Do we really have the best health care in the world?

Bob Berenson of the Urban Institute writes about the quality of care in the United States as compared to other countries.

The rhetoric about health care reform has heated up and thickened over the summer months, and it is now more critical than ever to discern what, exactly, is at stake in these health reform debates.  If people are getting increasingly passionate in their support for, or opposition to, health care reform, then there must be quite a few perceptions circling around out there about things that we want to gain out of reform, as well as perceptions about things we are fearful of losing. 

So what, exactly, do we stand to lose if health care reform happens?  We could lose the appallingly high number of uninsured Americans, for one thing.  (Is that a problem for anyone?)  And, there’s also a perception that we could lose the care that we have—based on a belief that America has the best health care in the world, and that we are headed for surefire doom if we adopt a system similar to Canada’s or England’s.   (Never mind that proposals to transform us into Canada and England aren’t even on the table—fact seems to be beside the point these days).

Well, a team of researchers, headed by myself, actually took a look at the evidence for whether the United States does have the best health care in the world.  A new issue brief out today talks about what we found.

A word about these issue briefs:  RWJF sponsors a tremendous amount of research, but the quick-strike series that RWJF does with Urban, which this brief is a part of, is about more than research.  It’s about making sense of the research, especially for policy-makers who are facing momentous decisions about how we get more Americans the care they need.  This series began with some briefs related to health care coverage—then ventured into the wider health reform debate—and now we are adding some briefs that will specifically address what results we might expect to see from actions we take to improve American health care.

In this first issue brief about improving care, we looked at the quality of health care in the United States as compared to other countries and unsurprisingly, we found that the evidence was mixed as to where the U.S. stands on quality. There was no objective evidence that the U.S. has the best quality in the world, although personal testimonials of exceptional care in particular circumstances should not be dismissed. Overall, there is a lot of room for improvement.

First, we define what we and other experts mean when we even use the term “quality” in relation to health care, because the attribute of quality is like beauty—depends on the eye of the beholder, so to speak.  There are several attributes of quality that we explore in our international comparison analysis, and using this consistent definition is what yielded the mixed bag.  The headline:  the United States is among the best in some areas, such as cancer outcomes, and nowhere near the best in others, such as prevention, and deaths from preventable or manageable illnesses.  In other words, we may do better when people are already quite sick – the U.S. seems to emphasize “rescue” care --  but we are not doing well in helping people not get so sick in the first place, and ultimately, our life expectancy is nowhere near stellar when compared to what other industrialized countries have achieved.

What do these findings mean?  In the context of health care reform, our analysis might help inform what we really do have to win or lose if health care legislation passes. Those concerned that current health reform proposals would compromise current excellent care should feel reassured – the care on average isn’t all that good to begin with; and providing insurance coverage for the uninsured can only help raise the average.   None of us are aiming for perfect—but is there room for significant improvement in how we deliver health care?  Absolutely.  And isn’t that, really, what the very definition of reform is—changing something to a better state or condition than that which previously existed?  

Comments

[Lilly]

No, America does not have the best health care---because our health care laws are influenced by the medical profession--health care industries---hospitals and

Patient Safety Programs that are in name only---to portect the medical profession from medical malpractice laws is not concerned for the patient.. A Patient Safety program that does not mandate doctors to report medical or medication errors---only in they wantto volunteer is unethical.

The Federal and State Legislature funds and allows medical reserch that many times poses a conflict of interest. America needs integrity, accountabity and responsiblity in the managment of our health care System I forgot to mention that reading the financial disclosures of elected and appointed officials proves my point---the majoority have investments in the medical and health care industries---especially pharmaceutica!!!!

[Lilly]

No, America does not have the best health care---because our health care laws are influenced by the medical profession--health care industries---hospitals and the pharmaceutical companies. Patient Safety Programs that are in name only---to portect the medical profession from medical malpractice laws. A Patient Safety program that does not mandate doctors to report medical or medication errors---only if they want to volunteer is unethical. The Federal and State Legislature funds and allows medical reserch that many times poses a conflict of interest.
America needs integrity, accountabity and responsiblity in the managment of our health care System I forgot to mention that reading the financial disclosures of elected and appointed officials proves my point---the majoority have investments in the medical and health care industries---especially pharmaceutica!!!!

[LindaL]

Being the owner/operator of a small grocery store, I have a great idea to save a ton on our health care system.

The federal food stamp program (now renamed SNAP) allows the purchase of candies, confections, chips, dips, sodas and ice creams. How about having nurses as cashiers? We can give the insulin injections at the same time they check out all the junk food they can buy. Bill it to the feds in one swoop?

Seriously folks--I see it all day long. Stop blaming the fast food companies. Blame food stamps. This is like the 800 pound elephant in the room and nobody is discussing it. Talk about blowing our money. It really is a scandal. A stupid scandal.

[Lloyd Bennett]

It fair to note that we don't have the best Health Care System in the World, but it is superior to which ever is second.
Large numbers uninsured? About 45.7 million Americans according to the US Census of 2007 are Uninsured. Removing non-citizens about 36 million are uninsured or about 11.7% of the American people. About 1/4 of those are elible for medicaid or CHIPS leaving about 7.7% with no means of health care. These statistics taken for NPR article circa August,2009
While we should improve our system, many from forieng countries seek our medical facilities. We either create or possess superior techniques, excellant Physicians, and technological advantages. Why shall we destroy a system that works for 93.3% us for the concern 7.7%?
Effectiveness needs improved but most of all cost must be contained and that is best done by the medical industry, not to be borne by the Government. Do we need tighter regulation creat teams from Insurance, Government, Physicians, Hospitals, and providers? Yes. They seem to know what is needed but havn't figured out the means. This is process that needs to be slowly implemented to discover best practice and effectiveness. Not a blind partisian agenda to win regardless of impact to society.

[Susan B]

Lloyd, How will the 36 million non-citizens really be "removed"--one of the biggest expenses brought to bare right now are the emergency room non-citizens expenses. I understand they will not get "health care policies"--but this will not be stopped. I don't know that it ever can. How can we turn away sick ppl and not pay the provider? Where will that money come from with this new reform? A different place? The really rich? I just cannot see how this will change.