United States Ranks Last on Measures of Access, Quality and Care Coordination

Despite spending nearly double that of other countries on healthcare per person, the United States ranks last on measures of access, equity, quality, efficiency and healthy lives, according to a new Commonwealth Fund report.

The United States spent $8,508 per person on healthcare in 2011, compared with $3,406 in the United Kingdom, which ranked first overall. The other countries included in the study were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland. While there is room for improvement in every country, the United States stands out for having the highest costs and lowest performance.

An investment in primary care is essential to improving access and care coordination, as the Affordable Care Act (ACA) expands coverage for consumers, researchers say.

Inadequate access to primary care, and inequities and inefficiencies in the U.S. healthcare system overall are responsible for the low ranking, according to “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2014 Update.” However, provisions in the ACA that have already extended coverage to millions of people in the United States can improve the country’s standing in some areas, particularly access to affordable and timely primary care, researchers noted.

Key findings related to the United States include the following:

  • Healthy lives: The United States does poorly, ranking last on infant mortality and on deaths that were potentially preventable with timely access to effective healthcare and second-to-last on healthy life expectancy at age 60.
  • Access to care: People in the United States have the hardest time affording the healthcare they need. The United States ranks last on every measure of cost-related access. More than one-third (37 percent) of U.S. adults reported forgoing a recommended test, treatment, or follow-up care because of cost.
  • Healthcare quality: The United States ranks in the middle. On two of four measures of quality — effective care and patient-centered care — the United States ranks near the top (3rd and 4th of 11 countries, respectively), but it does not perform as well providing safe or coordinated care.
  • Efficiency: The United States ranks last, due to low marks on the time and dollars spent dealing with insurance administration, lack of communication among healthcare providers, and duplicate 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 United Kingdom (16%).
  • Equity: The United States ranks last. About four of 10 (39 percent) adults with below-average incomes in the United States 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 United Kingdom, 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.

The report was also produced in 2004, 2006, 2007, and 2010, with the United States ranking last in each of those years. Four countries were added to this year’s report: Switzerland and Sweden, which followed the U.K. at the top of the rankings, and Norway and France, which were in the middle of the pack. Australia, Germany, the Netherlands, New Zealand, and Norway also placed in the middle, while Canada was just above the United States at the bottom.

Source: Commonwealth Fund, June 16, 2014

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