There is always some group trying to measure the US Health Care system to other countries, frequently for purely political purposes. A recent report by the Commonwealth Fund in my opinion is a recent thrust in that direction. It examines in its own world of metrics the US system to others and as one would expect it results in the US being last.
We have from the Guardian[1]:
The NHS has been declared the world's best healthcare
system by an international panel of experts who rated its care superior to
countries which spend far more on health.
The same study also castigated healthcare provision in
the US as the worst globally. Despite putting the most money into health,
America denies care to many patients in need because they do not have health
insurance and is also the poorest at saving the lives of people who fall ill,
it found.
The report has been produced by the Commonwealth Fund, a
Washington-based foundation which is respected around the world for its
analysis of the performance of different countries' health systems. It examined
an array of evidence about performance in 11 countries, including detailed data
from patients, doctors and the World Health Organisation.
"The United Kingdom ranks first overall, scoring
highest on quality, access and efficiency," the fund's researchers
conclude in their 30-page report. Their findings amount to a huge endorsement
of the health service, especially as it spends the second-lowest amount on
healthcare among the 11 – just £2,008 per head, less than half the £5,017 in
the US. Only New Zealand, with £1,876, spent less.
The above uses some less that substantial metric for quality
and also uses the costs metric. The conclusion is that it is less than half of
the US. The NHS is hardly free of criticism. In fact it has been beaten up
especially over the results of its often limited cancer care efforts.
Subsequently from the Guardian[2]:
A slow hand clap for Andy McGovern, a London hospital
nurse who has proposed that the Royal College of Nursing supports a £10 charge
to visit a GP. On its own terms, the proposal is an unacceptable assault on the
very foundations of the NHS: that it is free at the point of use. But the
suggestion is so menacing because of where it originates from. The many enemies
of the NHS – who have to be diplomatic, knowing that the NHS "is the
closest the English have to a religion", as Nigel Lawson once put it –
will rejoice. "Aha!" they will think. "Now even the nurses are
debating NHS charges, we have been given the political cover we need!"
That the NHS has just been declared the world's best
healthcare system by the Washington-based Commonwealth Fund should be a matter
of national pride. But the institution is in mortal danger. The free market
crusaders who first took power in the late 1970s have long regarded NHS as an
aberration. It is an irritating example of a service run on the basis of social
need, rather than private profit – and, even worse, it is loved for it. As long
as the NHS exists, it serves as a defiant reminder that there is an alternative
to the neoliberal project.
Thus it appears as if there is a stirring in the NHS to enact
a fee for service, albeit nominal. Yet from the Left in the UK that is opposed.
Let us briefly examine some of the measures used. From
Commonwealth[3]:
Key findings related to the U.S. include:
Healthy lives: The U.S. does poorly, ranking last on
infant mortality and on deaths that were potentially preventable with timely
access to effective health care and second-to-last on healthy life expectancy
at age 60.
What is a death preventable by timely access? Also what are
the causes of infant mortality? The first is a measure based upon personal
choice all too often. Take obesity. Namely in the US we have an expanding
number of such cases and they are due to individual choice and not lack of
care. US physicians are all too often fearful of being too emphatic with such
patients and thus just over medicate. That increases the costs due to the
medication, the follow on care and the sequelae.
Access to care: People in the U.S. have the hardest time
affording the health care they need. The U.S. ranks last on every measure of
cost-related access. More than one-third (37%) of U.S. adults reported forgoing
a recommended test, treatment, or follow-up care because of cost.
This is a question of access due to cost. In the UK there is
no such issue it is just getting the service in a timely manner. The cost to
the patient directly is not present. Thus this question or measure begs the
answer.
Health care quality: The U.S ranks in the middle. On two
of four measures of quality—effective care and patient-centered care—the U.S.
ranks near the top (3rd and 4th of 11 countries, respectively), but it does not
perform as well providing safe or coordinated care.
Quality is elusive. We have discussed this at length. The
statement that US care is not safe is somewhat without basis. The issue of
coordinated care is another measure that begs the answer. Coordinated how? It
was the head of Commonwealth that promulgated the Electronic Health Record
system while in the Government. Was this promulgation a failure? Did the work
he did fall on deaf ears despite the billions spent and mandated to be spent?
Does this added costs element have no value?
Efficiency: The U.S ranks last, due to low marks on the
time and dollars spent dealing with insurance administration, lack of
communication among health care providers, and duplicative medical testing.
Forty percent of U.S. adults who had visited an emergency room reported they
could have been treated by a regular doctor, had one been available. This is
more than double the rate of patients in the U.K. (16%).
How many times do they ask the same question? It is a simple
technique to prove one’s answer, via a tautology. The ER statement is a symptom
of the people not the system. Spend some time in an ER. See the elderly who are
sent back and forth because of the incompetence of many care facilities or the
intent by the facility to increase their revenue. Look at the gun-shot victims,
the overdoses, the assaults. Go to Mass Gen after a basketball game and see the
drunks with various assault wounds. That does not reflect efficiency, it
reflects a societal norm.
Equity: The U.S. ranks last. About four of 10 (39%)
adults with below-average incomes in the U.S. reported a medical problem but
did not visit a doctor in the past year because of costs, compared with less
than one of 10 in the U.K., Sweden, Canada, and Norway. There were also large
discrepancies between the length of time U.S. adults waited for specialist,
emergency, and after-hours care compared with higher-income adults.
This is a strange measure. It is a Piketty type measure,
namely one where the measure is intended to provide the US with the lowest
rank. Note how it is phrased, it is 39% of “below-average incomes”, namely 39%
of some other smaller percent, less that say 25%. That means say 16% as a
guess. Well 16% is about 1 of 7 as compared to 1 in 10 for the others. The
countries mentioned have a socialized medical system and that is what the
report says is best. After all it posed the questions it appears to obtain that
answer.
One should examine the Board of Commonwealth[4].
It is a mix but all with what appears to be a slanted mix. In my opinion one
should give little if any weight to this report.
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