Commonwealth
Fund's most recent international
comparison of health care certainly
makes the United States health care system look like one of the weakest in the
developed world. The analysis compares the health care system in the U.S.
to that of 10 other high-income nations, examining 72 indicators that measure
health care performance in five domains - access, administrative efficiency,
care process, equity and health care outcomes.
Let's
start by looking at a comparison of health care spending as a percentage of GDP
among the 11 nations in the studying back to 1980:
As
you can see, over the past 35 years, U.S. health care spending as a percentage
of GDP has been the highest among all 11 high-income nations and the
differential has been growing with time. Back in 1980, U.S. health care
spending totalled 8.2 percent of GDP; this has risen to 16.6 percent in 2014,
5.2 percentage points higher than the second place finisher, Switzerland.
Now,
let's look at the rankings for the five domains as listed above:
1.)
Access: includes two subdomains - includes two subdomains - affordability and
timeliness of treatment
2.)
Administrative Efficiency: includes four subdomains that measure barriers to
care experienced by patients including availability of regular doctor, medical
records and test results and three subdomains which measure patients' and
physicians' time and effort required to deal with paperwork and
insurance/government documentation.
3.)
Care Process: includes four subdomains - preventative care, safe care,
coordinated care and engagement and patient preferences
4.)
Equity: compares health care performance for lower- and higher-income
individuals
5.) Health Outcomes: includes three subdomains - population health outcomes,
mortality amenable to health care and disease-specific health outcomes measures
As
you can see on this table, the United States performs well only on the care
process domain and even then, it is still only in fifth place. On all
other domains, the American performance comes in last or second last place:
Obviously, when it comes to health care, the bottom line measure is mortality, particularly amenable
mortality which is defined
as:
"...deaths
from a collection of diseases such as heart disease, cancer, diabetes and
appendicitis that are potentially preventable given effective and timely health
care. This serves as a marker that highlights the performance of a health
care system."
Here
is a graphic comparing the mortality amenable to health care rate for all
eleven nations, showing the changes in the rate between 2004 and 2014:
In
all countries, the rate of deaths related to a lack of effective and timely
heath care dropped over the decade, however, the United States still has the
highest amenable mortality rate.
Finally,
let's close this posting with one last graphic that shows how, once again, the
United States is the outlier when it comes to a comparison of health care system
performance and health care system spending (as a percentage of GDP):
While
Congress continues to quibble over health care for Americans, as we can see
from the Commonwealth Fund study, no matter which political party is in
control, Americans pay more and get less when it comes to health care provision
and results.
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