Health Care Quality Compared in Five
Countries
Americans spend more, but they are not healthier, survey
finds
By Kenna Brigham School of Public
Health
Despite spending more for health care, Americans do
not have the best medical care in the world, according to
researchers from the Johns Hopkins
Bloomberg School of Public
Health and other institutions. The study is the first
to use a universal set of standards to compare the quality
of health care in the five countries surveyed. The
researchers found that no country scored the best or worst
overall and that each country was the best and worst in at
least one area. The study is published in the May/June
issue of the journal Health Affairs.
Peter S. Hussey, lead author of the study and a
doctoral candidate in the
Department of Health Policy and Management, said, "It
is well-known that the United States spends much more on
health care per capita than other countries, and it is
commonly assumed that we have the best health care system
in the world. However, the results of our study show that
the United States performs better than other countries in
only a few areas, while performing worse in others. This
raises the question of what Americans receive for all of
the money devoted to health care."
The international group of researchers worked together
as the Commonwealth Fund International Working Group on
Quality Indicators. Data on 21 health indicators that
reflect the quality of medical care in Australia, Canada,
New Zealand, the United Kingdom and the United States were
collected and examined. Five-year cancer survival rates,
30-day case-fatality rates after heart attack or stroke,
breast cancer screening rates and asthma mortality rates
are a few of the indicators the researchers studied. The
researchers broke the 21 health indicators into three
categories, which include survival rates for various
cancers and transplants; avoidable events such as suicides,
asthma and smoking rates; and process indicators that
include vaccination and screening rates.
The United States had the highest breast cancer
survival rate, the highest cervical cancer screening rate
and the lowest smoking rate. For breast cancer survival
rates, the United States at 86 percent was 11 percentage
points better than the worst country, which was the United
Kingdom. For cervical cancer screening, the United States
at 93 percent was 26 percentage points better than the
United Kingdom, the worst country. The United States tied
with Canada for having the lowest smoking rate. The United
States performed more poorly on indicators including asthma
mortality rates and survival after kidney and liver
transplants. The United States is the only country where
asthma mortality rates have been increasing over time; they
are now higher than in the United Kingdom and Australia.
The survival rate after kidney transplant in the United
States was 83 percent, 11 percentage points lower than in
Canada, the country with the highest rate.
One noteworthy pattern was the United Kingdom. It was
the lowest country in five of the nine survival rate
indicators and highest in five of the eight avoidable event
indicators, meaning that the United Kingdom is exceptional
at preventing avoidable health issues like contracting
pertussis or hepatitis B but has the lowest cancer survival
rate of the five countries studied.
"Each country in our study has areas of care where it
can learn from the other countries and areas where it could
teach others. That tells us that there are opportunities
for improvement in the quality of health care in all five
countries. We hope our study will be expanded upon so that
it can be used to judge overall health system performance
around the world," Hussey said. He also noted that
Americans were spending more on health care but not
receiving extra benefits or having better health care
experiences.
Hussey and colleague Gerard F. Anderson, a professor
of health policy and management at Johns Hopkins, also
co-wrote a second article about Americans spending the most
per capita on health care. In the article, which is also in
the May/June issue of Health Affairs, they address why
Americans pay much more for health care than their foreign
counterparts. Anderson, Hussey and co-author Uwe E.
Reinhardt, with the Woodrow Wilson School of Public and
International Affairs at Princeton University, found that
the second highest-spending country, Switzerland, spent
only 68 percent as much as the United States on health care
per capita.
"How Does The Quality of Care Compare in Five
Countries" was co-authored by Peter S. Hussey, Gerard F.
Anderson, Robin Osborn, Colin Feek, Vivienne McLaughlin,
John Millar and Arnold Epstein. The study was supported by
The Commonwealth Fund.
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