United States Still Ranks Last Among Developed Nations in Healthcare Performance

The Commonwealth Fund has just released its 2010 rankings of seven of the developed world’s healthcare systems, and once again, the United States came in dead last. The nonprofit, New York-based foundation studied seven countries – Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States – in terms of how each performed on a list of healthcare quality indicators. These indicators include access, patient safety, coordination, efficiency, equity, quality and life expectancy. Not surprisingly, the U.S. scored poorly on most of these measures, the main reason for this being the absence of a universal healthcare program like single-payer. All of the other countries studied have systems that cover everyone.

The U.S., the study said, performed poorly on indicators such as chronic care management, reduction of medical errors, accessibility to primary care doctors, health spending, administrative costs, use of information technology, and equality of access to coverage. In only things like preventive care (ie. advice on nutrition and exercise) and access to specialists did the U.S. do relatively well. Overall, the U.S. healthcare system ranked at the bottom of the list of countries.

What makes this study different from previous ones, is that The Commonwealth Fund interviewed patients as well as doctors in its survey. We are constantly told by politicians and the media that Americans are generally satisfied with the healthcare they receive, but that doesn’t take into account the fact that most people rarely use the coverage they have. The Commonwealth Fund’s study digs deeper and the dissatisfaction is revealed when people are using healthcare services more extensively. The Fund’s authors asserted:

It is difficult to disentangle the effects of health insurance coverage from the quality of care experiences reported by U.S. patients. Comprehensiveness of insurance and stability of coverage are likely to play a role in patients’ access to care and interactions with physicians. While the U.S. differs from the other countries in the survey because of the absence of universal health insurance coverage, we found that even insured Americans and higher-income Americans were more likely than their counterparts in other countries to report problems such as not getting recommended tests, treatments, or prescription drugs. This is undoubtedly a reflection of the lack of comprehensive health insurance coverage and the high out-of-pocket costs for care in the U.S., even among the insured and those with above-average incomes. Fragmented coverage and insurance instability undermine efforts in the U.S. to improve care coordination, including the sharing of information among providers. Patients in other countries, in addition, are more likely to have a regular physician and long-time continuity with the same physician.

The Fund’s authors noted that the recent reform legislation passed by Congress and signed into law by President Obama earlier this year should help with some of the problems insured and uninsured Americans are currently facing. However, the reforms won’t fully be implemented until 2014. In the meantime, millions of Americans will continue to go without needed care because they are adults with pre-existing conditions and/or cannot afford coverage.

Americans are still losing jobs and along with that, their healthcare coverage. And there are indications that the billions in federal aid the Obama administration has set aside to help the stranded before all the reforms kick in are inadequate.

But even with all the federal reforms in place, the U.S. will likely not have solved the problems of out-of-control costs, inefficiency and access. Those unresolved problems will still affect overall quality. And, according to the Health and Human Services’ Center for Medicaid and Medicare Services report, ten years from now, over 20 million Americans will still be uninsured.

The federal legislation doesn’t do enough to curtail runaway costs because it insufficiently addresses weak state oversight of premium increases, leaving Americans at the mercy of greedy insurance companies. The legislation still leaves in place the messy, for-profit, employer-based health insurance system with its confusing hodge-podge of plans, co-pays and deductibles. The other countries surveyed by the Commonwealth Fund cover all of their citizens more cheaply, and none has to deal with a bloated, self-serving and for-profit insurance industry. The U.S. must follow in their footsteps, and California can help lead the way by approving SB 810.

sylvia@californiaonecare.org