Americans Sicker Despite Paying More for Health Care?
A study by the Commonwealth Fund of health care in the United States, the United Kingdom, Australia, Canada, Germany and New Zealand is getting a lot of attention in the press. A sampling of headlines from Google News:
US lags behind other nations in healthcare, study says (Boston Globe)
Care costs more in U.S. than other Western nations (FW Star-Telegram)
Americans pay more, get less for health care (Lexington Herald-Leader)
Higher costs, worse health care for Americans (Salt Lake Tribune)
Heres’s the WaPo story by Rob Stein that most of the above are based on:
Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations. The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated.
Although patients in every nation sometimes run into obstacles to getting care and deficiencies when they do get treated, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found. “What’s striking is that we are clearly a world leader in how much we spend on health care,” said Cathy Schoen, senior vice president for the Commonwealth Fund, a private, nonpartisan, nonprofit foundation that commissioned the survey. “We should be expecting to be the best. Clearly, we should be doing better.”
Other experts agreed, saying the results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket. “This provides confirming evidence for what more and more health policy thinkers have been saying, which is, ‘The American health care system is quietly imploding, and it’s about time we did something about it,’ ” said Lucian L. Leape of the Harvard School of Public Health.
The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period. The survey was aimed at evaluating care across varying types of health care systems, including the market-driven U.S. system and those that have more government controls and subsidies.
The survey, published in the journal Health Affairs, questioned 6,957 adults who had recently been hospitalized, had surgery or reported health problems between March and June of this year.
Sign me up for socialized medicine, stat! We’re in an absolute crisis here in the USA–I’m surprised anyone is still alive.
But wait. Here’s the story that brought the rest to my attention:
Canadian patients surveyed reported almost the same levels of medical errors as patients in the United States, says a new survey. The Commonwealth Fund surveyed people with health problems in six countries: the U.S., Canada, the United Kingdom, Australia, Germany and New Zealand.
According to the survey, 34 per cent of Americans reported medication or medical mistakes or lab errors. By comparison, 30 per cent of Canadians with health problems reported they experienced errors. Patients in the United Kingdom were the least likely to report errors (22 per cent).
Canadians and Americans were less likely to get same-day or next-day access to their doctors (23 per cent and 30 per cent), compared to people in the other four countries. New Zealand reported the speediest appointments, with 58 per cent of people reporting same-day access to doctors, while Germany followed at 56 per cent.
The Commonwealth Fund, which says its mission is to support independent research on health care, conducted the survey between March and June 2005. Surveyors questioned 700-750 adults in Australia, Canada, and New Zealand and 1,500 or more in the UK, United States, and Germany. The respondents rated their health as fair or poor and had recently been hospitalized or had an injury or disability.
This is not a study of the quality of health care in six of the world’s richest countries. Instead, it is a study of the health care of those who “rated their health as fair or poor and had recently been hospitalized or had an injury or disability.”
This is confirmed by looking at the study, Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries, itself.
Sample and study design. The survey screened initial random samples of adults age eighteen or older to identify those who met at least one of four criteria: rated their health as fair or poor; reported that they had a serious illness, injury, or disability that required intensive medical care in the past two years; or reported that in the past two years they had major surgery or had been hospitalized for something other than a normal pregnancy.
Further, if one looks at the actual breakdowns of the sample, we see that the U.S. cohort was both older and sicker than average:
You’ll note, too, that the U.S. sample had much higher incidence of diabetes and hypertension than that from other countries. Presumably, this is because they are fatter.
Also, 40% of the U.S. cohort were taking four or more prescription medications, far more than any of the other cohorts. Whether this is a function of being sicker to begin with or an artifact of the American preference to be treated with drugs is not something that can be determined from the chart.
The bottom line is that we’re not comparing apples and apples here. It may well be that Americans pay more for health care and get less for it. But this study certainly doesn’t prove it.