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New global report: U.S. healthcare ranks last again

Posted Jul 08 2010 7:52am

by Christopher Cornue

There's more dismal news on our healthcare system. When compared to six other developed countries on a number of indicators, the U.S. came in last, according to a report released on June 23by the Commonwealth Fund.

We ranked last or next to last on five "dimensions of a high performance health system" compared to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.

The meat of the report is worth digesting fully. Among the many "takeaways" was one line that supports where I believe healthcare in the United States should go in the future: "Rather than focus solely on best practices within its borders, the U.S. would benefit from analysis of promising innovations in other countries and great investment in cross-national research."

Compared with the other countries, we spent more money (health expenditures per capita) for our healthcare system at $7,290. The next closest country was Canada at $3,895. The report further details how the U.S. falls behind other comparison countries in many performance metrics, but also does well in others. Among the highlights:

Access: Looking at cost-related access problems and timeliness of care, the report suggests that one of the main differences between the U.S. and other nations is the lack of universal health insurance coverage. The newly signed healthcare legislation will begin to address this over the next few years, which should help improve the U.S. ranking in these studies. But addressing healthcare access (universal health insurance) alone will not improve our overall standing.

Quality: The report defines quality as care that is effective, safe, coordinated and patient-centered. Overall New Zealand ranked first and Canada ranked last based upon an overall review of all four components of quality.

* Effective Care: When compared to the other countries, the U.S. performs well in providing preventative care, such as reminder notices and advice about diet and exercise. When it comes to managing chronic diseases, the UK outshines the other countries overall; however, the ranking depends upon the specific chronic disease being measured. The U.S. ranks average with respect to managing chronic disease.

* Safe Care: Australia, Canada and the U.S. ranked highest in reported medication errors across the six countries. It was interesting to note that these countries also lag in using information technology (such as automated alerts or prompts about adverse drug interactions, doses, etc.). Only 20 percent of Canadian physicians receive these alerts, but 95 percent of physicians in the Netherlands (which ranked highest) receive these automated alerts. These results suggest that technology plays a critical role in ensuring safe care.

* Coordinated Care: New Zealand has the highest ranking when it comes to ensuring there is a "coordination of patient care throughout the course of treatment and across various sites of care." Germany and the U.S. rank at the bottom. Here's an example that reflects the divide. Eighty-two percent of chronically ill U.S. patients report they have a regular doctor, while in the Netherlands, 99 percent of them do. Other indicators used in the report look atwhether primary care physicians receive information from specialists, whether patients receive a written plan of care upon discharge, and whether follow-up appointments are arranged for patients post-discharge.

* Patient-Centered Care: The U.S. was average in these metrics, while New Zealand and Australia ranked highest. This area factors in communication, continuity/feedback, engaging the patient and understanding the patient's preferences. Again, like the other focus areas, these seemlike no-brainers. They're relatively straightforward. Yet, the report suggests that all countries need to improve these aspects of patient care.

Efficiency: The report looked at each nation's total national healthcare expenditure as a percentage of GDP and the percent spent on health administration and insurance. The U.S. scores last in this area primarily due to high healthcare spending, but also because of untimely access to records and results. Additionally, duplicative tests, re-hospitalization, and the lower IT usage by physicians affected the overall score.

Equity: Thesemetrics are closely related to those for access. As a result, the U.S. ranks lowest again. The report details that Americans with below-average incomes are less likely to seek out care, such as corresponding tests, follow-up treatments, and prescriptions, than consumers in the other countries. Lower-income patients in the U.S. also say they find it more difficult to access care in the evenings, or on weekends and holidays. The Netherlands and the UK scored highest.

As I've said repeatedly, the future of healthcare is global. This report shares many lessons to be learned and while the face of healthcare in the U.S. is changing due to recently enacted healthcare legislation, we need to do more with our international partners to improve healthcare globally. We have a great deal to offer other countries, but also so much to learn from them.

Christopher Cornue is principal for slainte global partners and is the former CEO at McKee Medical Center in Northern Colorado. He has also served as vice president at Mount Sinai Hospital and Health System in Chicago, and has held leadership roles at University Health System Consortium and the University of Chicago Hospitals.

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