US lags in health care despite largest investment, survey showsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7546.869-a (Published 13 April 2006) Cite this as: BMJ 2006;332:869
US lags in health care despite largest investment, survey showsWashington, DC
Ill people in the United States were more likely than those in other countries to report receiving the wrong drugs and incorrect or delayed test results, shows a survey of similar patients in six developed countries.
The survey, which was conducted by the New York based Commonwealth Fund, a private foundation that works towards improving healthcare coverage and quality, showed that the United States scored last in four of six categories—efficiency, patient centredness, equity, and patient safety—even though it spends upwards of $2500 (£1440; €2700) more per person on health care than the next highest spending country surveyed.
The survey showed that the amount spent on health for each person in the US, adjusted for cost of living, was $5635. The country spending the least, at $1886 per person, was New Zealand.
Germany scored the highest overall, coming first in three of the six categories, followed by New Zealand, then the United Kingdom, Australia, and Canada. The UK was top in patient safety and equity.
"These finding indicate that, from the perspective of the patients it serves, the US health care system could do much better in achieving high quality performance for the nation’s substantial investment in health care," the study states. Karen Davis, president of the Commonwealth Fund, led the research team.
In assessing efficiency, the survey showed that ill Americans reported more often than ill people in the other countries going to emergency departments for treatment of conditions that could have been handled in a primary care clinic if one had been available. They were also were more likely to report that laboratory test results and medical records failed to reach their doctor’s office in time for their appointment.
Concerning the issue of equity, more than two fifths of US adults on a low income said that they went without care they needed care because of the cost. "Compared with their counterparts in the five other countries, low-income Americans were significantly more likely to have access problems related to cost, even after controlling for health status and insurance," the study says. The US was the only country surveyed without a universal health insurance system.
However, the US ranked highest in the effectiveness category, which included provision of preventive care and care for chronically ill patients. Patients in the US and Germany reported the fewest delays to see a specialist, but Americans and Canadians were more likely than people from other countries to say that they waited six days or more for an appointment or had difficulty getting care on nights and weekends.
Data for the survey came from the Commonwealth Fund’s 2004 international health policy survey and its 2005 international health policy survey of sicker adults. The first was conducted among a nationally representative sample of 8700 adults in Australia, Canada, New Zealand, the United Kingdom, and the United States; the second was conducted among a sample of 7000 adults with health problems in the same five nations and Germany.
The researchers caution on the "limits to reliance on patient perspectives to assess quality of care." Yet, they add, the World Health Organization’s comparisons of health systems "also suggest that the US achieves the least for its population among these five countries."
The analysis concludes that a "consistent relationship" exists between equity in access to health and how patients rate performance on other quality factors. "Rather than disregarding its performance on equity as a separate and lesser concern, the US should devote far greater attention to seeing that the health system works well for all Americans," the authors wrote.
Mirror, Mirror on the Wall: An Update on the Quality of American Health Care through the Patient’s Lens is available at www.cmwf.org.
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