TUESDAY, April 4, 2006 (HealthDay News) -- Even though the United States spends more than twice as much per capita on health care as some other western nations, it trails them in such measures as efficiency, equity, and patient safety and access to care, according to two new reports.
The United States did score well on effectiveness of care, especially preventive care. But Americans also contend with big disparities in health care, primarily due to differing income levels, the studies found.
There's a persistent myth that U.S. health care is the best in the world, said Dr. Donald M. Berwick, president and CEO of the Institute for Healthcare Improvement. But, he added, "The U.S. is far from the best health-care system in the world, even though it's by far the most expensive."
The reports were prepared by The Commonwealth Fund, a nonprofit group that works to improve health care in the United States. They looked at differences in health care in Australia, Canada, Germany, New Zealand, the United Kingdom and the United States.
"What is disturbing about these findings is that while the U.S. ranked first on health-care spending in the world, we are often last in measures of quality of care," said Commonwealth Fund President Karen Davis. "Higher spending doesn't mean that we receive more or better care -- we simply pay more."
The reports are titled, Mirror, Mirror, on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens, and The U.S. Health Care Divide: Disparities in Primary Care Experiences by Income -- Findings from the Commonwealth Fund 2004 International Health Policy Survey.
In the first report, researchers found the United States ranked last when it came to patients experiencing a lab test error, including wrong tests or delays in being notified about abnormal test results.
The U.S. also ranked last on patients leaving a doctor's office without getting important questions answered, and also on the ability to get care on nights and weekends. And the U.S. had the highest number of patients who have to go to the emergency room for a condition that could have been treated by a regular doctor. The U.S. also fared worst when it came to differences between below- and above-average income patients not filling prescriptions or skipping doses due to cost.
The United States did rank first on preventive services, such as Pap tests and mammograms, and on providing counseling on diet and exercise. But, it ranked last on patients not filling prescriptions; skipping recommended tests, treatments, or follow-up; or not visiting a doctor when needed due to cost.
"These shortfalls are the result of our fragmented system of care in the U.S.," Davis said. "Very few things are more debilitating or discouraging to seriously ill patients and their families than navigating the complex U.S. health care system."
"We can do better. We have the wealth, the health-care institutions, the dedicated professionals, the technological process, the medical research and the ingenuity required to make the U.S. health-care system the best in the world," she added.
In the second report, researchers found that 22 percent of U.S. patients with a below-average income rated their doctor as "fair" or "poor," compared with 7 percent of patients with above-average incomes.
In addition, lack of insurance increased disparities in U.S. health care. Seventy-six percent of uninsured adults went without needed care because of cost in the last year. Uninsured patients also had more fragmented care and less continuity of care from a regular doctor, the report said.
Yet, even when they had insurance, Americans with below-average income still had more barriers to care than those with insurance and above-average income.
"The U.S. is unique among advanced industrialized nations for failure to provide basic universal coverage to insure access and remove the fear of financial consequences in bills when ill," said Cathy Schoen, a senior vice president at the Commonwealth Fund.
The findings in the second study highlight the importance of having insurance to access basic care, and the importance of primary care, Schoen said. "The broad health-care divide by income and the growing gap between us and other countries is putting the workforce and the nation at risk."
Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said it's time to ask serious questions about the state of health care in the United States.
"The U.S. health-care system has serious flaws, beginning with the fact that we don't insure everyone, and thus maintain the very concept of health care in a purgatory between right and privilege," Katz said.
Disparities in health care are inescapably linked to disparities in wealth, education, and privilege, Katz said. "Disparities in health -- and the care rendered to preserve and protect it -- follow logically from disparities in everything else," he said.
"We can and should improve the quality of health-care delivery in the U.S.," Katz said. "But the graver issues in these reports point to deeper questions with no simple answers: Is health care a right or a privilege? Are we willing to consider universal health insurance? Will our society tolerate disparities?"
More information
For more on the reports, visit The Commonwealth Fund.
