International Health Policy Without All That Pesky Reading
I haven’t really seen much discussion of this really, really important 2007 Commonwealth Foundation Survey of 7 Countries (wait, don’t click!), so I thought I’d give you my take. Without all that pesky reading and analysis. We’ll just summarize the tables. (I know, I know, this is not the recommended way to read an article.)
If you want to read them yourself: Table 1 , Table 2 , Table 3 , Table 4 , Table 5 , Table 6 , Table 7 . But really, here’s the summary:
7 countries, phone interviews conducted: Australia, New Zealand, Germany, the Netherlands, the United Kingdom, and the United States. At least 1000 people surveyed in each country. A wide variety of questions asked. These ranged from questions about primary care access to prescription drug costs to medical errors to going without care because of cost to electronic medical record usage to ER visits to elective surgery wait times to chronic disease to health care quality. (Yes, of course, some of these answers depend on culture and stuff. Hear me out.)
If you do look through all that data, you’ll notice something really striking: country to country, it’s really not all that different . Sure, there’s lots of variation. Germans are the most confident they’ll receive the “best medical technology”; people in the Netherlands are the least likely to wait greater than 6 months for elective surgery; Australians are the most likely to be able to contact their doctor on the weekends; Americans were the most likely to receive reminders for preventative or follow-up care; it’s very easy for New Zealanders to contact their doctor by phone during regular hours; the Brits are the most likely to have financial incentives for quality.
If you look at the numbers, however, again: things are fairly similar. As a general trend, what separates the best from the worst is only 10 or 20 percentage points’ difference. Overall, these 7 countries are fairly similar. Sure, in some areas there are countries that seem to really be doing a better job–but it’s not consistent for every area and for every country. There’s not one health care system that’s the best, and as the authors point out, all these countries (not just ours) are struggling, trying to figure out how to provide care for an aging population with technology that’s advancing faster than we can pay for it. In this way, I do agree with KevinMD –that if we’re going to redesign our health care system, we can’t just copy Canada or France–their systems are struggling just as ours is.
But there is one area where things are markedly different. (You knew where this was going, right?) Cost . In the US, we’re spending 16.0% of GDP on our healthcare system, where the next closest country in this survey, Germany, comes out at 10.2%. Now you say to yourself, “Self, that’s only 5.8% difference!” But that difference ends up being hundreds of billions of dollars (and $3,410 per person). And you look at percent uninsured, and New Zealand is our closest competitor, at less than 2%. We’re up at 16%.
So you look at all this survey data, where the United States is clearly in the middle of the pack (along with everyone else), and don’t you seriously have to wonder, “Then what the hell are we paying so much for?” If we’re not the fastest to get elective surgery (that award goes the Germans), and we’re not the most likely to see 2 or more specialists (again, Germany wins that one), and yet we’re the most likely to have people report forgoing care because of cost, and the most likely to have a problem with coordination of care (getting lab results or medical records sent to another doctor), again, where’s the money going?
For what we’re paying for, our health care system should be winning every single poll, every single year. What a disgrace.
