US Ranks Behind Germany in Healthcare

Americans are often told that they have the best healthcare system in the world.  And that may be true for the upper 5% of the population in terms of income: they have by far the best medical options that money can buy.  For the rest of us, however, the situation is not so rosy.  The Commonwealth Fund has issued its report on healthcare, and the US performed poorly -placing last, in fact – among the six countries surveyed on six key domains of healthcare: Patient Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency and Equity: 

Overall, the findings indicate that the U.S. health care system often performs relatively poorly from the patient perspective. The U.S. system ranked first on effectiveness but ranked last on other dimensions of quality (Figure ES-1). It performed particularly poorly in terms of providing care equitably, safely, efficiently, or in a patient-centered manner. On measures of timeliness, the U.S. system did not score as well as some of the other countries and rarely received top scores. For all countries, responses indicate room for improvement. Yet, the other five countries spend considerably less on health care per person and as a percent of gross domestic product than the United States. These findings indicate that, from the perspective of the patients it serves, the U.S. health care system could do much better in achieving high-quality performance for the nation’s substantial investment in health.

For me, the most telling category was Equity: the higher the income, the better the healthcare:

Equity: Nine measures from the two surveys gauged the extent to which patients’ income affected their ability to access care. The U.S. scored last on seven of the nine measures of low-income patients not receiving needed care and had the greatest disparities in terms of access to care between those with below-average and above-average incomes. With low rankings on all measures, the U.S. ranked last among the six countries in terms of equity in the health care system. The U.K. ranked first, with no or negligible differences in terms of patients’ access to care by income. The U.S. is the only country surveyed with large numbers of uninsured, and this contributed to its low rating for equity in the health care system. But even among above-average income respondents, the U.S. lagged considerably behind their counterparts in other countries.

The problem in the US is entirely systemic: 45 million Americans have zero health-insurance, and the vast majority of the "lucky" insured Americans are underinsured.  The result is a predictible failure to address epidemiological risk. Millions of people just don’t take care of themselves, and tightfisted insurers inhibit them from engaging in preventative care. Lacking a single-payer insurer, there are no incentives to initiate programs to make necessary changes in lifestyle that would improve health on a large scale. The result is poor health outcomes for more and more Americans.

Polls show that healthcare is a primary concern for many Americans. Will that lead to change fo a single-payer system?  Don’t bet on it.  The last "improvement" offered by the Republican-controlled US Congress was the Medicare-Part D prescription drug benefit which turned out to be cruel nightmare for elderly Americans and a financial bonanza for the drug companies.

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