Are Americans Getting the Quality Health Care We Pay For?

On December 21st, we discussed health care costs and compared spending in the United States to that of other industrialized countries in the Organization for Economic Cooperation and Development (OECD). We saw that the United States spend far more per capita on health care services than any other country.  Our higher costs are attributable in large part to the higher payments we make to physicians and for pharmaceuticals and diagnostic equipment.  Todaywe will look at how well our system performs compared  to other countries.

Researchers have compared the quality or effectiveness of the healthcare system in different countries in several ways, including survival rates for patients with certain diseases, the use of evidence-based measures to treat particular illness, rates of hospitalization for chronic conditions and  surveys of patients’ and physicians’ satisfaction. No measure is complete, but many of them are helpful.  Most comparative studies focus on countries in the OECD, which comprises some 30 industrialized democracies.

review of the work by the Robert Wood Johnson Foundation and the Urban Institute  found, among other things,  that cancer patients in the United States are more likely to survive five years from the date of diagnosis than in other countries because of the high rate of cancer screening here.

The Commonwealth Fund supports comparisons of health care spending and effectiveness among at least five OECD countries each year. In September, 2011, it reported on a comparison of the effectiveness of the health care systems of 16 high-income countries at preventing “amenable mortality,” 0r deaths that could have been prevented with timely, appropriate health care. Using data from the World Health Organization, the researchers compared the number of deaths from specific causes in the 16 countries in 1997-1998  and 2006-07. All countries showed reductions in unnecessary deaths, and progress varied dramatically. In 1997, Ireland had the the highest rate, 134 per 100,000 people. As of 2007, Ireland’s rate improved by 42 percent, to 78.  The average rate of decrease was about 32 percent. The United States ‘ rate of improvement was among the bottom two, at 20.5 percent. Amenable mortality here dropped from 120 to 96 per 100,000 population, the highest among the 16 countries, and the only one remaining over 85.  Several factors unrelated to our health care system could contribute to the relatively high rate, however.

Other relevant measures of quality of health care include:

  • Safety (absence of medical errors, and healthcare acquired conditions)
  • Effectiveness
  • Timely access to needed care
  • Control of chronic illnesses such as asthma or diabetes

Studies have compared outcomes of U.S.  patients to patients in other countries who were treated for heart disease, hip fracture and cataracts.  Patients in the United States and Brazil  undergo more invasive cardiac procedures, on average, than others. They were found to have lower rates of readmission for  unstable or refractory angina,  no overall reduction in the rate of cardiac death or heart attack and a slightly higher risk of stroke than those of other countries.  American patients who underwent surgery after a hip fracture had higher survival rates than Canadians. treated for hip fracture. Another study found that patients in six countries had about the same level of visual acuity after cataract surgery, though one method used in the United States and Manitoba was associated with  earlier post-operative problems.

There is some evidence that the United States has a higher incidence of death caused by medical and surgical errors, but differences in reporting standards and methodology leave room for doubt.

A July 2011 study compared health care spending and other  measures of quality and effectiveness in the United States to 11 other industrialized nations.  Hospital admissions for five  chronic diseases were compared. The United States had the highest number of admissions for three:  asthma, congestive heart failure and acute complications of diabetes,  120,  441 and 57 per 100,000 population, respectively. Only admissions for hypertension were lower than average.

The United States’ rates of death in the hospital within 30 days after admission for three conditions were compared with eight other countries. The U.S. had the third-highest percentage of fatalities  for acute myocardial infarction , the second highest for hemorrhagic stroke and the fifth for ischemic stroke – not the worst record, but perhaps too high in light of our spending.

Why is there such a disconnect between what we spend and what we get for it?