US gets mediocre results despite high spending on health careBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7570.672-b (Published 28 September 2006) Cite this as: BMJ 2006;333:672
The United States spends twice as much on health care as a percentage of gross domestic product as other industrialised countries, a new report says. But it is behind the other countries in providing its citizens with good health outcomes, quality of care, access to care, efficiency, and equity, the report concludes.
The report, from the Commonwealth Fund, a private, non-profit foundation that works to increase healthcare coverage and quality, says: “Although national health spending is significantly higher than the average rate of other industrialized countries, the US is the only industrialized country that fails to guarantee universal health insurance, and coverage is deteriorating, leaving millions without affordable access to preventive and essential care.
“Quality of care is highly variable and delivered by a system that is too often poorly coordinated, driving up costs and putting patients at risk.”
The Commonwealth Fund's Commission on a High Performance Health System released its first national “scorecard,” which rates US health care on 37 indicators of performance. The report was published online in Health Affairs on 20 September (http://www.healthaffairs.org, doi:10.1377/hlthaff.25.w457). The fund plans to issue an annual scorecard.
This first scorecard used “benchmarks” to compare measures of healthcare performance in the US with the scores achieved by the top performing countries or by the top 10% of US states, health plans, hospitals, or other providers, depending on the measure. The score, out of a possible 100, is the ratio between actual US performance and the achievable benchmark.
Karen Davis, president of the fund, explained that in all cases the data are the latest available, including data on uninsured people that were updated with the new US Census report at the end of August 2006. In general, depending on the specific indicator, the most recent data are from 2000 to 2005 (2005, for example, in the case of numbers of uninsured people).
“The scorecard assesses how well the US health system is performing as a whole relative to what is achievable,” the report says. The average US score in the 37 indicators was 66 out of 100.
The US ranked last among 23 industrialised countries on infant mortality, with a rate of 7 deaths per 1000 live births, compared with 2.7 deaths per 1000 in the top three countries—Iceland, Japan, and Finland.
It tied for last place with Portugal, Ireland, Denmark, and the Czech Republic on healthy life expectancy at 60 years, indicating a shorter life expectancy and more years of life with poor health and disability.
The US ranked 15th out of 19 countries on the number of deaths before the age of 75 from conditions that are at least partially preventable or treatable. The US death rate on this measure was more than 40% higher than the benchmark, the average of the three best countries (France, Japan, and Spain).
Only half of US adults underwent recommended preventive and screening tests for their age and sex. If all US health insurance plans controlled diabetes and hypertension as well as the top 10% of plans, 20 000 to 40 000 deaths would have been prevented, and $1bn (£0.5bn; €0.8bn) to $2bn in medical costs would have been saved in 2004. The report used data from the National Committee on Quality Assurance's report The State of Healthcare Quality 2005 for this indicator.
A third of US adults aged under 65–61 million people—were either uninsured or underinsured at some point during 2003, and a third of adults aged under 65 reported problems with paying their medical bills or said they had medical debts.
Nearly a third of adults and more than half of children do not have a “medical home”—a provider of primary care.
The scorecard notes wide disparities between different areas and different health plans in rates of childhood vaccination and appropriateness of treatments for diabetes, congestive heart failure, and asthma.
A “wide gap” exists in access to care and quality of care between poor or uninsured people and people with higher incomes and insurance. Hispanic and black Americans are particularly at risk.
The US also “lags well behind other nations in the use of electronic medical records,” with only 17% of US doctors using them, compared with 60% to 90% in the leading countries.