U.S. Ranked Last In Healthcare
As reported by ScienceDaily US Ranks Last Among 7 Countries on Health System Performance, Report Says (6/10)
Despite having the most expensive health care system, the United States ranks
last overall compared to six other industrialized countries -- Australia,
Canada, Germany, the Netherlands, New Zealand, and the United Kingdom -- on
measures of health system performance in five areas: quality, efficiency,
access to care, equity and the ability to lead long, healthy, productive lives,
according to a new Commonwealth Fund report.
While there is room for improvement in every country, the U.S. stands out for
not getting good value for its health care dollars, ranking last despite
spending $7,290 per capita on health care 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 United
States' low marks in the quality and efficiency dimensions 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
Earlier editions of the report, produced in 2004, 2006, and 2007, showed similar
results. This year's version (2010) incorporates data from patient and
physician surveys conducted in seven countries in 2007, 2008, and 2009.
Key findings include:
• On measures of quality the United States ranked 6th out of 7 countries. On two
of four measures of quality -- effective care and patient-centered care -- the
U.S. ranks in the middle (4th out of 7 countries). However, the U.S. ranks last
when it comes to providing safe care, and next to last on coordinated care.
U.S. patients with chronic conditions are the most likely to report being given
the wrong medication or the wrong dose of their medication, and experiencing
delays in being notified about an abnormal test result.
• On measures of efficiency, the U.S ranked last due to low marks when it comes to
spending on administrative costs, use of information technology,
re-hospitalization, and duplicative medical testing. Nineteen percent of U.S.
adults with chronic conditions reported they visited an emergency department
for a condition that could have been treated by a regular doctor, had one been
available, more than three times the rate of patients in Germany or the
• On measures of access to care, people in the U.S. have the hardest time
affording the health care they need -- with the U.S. ranking last on every
measure of cost-related access problems. For example, 54 percent of adults with
chronic conditions reported problems getting a recommended test, treatment or
follow-up care because of cost. In the Netherlands, which ranked first on this
measure, only 7 percent of adults with chronic conditions reported this
• On measures of healthy lives, the U.S. does poorly, ranking last when it comes
to infant mortality and deaths before age 75 that were potentially preventable
with timely access to effective health care, and second to last on healthy life
expectancy at age 60.
• On measures of equity, the U.S. ranks last. Among adults with chronic conditions
almost half (45%) with below average incomes in the U.S. reported they went
without needed care in the past year because of costs, compared with just 4
percent in the Netherlands. Lower-income U.S. adults with chronic conditions
were significantly more likely than those in the six other countries surveyed
to report not going to the doctor when they're sick, not filling a
prescription, or not getting recommended follow-up care because of costs.
Data was drawn from the Commonwealth Fund 2007 International Health Policy
Survey, conducted by telephone in Australia, Canada, Germany, the Netherlands,
New Zealand, the United Kingdom, and the United States; the 2008 International
Health Policy Survey of Sicker Adults, conducted in the same seven countries
plus France; the Commonwealth Fund 2009 International Health Policy Survey of
Primary Care Physicians, conducted in the same eight countries plus Italy,
Norway, and Sweden; the Organization for Economic Cooperation and Development
Health Data 2009; and World Health Organization mortality and population
statistics for 2002-03. The 2007 Commonwealth Fund survey focuses on the
primary care experiences of nationally representative samples of adults ages 18
and older in the seven countries. The 2008 survey targets a representative
sample of "sicker adults," defined as those who rated their health status as
fair or poor, had a serious illness in the past two years, had been
hospitalized for something other than a normal delivery, or had undergone major
surgery in the past two years. The 2009 survey looks at the experiences of
primary care physicians.
The Commonwealth Fund is a private foundation supporting independent research on
health policy reform and a high performance health system.