A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

US: We're Number One in All the Wrong Ways

US: We're Number One in All the Wrong Ways

May 20, 2007

Last month, at an Oklahoma University debate on MA health reform, Michael Tanner from the Cato Institute and I tussled over whether the US health care system is the best in the world. I was pretty incredulous that Tanner really thought it was. Wish I had this new material from the Commonwealth Fund with me. Bottom line: we stink pretty badly.

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care by Fund president Karen Davis, Ph. D., and colleagues includes data from surveys of patients and primary care physicians about their medical practices and views of their countries' health systems. The authors say the poor performance in the U.S. reflects its status as the only country in the study without universal health insurance coverage.

Among six nations (Canada, UK, New Zealand, Australia, and Germany), we're number six on quality, access, efficiency, equity, and healthy lives. Even though we pride ourselves on our "technologically advanced" system, we're number six in terms of investment in information technology.

An updated Commonwealth Fund chartbook by researchers from The Johns Hopkins University compares health spending data in nine Organization for Economic Cooperation and Development (OECD) countries and, where possible, the median of all 30 OECD countries. Although the U.S. spends more than twice as much per capita on health care as other nations ($6,102 vs. $2,571 for the median of OECD countries in 2004), the country spends far less on health information technology--just 43 cents per capita, compared with about $192 per capita in the U.K.

Some favorites:

Americans spend way more out of pocket on medical expenses than do citizens of all other advanced nations, all of which do a much better job controlling health expenditures.

We have the lowest number of acute care hospitals beds per capita and the second lowest average length of stay than other advanced nations, in spite of having far and away the highest per capita hospital costs.

We are far and away number one on obesity prevalence -- 30 percent vs. 23 percent in the UK (#2).

We are far and away number one on potential years of life lost due to diabetes -- 101 vs. 59 in Canada (#2).

We are also number one on deaths due to surgical or medical mishaps, Germany close behind at #2: .07 deaths per 100,000 vs. .06.

Good news: We have the second lowest share of adults who are daily smokers, next to Canada -- 17 vs. 15 percent.
John McDonough