Despite leading the world in spending on healthcare, the United States continues to lag behind other industrialized nations in performance, according to a recent report published by the Commonwealth Fund.
Of the 11 countries studied in the 2014 update to its report on healthcare performance at the national level, the Commonwealth Fund ranks the US last overall, show that it consistently underperformed in the areas of efficiency, equity, and healthy lives.
Despite the overall rankings, even high-performing countries would have several areas where they underperformed. Whereas the ninth-ranked France led the way in healthy lives, top-ranked United Kingdom had the second-to-worst score. Third-ranked Sweden scored last or second-to-last in three areas: coordinated care (11), effective care (10), and safe care (10). Care coordination also represented fifth-ranked Germany’s worst score, coming in ahead of Sweden at tenth.
So what does this mean to the healthcare industry in the US? According to the authors of the report, improvements to the performance of the nation’s health system are not found in one foreign country but from several:
In seeking to improve health system performance, the U.S. can look to the experiences of other countries. The U.K. ranks high in all dimensions except for healthy lives; Switzerland does well on timeliness, equity, and offering patient-centered care; and France and Sweden demonstrate superior performance on healthy lives indicators. The U.S. would benefit from analysis of promising innovations in other countries and greater investment in cross-national research as well as looking at best practices within its borders.
Another conclusion drawn by the authors is the fact that even top-ranked countries were far from perfect. In looking at raw scores, they argue that a closer look “shows that in many or most instances the top-ranked country is performing at less than an ‘ideal’ level,” a recognition that variation occurs within each country.
An important correlation the reports reveals between equity and patient satisfaction is particularly meaningful as the US further implements provisions of the Affordable Care Act, such as the expansion of health insurance coverage by tens of millions individuals:
These results indicate a consistent relationship between how a country performs in terms of equity and how patients rate other dimensions of performance: the lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet needs for the average citizen. Rather than regarding performance on equity as a separate and lesser concern, the U.S. should devote far greater attention to building a health system that works well for all Americans.
As the report indicates, increased healthcare expenditures do not lead to increased outcomes, lending support to the growing belief among healthcare organizations and providers that a shift away from volume to value is a step in a better, healthier direction for the US.