Mirror, Mirror, a Portrait of the Failing US Health System
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
The Commonwealth Fund publishes an annual report card comparing ten nation’s health systems. The ten include the US, UK, France, Germany, Canada, Australia, New Zealand, Netherlands, Switzerland and Sweden. The US ranked tenth or dead last by a long shot on the compilation of the six measures studied – including cost, health outcomes, efficiency, equity, access to care, and the process of care. On all but one measure, the US health system was last or next to last. On most measurements, the US was not even close to the other nine. The one measure on which the US excelled was the process of care; this includes timely access to preventive services, vaccinations, safety, and patient engagement.
Every other nation had universal coverage and spent 10-12% of their GDP (gross domestic product) on health care. The US still has 26 million uninsured after the ACA’s implementation, and is spending 16.5% of GDP on health care.
The US had the worst access to care, meaning both affordability and accessibility. Too many of us have high copays and deductibles and cannot afford care. We face shortages of primary care doctors and limited access to care after hours; too many of us do not have access to a regular primary care doctor. In other nations, there are limits on copays and deductibles to assure that care is affordable. There are more primary care doctors, better access to after hours care outside the ER, better access in rural communities. For example, in Germany which has private insurance, out of pocket is limited to 1-2% of a person or family’s income; in Netherlands also with a private insurance model, primary care doctors are part of networks that rotate in providing after hours care.
The US had the second-best delivery of care process. This is due in large measure to the ACA led reforms in provider and insurer payments, focused on prevention, safety, vaccinations, outcomes and patient engagement. Netherlands and New Zealand also excelled with their strong financial incentives for prevention and safety and good outcomes.
Australia and the UK excelled in administrative efficiency while the US and Switzerland were by far the worst. In Australia, the providers have nearly instantaneous billing and payment in place with all the different public and private payors. There are no insurers in the UK; the government uses electronic billing and payment systems monthly. The US and Switzerland have multiple insurers and payors with complex, difficult, different, and confusing payment systems for their providers to get paid for their patient care.
The US and New Zealand were the worst in patient equity – i.e. there was the biggest difference between higher income and lower income patients in access to care and the care experience. Germany and Australia had the least differences in patient care between higher and lower income patients. When gender and geography were added to the equity measurements, the US and New Zealand continued to rank at the very bottom, but Switzerland ranked first.
The US ranked dead last on patient outcomes while the Australians and Swiss ranked at the top. US life expectancy was 4 years less than its peers. Among the contributing factors were our high rates of preventable and treatable deaths, our poor response to Covid, high gun deaths and our high rates of substance abuse.