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U.S. ranks last among seven countries on healthcare performance

June 23, 2010 | Bernie Monegain, Editor

NEW YORK – The U.S. healthcare system comes in last for performance among seven industrialized nations, despite spending the most, according to a new Commonwealth Fund report. The researchers note that healthcare reform and uptake of health information technology hold promise for the future.

Despite having the most expensive healthcare system, the United States ranked last overall compared to Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom.

The research measured five performance areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.

While there is room for improvement in every country, the United States stands out for not getting good value for its healthcare dollars, ranking last despite spending $7,290 per capita on healthcare in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first overall.

Provisions in the Affordable Care Act that could extend health insurance coverage to 32 million uninsured Americans have the potential to promote improvements to the United States' standing when it comes to access to care and equity, according to "Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update," by Commonwealth Fund researchers Karen Davis, Cathy Schoen, and Kristof Stremikis.

The low marks in the quality and efficiency dimensions for the United States demonstrate the need to quickly implement provisions in the new health reform law and stimulus legislation that focus on realigning incentives to reward higher quality and greater value, investment in preventive care, and expanding the use of health information technology.

"It is disappointing, but not surprising that, despite our significant investment in health care, the U.S. continues to lag behind other countries," said Commonwealth Fund president and lead author Karen Davis. "With enactment of the Affordable Care Act, however, we have entered a new era in American healthcare. We will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high quality, efficient health care."

Earlier editions of the report, produced in 2004, 2006 and 2007, showed similar results. This year's version incorporates data from patient and physician surveys conducted in seven countries in 2007, 2008 and 2009.

Key findings from the study are on the next page.

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Reader Comments (5)Login to Post a Comment

robforster says: Did you look at the methodology?
June 28, 2010 | 10:19AM GMT

MFortier-did you look at the self-reported survey as their tool? If you did not then do not assume this study has any merit. Evidence based metrics will only suffice to avoid this "belief".

As far as food choices having an impact on population health --it has a great impact and fits in the CULTURE (behavior) category. Another example: we are the "thickest" country in the world bar none. It leads to D.M, hypertension, breast and colon cancer, osteoarthritis and others. Most countries who rank higher on population health are closer to ideal weight and thus do not experience this degree of disease burden. It is our culture and its desire to have a quick medicinal fix. Lifestyle (includes food) is the #1 major contributor to overall health next to exercise.
Rob MD

MFortier says: U.S. ranks last among seven countries on healthcare performance
June 28, 2010 | 8:30AM GMT

This is a pretty good article which helps to show where the US can improve. However I believe it misrepresents how well we is really doing in healthcare compared to the rest of the world. The US recognizes 194 countries worldwide and if we're ranked 7th in Healthcare performance, that puts us in the top 5%. If you compared the US with the top 10 most populated countries (which includes China, Russia, and Japan)it looks like we would be ranked #1. I guess a lot depends on how you look at the data.

Dave, RN says: It's what we eat
June 25, 2010 | 12:24PM GMT

One of the reasons we lag behind is becuase our diet in this country is terrible. Sugar, high carb and low in natural foods. In many other countries meat is grass and not corn fed. They eat real fats from butter and not margarine (like France). Ruminents eat grass, not grain. It's an un-natural diet that affects the nutrition of the meat.
We eat a mostly processed, factory made diet. We need to get back to eating Real Food, and get the healthy saturated fats back in our diet. The recently released dietary guidlines are a recepe for continued physical decline. Good for big agra, but not for your health. But it's put out by the USDA, so I guess we sould expect an unhealthy grain based, carb saturated diet from that little bit of conflict of intrest.
We've been on a downhill slide even since Ancel Keys published the 7 countries study, where he kicked out the countries that did not match his hypotheses (that consuming fat causes heart disease). The decline accelerated once the first food pyramid came out.
The sooner the government gets out of dietary advice, the better off we'll all be. Meanwhile, ignor it. It's been an abject failure. Go back to eating Real Food that oy have to pick or kill and stop eating out of a box. I did and it cured my blood sugar problem and I lost 30lbs doing it. Normalized my blood pressure to.

robforster says: This miror has no reflection
June 23, 2010 | 1:29PM GMT

With respect, one must consider the ideology of the Commonwealth Fund whoes mission is focused on the vulnerables and who repeatedly support the PPACA (health reform)plan stating it promotes access (yes) and affordabilty (not for 90% of Americans it does not). This bias must be viewed with their results and their study methodology which is terribly flawed. The study is based on self reported telephonic surveys of both patient and physician "perceptions" in the context of their culture and expectations. Comparing apples to oranges has no scientific validity. Despite Ms. Davis being a prominent economist, the cost of our medical delivery system has almost nothing to do with "long, healthy productive lives" which she equated to medical outcomes. Population health is principally driven by culture (patients behavior/misbehavior/life style) and genetic and gestational endowments. The healthcare system is for treating the ill--Public health is the principle driver of population health information and primary prevention. After cleaning the water and sewage and childhood immunizations, the healthcare system has little impact on overall population health and longevity.

Cost issues are driven by history of our payment system and overuse of unnecessary technology (testing, imaging, pharmaceuticals) driven by American expectations and provider education and patient demands and many other drivers, e.g. lack of tort reform, etc..Provider oligopolies also are driving current cost trends. These are all complex issues-- trying to formulate rankings from self-reported surveys of different cultures is laughable. No hard evidence was presented to support their conclusions.
Does equity mean "social equity?"--In all of the "superior" countries, money talks and allows faster access/quality than their official universal healthcare system--it is just a worldly fact-collectivism does not exist where there is a diversity of wealth. Is our delivery system too costly-yes. Should we have a basic universal health system-yes. Let's fix it with real world answers that we can afford and sustain.
Rob MD

brahman says: This report is weak and anemic!
June 23, 2010 | 12:23PM GMT

It doesn't take into consideration that US patients are the most fussy and argumentative/ litigious. Whereas patients in other countries just shut up and accept whatever healthcare they get because it is FREE anyway. In the US people actually pay with their own hard earned money and they have the right to complain (Don't americans always complain anyway?). As a result, when CF president and lead author goes around surveying, they get these skewed results. All of the report is wrong mostly. If you adjust for the complaining factor of americans, US providers will actually look far better than those in the other 6 countries.

Let me know who agrees with me - don't hold this against me for my honest opinion. Couldn't have said this in a better or more polite way - sorry!

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