Dead last: health care quality in the U.S.

A few paragraphs in the executive summary of a new report quickly reveal the brutal truth:

Among the six nations studied — Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States — the U.S. ranks last, as it did in the 2006 and 2004 editions of [our report]. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and … the U.S. is last on dimensions of access, patient safety, efficiency and equity.

The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term “medical home.”

It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.

The study was conducted by the Commonwealth Fund, a prestigious and progressive private foundation in New York City that “aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children and elderly adults.”

The total sample across all countries was approximately 16,000 adults and over 5,150 primary care physicians sampled over a period of three years.

The report, titled “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care,” includes the following key findings:

Quality: The indicators of quality were grouped into four categories: preventive care, safe care, coordinated care and patient-centered care. Compared with the other five countries, the U.S. appeared to deliver better preventive care; however, low scores on all other aspects of quality care pulled the overall quality of health care score down. In addition, the other countries are more advanced than the U.S. in the use of information technology, which allows health care providers to more effectively monitor patients with chronic illnesses and to more effectively manage medications and patient care.

Access: The profits-before-people “fee for service” orientation of the medical industry in the U.S. means that people 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 problems getting medical care because of cost. However, patients in the U.S. with adequate health care plans — an ever-decreasing proportion — have timely access to specialized health care services. In the U.K. and Canada, patients have little to no financial burden, but they may experience longer wait times for such specialized services based on medical and public health criteria rather than income or type of health insurance. The U.S. is among the worst in terms of timely appointments with physicians.

Efficiency: The U.S. ranks last among the six countries on indicators of efficiency. For example, the U.S. spends way too much on national health expenditures and administrative costs compared to the other countries in the study.

Equity: The U.S. is dead last on all measures of equity. Compared to comparable populations in the other countries, low-income Americans were much more likely to report not being treated by a physician when sick — foregoing a recommended test, treatment or follow-up appointment; skipping a prescription; or not seeing a dentist — because of cost. More than two-fifths of lower-income adults in the U.S. said they skipped needed care because of cost in the past year.

Healthy lives: Tragically, and not surprisingly, the people of the United States rank last overall with poor scores on all three indicators of healthy lives used in this study. The U.S. had much higher death rates from conditions that can be treated by medical care. These rates were 25 percent to 50 percent higher than Canada’s and Australia’s.

In the U.S. today, profits could not be better, but the quality of health care for working people could hardly be worse. It is a deadly and necessary relationship that can be reversed only with the establishment of a real national health service in the United States based on the sound concept of people before profits.