U.S. Health System Tops in Spending, Last in Results

US health system tops in spending, last in results
Jason Smalley Photography/Alamy
By Dan Mangan | @_DanMangan

Bang for your buck? No such luck -- not even close.

The United States health care system has finished dead last -- yet again -- in a comparison of first-world countries, despite vastly outspending those nations on health services, according to a new study released Monday.

Adding insult to injury, the Commonwealth Fund-issued study ranked the United Kingdom in first place in the rankings despite the fact that the U.K. spent just $3,182 per capita on health -- the second-least amount of the 11 countries surveyed.

And Canada, which was just above the U.S. in the overall rankings, spent just $4,522 per person on health services.

In contrast, the U.S. spent $8,508 per person on health care, or 17.7 percent of the gross domestic product.

"The claim that the United States has 'the best health care system in the world' is clearly not true," stated the Commonwealth Fund report.

"To reduce cost and improve outcomes, the U.S. must adopt and adapt lessons from effective health- care systems both at home and around the world," said the report, which examined 80 separate indicators from the countries related to five overall areas of performance: health, quality, efficiency, access and equity.

The Commonwealth Fund is a private foundation whose self-stated goals are promoting "a high-performing health care system that achieves better access, improved quality and greater efficiency."

The study found that after the United Kingdom, the top-ranked health systems were those of Switzerland and Sweden, followed by Australia, a tie between Germany and the Netherlands, a tie between Norway and New Zealand, France took ninth place, with Canada and the U.S. bringing up the rear. The most recent report, in 2010, had looked at just seven countries. This year, France, Sweden, and Switzerland were added to the mix.

In each of the four prior versions of the report the fund issued since 2004 "the U.S. has been systematically in last place," noted report co-author Karen Davis, of the Johns Hopkins Bloomberg School of Public Health.

But Davis said she expects that the ongoing implementation of the Obamacare, which is targeted at getting health coverage to tens of millions of people who lack insurance, could put an end to that dismal run.

"I think the Affordable Care Act is going to make a huge difference in U.S. performance," she said.

Contributing to America's failing grade this year was the fact that the country ranked dead last in all measures of cost-related access.

Many less-affluent U.S. residents experienced longer-than-average wait times in seeing doctors and in being able to afford those services in the first place. The U.S. was also last in rankings on infant mortality, and second-to-last in healthy life expectancy at age 60, the study found.

And America was ranked last in efficiency, as a result of excessive time and money spend on dealing with insurance administration, lack of communication between medical providers and duplicative tests.

Davis noted nearly 40 percent of Americans did not visit a doctor in the past year because it would cost them too much money, compared to less than 1 in 10 people who reported the same thing in the United Kingdom, Canada, Sweden and Norway.

And 40 percent of U.S. adults said they sought treatment at an emergency room for conditions that could have been treated by a regular doctor if one had been available, the Commonwealth Fund report found. In contrast, just 16 percent of patients in the U.K. reported such a problem in access to a doctor.

Davis said that in recent years, the U.K. has made "huge progress" in reducing wait times for elective surgeries and visits with specialists, and is among the average or top half of performing countries in wait times.

She said the U.K.'s experience, as well as other countries with universal health coverage -- which the U.S. doesn't have -- puts the lie to the argument that such systems will invariably lead to longer-than-acceptable wait times for treatment.

"Patients in the U.S. have rapid access to specialized health care services; however they are less likely to report rapid access to primary care than people in leading countries in this study," the report said. "There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable -- however, the Netherlands, U.K. and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services."

"Basically, there's no wait times in countries like Germany, so it's not true that there's a tradeoff," Davis said. "Canada has long waits for specialists, but Canada and the U.S. have long waits just to get in to see your primary doctor."

It wasn't all bad news for the U.S. in terms of rankings.

America ranked in the middle overall for health care quality metrics. And the country came in third and fourth place for effective care and patient-center care, although it fell short in measures of safe or coordinated care.

And the report underscores the fact that even when America ranks high relative to most other countries in some metrics, it is doing so while spending a grossly disproportionate amount of money to do so.

"For all countries, responses indicate need for improvement," the report said. "Yet, the other 10 countries spend considerably less on health care person person, and as a percent of gross domestic product than does the United States."

"These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation's substantial investment in health."

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Happy-Bday ugly

the vast majority of us might have very expensive health care and terrible health care in general, but at least the private insurance companies are getting richer and richer and also our public workers still have very affordable great health care, along with our politicians, because for some reason they get to keep their tax payer supplied health care why the rest of us get Obama care which is now even higher priced than what we had before and going up. We need now, single payer system for everyone, cost controls, before we all go broke.

June 17 2014 at 7:00 PM Report abuse +1 rate up rate down Reply

Plot another parameter - physician income. I'll bet the top scoring have a two tier system - you pay more, you get more.

