While the U.S. healthcare system was shown to be the most expensive when compared with six other industrialized nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—it failed to achieve better health outcomes when compared to those countries, according to a new Commonwealth Fund updated report, Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally.
Overall, the U.S. stood out for not getting good value for its healthcare dollars—ranking last despite spending $7,290 per capita on healthcare in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first. The U.S. had ranked last in value as well in the previous three Commonwealth Fund studies that compared it with the other countries.
"These findings are clearly disappointing for U.S. patients and their families. We're simply not getting commensurate return for a much higher investment in healthcare," said Commonwealth Fund President Karen Davis, PhD, in a telebriefing.
However, the new healthcare reform legislation may hold "substantial promise" for changing some of these results, Davis said. The Fund's analysis shows that investments in improved coverage, expanded health information technology, a stronger primary care foundation, and expanded quality and safety initiatives "could bear fruit in the upcoming decade," she said.
In response to questions that the American population may face different challenges because of higher rates of obesity, Davis said the other countries face other health issues such as higher rates of smoking. "Certainly those factors come into play," Davis said. "However, dimensions of care—such as, do you wind up in an emergency room for something that a doctor could have taken care of—are universal issues and quite independent of the specific disease profile."
Other countries may be challenged by an older population, said Cathy Schoen, a senior vice president with the Commonwealth Fund. For instance, Germany has a percentage of the population over age 65 that the U.S. has not yet experienced. "They're grappling with growing rates of chronic disease and frail elderly. But each country can claim a growing area of need."
But indicators that are being observed in the U.S., such as hearing about hospital readmissions or not getting care afterhours, is a "reflection of a healthcare system that is not organized . . . or well-coordinated around a patient, irrespective of what condition they have," Schoen said.