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?