June 17 2014 at 12:48 PM Report abuse rate up rate down Reply

Capitalize now on your fellow man, rip him off, take him now for everything he's got that's capitalism for ya. GREED is destroying America.

June 17 2014 at 12:07 PM Report abuse +1 rate up rate down Reply

Let's look at Japan. Their people live really, really, really....long. Oldest, 111. passed recently. Healthcare cost, down to the ground. Yet, people are under stress all the time. Diet? Possibly. They sure don't spend their time stuffing twinkies in their mouth.
However, eating raw fish can come with a high rate of stomach aliments And they spend less time in long term care facilities, because for their deep commitment to family.
The United States ranks number 1, in adulthood obesity. Has a high divorce rate, and a bunch of lonely people, even with social media outlets. Over half are on pain pills, or depression medication. Heart disease, smoking, obesity cost tons of dough.
Now what?

June 16 2014 at 3:29 PM Report abuse +1 rate up rate down Reply

Wait times in the ER nationwide are getting longer not shorter. So imagine a solo primary care doctor.

June 16 2014 at 3:14 PM Report abuse +2 rate up rate down Reply

Here's a rather odd stat. According to the WHO, Greece is number uno in childhood obesity. Yet...Greece has Doctors galore.
And we haven't gotten to Medicaid patients still using the ER, even with the expansion of Medicaid.

June 16 2014 at 2:59 PM Report abuse rate up rate down Reply
1 reply to theycallmeroy3's comment

Yet . . . the average Greek lives two years longer than the average American and their infant mortality rate is a little over half of the U.S. rate.

June 17 2014 at 11:48 AM Report abuse rate up rate down Reply

Being a doctor in our country comes with heavy rules and regulations. And that's before the passage of the ACA. Going forward it will be increasing difficult for a doctor to have a solo practice.
If a doc isn't in a large group or in a hospital setting, they won't survive long. The paperwork and rules will be overwhelming. Example.
Starting next year, each patient will be given a pin number to access their medical records on line. Doctors must pick up the cost for that. frankly its surprising they even have the time to see patients at all.

June 16 2014 at 2:53 PM Report abuse rate up rate down Reply

Interesting article, I'm glad they mentioned lifestyle which is terrible here. I happen to work for a UK company and my colleagues there complain all the time about how long it takes to see a Dr. Not unlike some of the US VA facilities. Don't you think that this is the perfect of example of simply throwing money at the problem and not looking at the cause? Efficient spending is the key to everything and our government (neither party is better ot worse than the other) is just terrible at managing practically every program. Why would one think that Obamacare will be much better? Same red tape and regulations in place and more people going into the system. if you want to look at spending per person, then operate like a business and look at cost control first.

June 16 2014 at 1:58 PM Report abuse +2 rate up rate down Reply

The article stops just short of explaining the "why" of it all, yet the OECD report from which the data comes paints a pretty accurate picture. Of the 34 countries in the OECD, the U.S. ranks #27 for physicians/1000 (78% of the average), #30 for medical graduates/100K (62% of the average), #25 for hospital beds/1000 (63% of the average), and #23 for acute care hospital beds/1000 (75.7% of the average). In a laissez-faire market, where demand exceeds supply, price is the vehicle for rationing the supply available. The driver of the entire healthcare system is the physician population. Prescriptions do not get written nor hospital beds filled without physician support. Consequently, the paucity of hospital beds and acute care hospital beds are direct reflections of the number of doctors available to support the hospitals themselves — it is not a matter of patient need, it is a matter of available physicians. The fact that the U.S. ranks #27 and #30 in available physicians and medical graduates, respectively, is the real culprit for the high cost and marginal care evident in our national healthcare system. The recent uproar over the Veterans' Health Services is related to this —there are no more doctors available to the VA than to the rest of us. Want to fix the system? Make physician training a national priority. There is no incentive for the medical community to do this because maintaining a limited supply is in their financial best interests. Not one person reading this will escape the need for healthcare in his or her lifetime — it is a necessity, not a luxury, and it is a necessity that touches every one of us. Healthcare is a public utility and should be treated as such if this national embarrassment is to be reversed.

June 16 2014 at 1:03 PM Report abuse rate up rate down Reply

While chatting with my doctor I stated my belief that the individual mandate should be scrapped but that those who chose to go without insurance but got sick would have to pay from their own resources or go without care. He assured me that would not work because doctors could not ignore those who needed treatment even if they could not pay for it. I asked what would happen if my insurance company and I stopped paying my bills. He said the private group he works for would cut off my access. Sort of makes me think my plan would work.

June 16 2014 at 11:19 AM Report abuse -2 rate up rate down Reply