IHS Global Insight Perspective | |
Significance | Not surprisingly, Netherlands has topped the rankings table of health indicators after successively running at the top of European Health Consumer Polls for the last two years. "Health indicators" include quality of care, access, and efficiency, among others. |
Implications | The report reflects the increasing disparity within the U.S. system where, despite registering the highest health expenditure per capita, it reported the lowest figures on health outcomes. Among European nations, the United Kingdom edged past Germany, inching closer to the Netherlands. |
Outlook | The conclusions will reignite the debate on the incremental value of health dollars that the U.S. government and consumers are spending on services. The reform process, which kick-started earlier this year, will gather much support as a result of this report, underscoring the need to create an effective and equitable health system. |
The Commonwealth Fund, a private foundation which also tracks performance in global health systems released its latest report covering seven industrialised nations—Australia, Canada, Germany, Netherlands, New Zealand, the United Kingdom, and the United States. The assessment was based on key healthcare indicators, namely: quality of care, access, efficiency, equity, long, healthy productive lives, and health expenditures per capita. The methodology involved data extracted from the following surveys: the 2007 Commonwealth Fund International Policy Survey; the 2008 International Health Policy Survey of Sicker Adults; the Commonwealth Fund 2009 International Health Policy Survey of Primary Care Physicians; and the Organisation for Economic Cooperation and Development Health Data 2009, among others.
The main conclusions are:
- The top-three countries in terms of overall ranking were the Netherlands, the United Kingdom, and Australia.
- The U.S. ranked last, with equity, long, healthy, productive lives, and efficiency dragging down rankings. In terms of quality, effective care and patient-centred care in the United States were found to have qualified better (fourth out of seven countries) but this was mitigated with a low ranking for safe care and co-ordinated care.
- On efficiency, too, the poor ranking was attributed to spending on administrative costs, use of information technology, re-hospitalisation, and duplicative medical testing. Affordability of care led to compounding access concerns, with the United States ranking last on every measure of cost-related access problems.
- Among adults with chronic conditions, almost half (45%) with below-average incomes in the United States reported they went without needed care in the past year because of costs, compared with just 4% in the Netherlands. Lower-income U.S. adults with chronic conditions were significantly more likely than those in the six other countries surveyed to report not going to the doctor when sick, not filling a prescription, or not getting recommended follow-up care because of costs, the report concluded.
Commonwealth Health Fund Rankings | |||||||
Quality of Care | Access | Efficiency | Equity | Long, Healthy, Productive Lives | Health Expenditure/Capita, 2007 (US$) | Overall Ranking | |
Netherlands | 2 | 1 | 3 | 1 | 4 | 3,837 | 1 |
U.K. | 3 | 2 | 1 | 2 | 6 | 2,992 | 2 |
Australia | 4 | 6.5 | 2 | 4 | 1 | 3,357 | 3 |
Germany | 5 | 3 | 5 | 3 | 3 | 3,588 | 4 |
New Zealand | 1 | 4 | 4 | 6 | 5 | 2,454 | 5 |
Canada | 7 | 5 | 6 | 5 | 2 | 3,895 | 6 |
U.S. | 6 | 6.5 | 7 | 7 | 7 | 7,290 | 7 |
Source: Commonwealth Fund | |||||||
Outlook and Implications
The conclusions of the Commonwealth Fund's report will once again throw the spotlight on the state of the U.S. healthcare system. Despite having the highest health expenditure per capita among all the seven industrialised nations included in the survey, the United States came consistently last on key parameters such as access, affordability, and quality of care. This will reaffirm concerns over the direction of the country's health system, which since early 2010 has been going through a series of changes following the health reform process. Clearly, the report's conclusions will bolster support for U.S. President Barack Obama, who has been trying to intensify efforts in implementing the new healthcare legislation including an overhaul of the health insurance system, with expanding coverage being one of the cornerstones of this. While the United States has been foremost over several decades in terms of availability of superior medical treatments, that trend has almost been drowned out in recent years by the affordability concerns. As the report points out, Americans from low-income families are most likely to shun medical care due to costs. The higher health expenditure per capita also spotlights the issue of incremental value of the health dollars spent in the healthcare system, and the study is likely to boost debate in this direction.
In contrast to the U.S. rankings, the Netherlands has reaffirmed its position as one of the top destinations in terms of healthcare. This endorsement builds on the country's consistent performance in consumer polls on European Health over the last two years. It is interesting to note that Canada, which has a public sector payor-backed large healthcare system, has ranked sixth in the table with quality of care, efficiency, and access being major concerns. Almost the mirror image of this are the U.K. figures, a country with a similar health system to that of Canada, which ranks higher in efficiency and equity despite low healthcare expenditure per capita.
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