WASHINGTON — A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 — as other nations did with concerted effort and significant reforms — it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system.
“Although the U.S. spends more on health care than any other country and has the highest proportion of specialist physicians, survey findings indicate that from the patients’ perspective, and based on outcome indicators, the performance of American health care is severely lacking,” the Commonwealth Fund, a New York-based foundation that promotes improved health care, concluded in its extensive analysis. The charts in this post are from the report.
The data for the 2014 report was collected before the Affordable Care Act went into full effect, so that reform may eventually boost the U.S. out of last place by providing health insurance to some of the 50 million people who lacked it. But, according to the study, the problems of our health-care system remain so pervasive that it will take more than better access and equity to resolve them.
Karen Davis, a professor in the Bloomberg School of Public Health at Johns Hopkins University and lead author of the study, said overall improvement “is a matter of accountability, having information on your performance relative to your peers and being held accountable to achieving a kind of care that patients should expect to get.”
The United Kingdom, which spends just $3,405 per person on health care, placed first overall in the comparison of 11 nations that include Australia, New Zealand, Switzerland, Canada, France, Germany and others. (Previous surveys examined smaller numbers of nations.) In 2004, the U.K. ranked third of the five nations studied.
“They’re not your grandmother’s national health service any more,” Davis said.
The U.K. diagnosed its health care system’s problems and addressed them, Davis said. “They really have moved up over time. A lot of it has been systematic attention to increasing resources in the system,” she said. Officials hired more specialists, gave bonuses to family physicians who meet quality targets and adopted health information systems that allow physicians to easily share information about patients. And everyone has a doctor.
The United States, on the other hand, “ranks behind most countries on many measures of health outcomes, quality, and efficiency. U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles,” the report concludes. The U.S. is beginning to catch up as it responds to financial incentives to improve health information systems, and the Affordable Care Act should strengthen that effort.
The U.S. fares well in providing preventive care and patient-centered care, according to the report. But among its many deficiencies, according to Davis and the report, are a relative shortage of primary care physicians; lack of access to primary care, especially for the poor; a large number of low-income residents who skip needed care, do not get recommended tests or do not fill prescriptions because of cost; high infant mortality; inordinate levels of mortality from conditions that could have been controlled, such as high blood pressure; and lower healthy life expectancy at age 60.
Davis said that while the government can set standards, provide incentives and exact penalties for poor performance, professional organizations that represent various parts of the medical system must get behind the effort to force changes, and many have.
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