Tuesday, July 25, 2017

United States Health Care - Paying More and Getting Less

Commonwealth Fund's most recent international comparison of health care certainly makes the United States health care system look like one of the weakest in the developed world.  The analysis compares the health care system in the U.S. to that of 10 other high-income nations, examining 72 indicators that measure health care performance in five domains - access, administrative efficiency, care process, equity and health care outcomes.  

Let's start by looking at a comparison of health care spending as a percentage of GDP among the 11 nations in the studying back to 1980:


As you can see, over the past 35 years, U.S. health care spending as a percentage of GDP has been the highest among all 11 high-income nations and the differential has been growing with time.  Back in 1980, U.S. health care spending totalled 8.2 percent of GDP; this has risen to 16.6 percent in 2014, 5.2 percentage points higher than the second place finisher, Switzerland.

Now, let's look at the rankings for the five domains as listed above:

1.) Access: includes two subdomains - includes two subdomains - affordability and timeliness of treatment


2.) Administrative Efficiency: includes four subdomains that measure barriers to care experienced by patients including availability of regular doctor, medical records and test results and three subdomains which measure patients' and physicians' time and effort required to deal with paperwork and insurance/government documentation.


3.) Care Process: includes four subdomains - preventative care, safe care, coordinated care and engagement and patient preferences


4.) Equity: compares health care performance for lower- and higher-income individuals


5.) Health Outcomes: includes three subdomains - population health outcomes, mortality amenable to health care and disease-specific health outcomes measures 


As you can see on this table, the United States performs well only on the care process domain and even then, it is still only in fifth place.  On all other domains, the American performance comes in last or second last place:


Obviously, when it comes to health care, the bottom line measure is mortality, particularly amenable mortality which is defined as:

 "...deaths from a collection of diseases such as heart disease, cancer, diabetes and appendicitis that are potentially preventable given effective and timely health care.  This serves as a marker that highlights the performance of a health care system.

Here is a graphic comparing the mortality amenable to health care rate for all eleven nations, showing the changes in the rate between 2004 and 2014:


In all countries, the rate of deaths related to a lack of effective and timely heath care dropped over the decade, however, the United States still has the highest amenable mortality rate.

Finally, let's close this posting with one last graphic that shows how, once again, the United States is the outlier when it comes to a comparison of health care system performance and health care system spending (as a percentage of GDP):


While Congress continues to quibble over health care for Americans, as we can see from the Commonwealth Fund study, no matter which political party is in control, Americans pay more and get less when it comes to health care provision and results.