Tuesday, June 17, 2014

The Commonwealth Fund Keeps Score on U.S. Healthcare: Less Here Than Meets the Eye

YOU are in last place!
According to news reports on the Commonwealth Fund's comparison of the United States' healthcare to other developed countries, we are the sick man, on a losing streak and dead last


Just when the U.S. prevailed against Ghana in the World Cup, we have to deal with being called a loser.

Naturally, the Population Health Blog decided to investigate.  It discovered that the Commonwealth Fund ranked the U.S. against 10 other countries using a combination of multiple outcome measures. 

Here's the complete report

What does it actually say?  Rather than attempt to summarize the report's findings, the PHB provides some telling quotes:


"The United Kingdom ranks first and Norway last on quality, based on averages of the scores in these four areas. The U.S. falls in the midrange on this domain of performance."

Preventive Care:

"The U.S. does well in providing preventive care for its population. Respondents in the U.S. were more likely than those in most other countries to receive preventive care reminders and advice from their doctors on diet and exercise."

Effective Care:

"The U.S. is third on effective care overall, performing relatively well on prevention but average in comparison to other industrialized nations on quality of chronic care management."


"These findings indicate that the United States has improved on safety indicators.... For example, the U.S. now leads all nations with a relatively low number of sicker patients reporting an infection during a hospital stay or shortly after."

Care Coordination:

"Eighty-three percent of American patients had arrangements for follow-up visits with a doctor or other health care professional made for them when leaving the hospital, second only to the United Kingdom."

Patient Centeredness:

"The U.S. ranks fourth. All countries could improve substantially in this area."

Engagement and patient preferences:

"The United States did well on most indicators."

So, since the United States is doing well on quality, preventive care, effective care, safety, care coordination, patient centeredness as well as engagement and patient preferences, what's the problem? 

Again, some quotes:

Americans .... reported negative insurance surprises and the highest rates of serious problems paying medical bills.... On indicators of efficiency, the U.S. scores last overall with poor performance on the two measures of national health expenditures, as well as on measures of administrative hassles, timely access to records and test results, duplicative tests, and rehospitalization.

Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs.

The U.S. ranks last on mortality amenable to health care, last on infant mortality, and second-to-last on healthy life expectancy at age 60.

Plus this tidbit.....

Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home.

The PHB's take?  There is less to this than meets the eye:

1.  The United States performs well on a majority of overall quality measures.

2.  The United States suffers from high overall costs

3.  The Commonwealth Fund's ranking system faults the U.S. on two levels:  value (our high quality comes at a very high price) and equity (persons with lower incomes cannot afford to access our high quality system).  Add up the points in this scoring system, and the U.S. is last.

4.  The Commonwealth Fund uses data from prior to the 2014 implementation of Obamacare, which was specifically designed to address the United States' shortfalls by subsidizing commercial insurance and increasing Medicaid enrollment.

5. By the way, despite little evidence in the report that cost, value or access are necessarily increased by the U. S. version of the medical home, the Commonwealth Fund included it anyway.

How well will all those high out-of-pocket "bronze plans," Medicaid, Accountable Care Organizations and the medical home truly reduce cost inflation, enhance value and increase access? 

Stay tuned.  The PHB is looking forward to seeing how they'll rank Obamacare's impact in 2015.

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