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Report: U.S. Health Care Ranks Last Among Wealthy Countries

America trails in access, efficiency, equity, and healthy lives

Although the U.S. health care system is the most expensive in the world, it consistently underperforms compared with other countries on most dimensions of performance, according to a new report from the Commonwealth Fund.

Among the 11 nations studied — the U.S., the U.K., Canada, Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, and Switzerland — the U.S. ranked last, as it did in 2004, 2006, 2007, and 2010 reports. Most troubling, the U.S. failed to achieve better health outcomes than the other countries, and was last or near last on dimensions of access, efficiency, and equity. The U.K. ranked first, followed closely by Switzerland.

The new report incorporated patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. It also included information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013).

The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage, the report says. Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes. The Patient Protection and Affordable Care Act (PPACA) appears to be increasing the number of Americans with coverage and is improving access to care, although the data in the report were from years prior to the full implementation of the law.

The U.S. also ranked behind most countries on measures of health outcomes, quality, and efficiency. U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles, according to the report. Other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems.

Compared with the other 10 countries, the U.S. fared best on the provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pulled the overall U.S. quality score down. Continued adoption of health information technology should enhance the ability of U.S. physicians to identify, monitor, and coordinate care for their patients, particularly those with chronic conditions, the report notes.

Not surprisingly — given the absence of universal coverage — people in the U.S. go without needed health care because of cost more often than do people in the other countries, the report found. 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 are people in leading countries in the study.

On indicators of efficiency, the U.S. ranked last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. had poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing.

The U.S. also ranked last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.

The U.S. ranked last overall with poor scores on all three indicators of healthy lives — mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than had some of the other countries, e.g., the rates were 25% to 50% higher than those in Australia and Sweden. Overall, France, Sweden, and Switzerland ranked highest on healthy lives.

Sources: Commonwealth Fund Infographic; June 17, 2014; and Commonwealth Fund; June 16, 2014.

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