all had some good experiences, and we generally believe that the money we spend on technology and medicines equates to good care even though evidence shows those costly interventions may not deliver as advertised.
However, measured on several dimensions, including access to care, administrative efficiency, equity, and health outcomes, the U.S. compares poorly relative to other industrialized countries.
In its latest study comparing the U.S. with 10 other countries – the United Kingdom, Australia, The Netherlands, New Zealand, Norway, Sweden, Switzerland, Germany, Canada, and France – the U.S. ranks dead last. This is the sixth time since 2004 that The Commonwealth Fund has done such a survey.
“Each time we have managed to be last,” says Eric Schneider, a senior vice president of the Fund.
In the U.S., 44 percent of people with incomes below the median – about $55,700 in 2015 – reported that the cost of care prevented them from getting medical treatment. Twenty-six percent of those with incomes above the median said financial barriers such as high deductibles and coinsurance prevent them from getting care.
In the United Kingdom, only 7 percent of people with low incomes and 4 percent of those with higher incomes had trouble getting care.
In this latest survey, the U.K. ranked No. 1 overall and was judged the best when it came to equity and the process of care – preventive care, safe care, coordinated care and patient preferences – and third when it came to access. People in Britain seem to be doing OK despite all those queues for services Americans have heard about from the media.
When it came to equity, access to care, and health outcomes, the U.S. ranked last.
I would have expected our rankings to improve.
Schneider explained that the lack of universal coverage is a barrier and the cost of care is still too high for many Americans, even if they have insurance. Families with incomes in the middle ranges of eligibility for ACA subsidies – incomes of about $60,000 or $70,000 – get small subsidies and face high deductibles and other cost-sharing, a trade-off for those who can afford only plans with low premiums.
The administrative hassle is also a drawback. Fifty-four percent of U.S. primary care doctors said insurance restrictions made it hard to get treatment for patients, Schneider said. “That’s a big problem.”
The U.K., Australia, and New Zealand shine on this dimension. Schneider said that if the U.S. changed the way it pays providers, used fee schedules and global budgets – an amount a country, group, or hospital decides it will spend on care – the public would benefit.
Just as important, Schneider said, was the lack of U.S. investment in primary care compared to other countries where primary care is more widely and uniformly available. They dedicate a greater percentage of their medical workforce to that kind of care rather than specialty care. The U.S. favors expensive specialists.
So does the U.S. do well on anything? Although we ranked last on overall health outcomes such as life expectancy at age 60, there were bright spots such as breast cancer survival and fewer hospital deaths for heart attacks and stroke.
Those few achievements are simply not good enough.
What’s your biggest beef with the health care system? Write to Trudy at trudy.lieberman@gmail.com.
