A Medical Device Daily

A new report, just released by Commonwealth Fund (New York), underlines what we have been told many times before: that while the U.S. can boast the most costly healthcare system on the planet — and perhaps the most technologically sophisticated — it doesn't have the best health — or at least not the best delivery of healthcare. And the report says that the U.S. is way behind the curve when it comes to the use of new information technologies.

The U.S. healthcare system ranks last compared with five other nations on measures of quality, access, efficiency, equity, and outcomes, according to Commonwealth Funds' third edition of its analysis of international health policy surveys.

The report, titled "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care," was written by Karen Davis, PhD, president of Commonwealth, and her research colleagues. It compares surveys on physicians' and patients' experiences and views of their health systems in Australia, Canada, Germany, New Zealand, the U.K., and the U.S. between 2004 and 2006.

Among the key findings:

  • The U.S. overall ranked fifth out of the six countries. The U.S. ranked fifth in coordinated care and last in patients reporting that they have a regular doctor (84% vs. 92%-97% in other countries).
  • The U.S. ranked last overall on measures of access, including last on timeliness of care: 61% of U.S. patients said it was "somewhat" or "very difficult" to get care on nights or weekends, compared with 25%-59% in other countries. The report said that the U.S. and Canada rank lowest on the prompt accessibility of appointments with physicians, with patients more likely to report waiting six or more days for an appointment when needing care. Germany had the highest rating for accessibility to care.
  • The U.S. ranked last overall on efficiency, including last on the percentage of patients who have visited the emergency room for conditions that could have been treated by a regular doctor if one had been available (26% vs. 6%—21% in other countries).
  • The report says that the U.S. system does well on some measures of preventive care, but it ranks at the bottom on measures of safe care and coordinated care.

An executive summary of the report says that "the most notable way the U.S. differs from other countries is in 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.'"

This, it says, leads to underperformance "on measures of access to care and equity in healthcare between populations with above-average and below-average incomes."

The report also puts the U.S. as fifth among the six countries in the use of "high clinical information functions" by primary care practices. High clinical information functions are defined as the presence of seven of 14 office practice information functions, such as electronic records, electronic prescribing, computerized safety alerts, and patient reminders systems and registries (19% vs. 8%—87% in other countries).

The executive summary says that the U.S. is lagging in this area and that it could learn "from what physicians and patients have to say about practices that can lead to better management of chronic conditions and better coordination of care."

Germany, New Zealand and the UK use their information systems, it says, to "enhance the ability of physicians to monitor chronic conditions and medication use."

Another new Commonwealth Fund report comparing health spending data in industrialized nations also just published by the organization says that despite spending more than twice as much per capita on healthcare as other nations ($6,102 vs. $2,571 for the median of Organization for Economic Cooperation and Development [OECD] countries in 2004), the U.S. spends far less on health information technology, just 43 cents per person, compared with about $192 per person in the U.K.

The report, "Multinational Comparisons of Health Systems Data, 2006," by Jonathan Cylus and Gerard Anderson, PhD, of The Johns Hopkins University (Baltimore), compares health spending data in nine Organization for Economic Cooperation and Development (OECD) countries: Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, the UK, and the U.S. and, where possible, the median of all 30 OECD countries.

Among the key findings:

  • In 2004 the U.S. spent the most per capita on hospital services, and Canada and Japan spent the least. Adjusted for differences in cost of living, inpatient acute care spending per day in the United States was nearly three times the median OECD country ($2,337) and over five times more than Japan ($419).
  • The U.S. spent twice the OECD median per capita on drugs in 2004, $752 compared with $377.
  • Nearly one-third (30.6%) of individuals in the U.S. were obese in 2004, compared with 13% of the OECD median.
  • The U.S. had about two-and-a-half times the OECD median for years of potential life lost due to diabetes, 101 per 1,000 people compared with 39 per 1,000 (U.S. data is for 2002).

Karen Davis, president of Commonwealth, said that the U.S. "stands out as the only nation in these studies that does not ensure access to healthcare through universal coverage and promotion of a ‘medical home' for patients. Our failure to ensure health insurance for all and encourage stable, long-term ties between physicians and patients shows in our poor performance on measures of quality, access, efficiency, equity, and health outcomes. In light of the significant resources we devote to healthcare in this country, we should expect the best, highest performing health system."