Health care ranks lower in U.S. than in other countries

The U.S. health care system does a poor job providing efficient access to quality care compared with health systems in six other industrialized countries, according to a recent survey.

The report, released in June by the Commonwealth Fund, said the United States scored low in measures of quality, efficiency, access, equity of care and ability of people to lead healthy and productive lives.

"It's disappointing, but not surprising that despite our significant investment, the U.S. continues to lag behind," Commonwealth Fund President Karen Davis, PhD, said in a national teleconference on the report.

The U.S. spends more on health care -- $7,290 per capita in 2007 -- than do any of the other countries studied. By comparison, the Netherlands ranked highest for care and spent $3,837 per capita.

"We simply are not getting commensurate care for the amount we are spending on health care," Davis said.

Also ranked in the annual report were Australia, Canada, Germany, New Zealand and the United Kingdom. The rankings were based on data from surveys of 500 to 3,000 residents in each country (link).

Overall, the Netherlands and the United Kingdom scored highest while the U.S. and Canada scored lowest.

Davis said the U.S. has the chance to improve with the health system reform law, which will extend access to health coverage to an estimated 32 million uninsured Americans. The law also will bolster preventive care and improve quality of care through increased investments in health information technology and other areas, she said.

Cathy Schoen, Commonwealth Fund senior vice president for research and evaluation, said the U.S. ranked sixth in overall quality when measuring effectiveness, safety, coordination and patient-centered aspects of care. The fund's 2008 survey found chronically ill patients in the U.S. were most likely to report getting the wrong medication or incorrect dosages.

"We rank last on safety and do poorly on several dimensions of quality," Schoen said.

In areas measuring efficiency, such as rates of rehospitalization and use of information technology, the U.S. also ranked last. Inappropriate use of emergency care also was an issue, with 19% of chronically ill adults in the U.S. reporting that they went to an emergency department for nonemergent care, compared with 6% in Germany and the Netherlands.

In access to care, the U.S. and Australia tied for the lowest ranking. In the U.S., 54% of chronically ill adults surveyed in 2008 reported going without care because of cost, compared with 7% in the Netherlands. That number is increasing with rising health care premiums that cause more people to become uninsured or underinsured, Schoen said.

High rates of infant mortality and deaths before age 75 caused the U.S. to score poorly on the healthy lives measures.

"No country's health system is perfect," Davis said.