“If We Are So Good . . . Why Aren’t We Better?”

A Critical and Quick View of the U.S. Health Care System

Forces of Change - Fall 2010Eric D. Kupferberg, PhD

23 September 2010

HC Spending Rising Faster than GDP

HC Spending Rising Faster than Wages

U.S. Health Care Spending Outpaces All Other Countries

Note: $US PPP = purchasing power parity.Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

0

1000

2000

3000

4000

5000

6000

7000

8000

1980 1984 1988 1992 1996 2000 2004

United States

Canada

Netherlands

Germany

Australia

United Kingdom

New Zealand

Average spending on healthper capita ($US PPP)

0

2

4

6

8

10

12

14

16

1980 1984 1988 1992 1996 2000 2004

United States

GermanyCanada

NetherlandsNew Zealand

AustraliaUnited Kingdom

Total expenditures on healthas percent of GDP

$7,290

$2,454

16%

8%

U.S. Health Care Spending Outpaces All Other Countries

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

    AUS CAN GER NETH NZ UK US

OVERALL RANKING (2010) 3 6 4 1 5 2 7

Quality Care 4 7 5 2 1 3 6

Effective Care 2 7 6 3 5 1 4

Safe Care 6 5 3 1 4 2 7

Coordinated Care 4 5 7 2 1 3 6

Patient-Centered Care 2 5 3 6 1 7 4

Access 6.5 5 3 1 4 2 6.5

Cost-Related Problem 6 3.5 3.5 2 5 1 7

Timeliness of Care 6 7 2 1 3 4 5

Efficiency 2 6 5 3 4 1 7

Equity 4 5 3 1 6 2 7

Long, Healthy, Productive Lives 1 2 3 4 5 6 7

Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290

Country Rankings

1.00–2.33

2.34–4.66

4.67–7.00

U.S. Health Care System Ranks Poorly

U.S. Has Poor Access to Health Care

Many U.S. Citizens Have Trouble Paying for HC

U.S. Has High Number of Uninsured

62.0 62.259.1 58.5

61.7 61.9 61.7 62.9 63.9

31.6 32.1 31.028.7

31.5 31.3 32.0 33.7 34.4

0

20

40

60

80

1996 1997 1998 1999 2000 2001 2002 2003 2004

Uninsured for at least one month during year (in millions)Uninsured all year (in millions)

Data: Medical Expenditure Panel Survey, Household Component (Rhoades, J.A. 2006. Agency for Healthcare Research and Quality).

U.S. Has High Percentage of Population Uninsured

27.0 26.825.3 24.8

25.9 25.9 25.3 25.4 25.7

13.8 13.9 13.312.2

13.3 13.1 13.1 13.6 13.8

0

10

20

30

40

1996 1997 1998 1999 2000 2001 2002 2003 2004

Uninsured for at least one month during year (percentage)

Uninsured all year (percentage)

Data: Medical Expenditure Panel Survey, Household Component (Rhoades, J.A. 2006. Agency for Healthcare Research and Quality).

Uninsured Ranks are Growing

1813 15

10

28

39 3644

33

60

4339

49

37

59

0

20

40

60

80

100

Did not fill aprescription

Skipped amedical test,treatment, or

follow-up

Did not see adoctor for a

medicalproblem

Did not see aspecialist

when needed

Any of thefour accessproblems

Insured all yearUninsured in past year (but insured at time of survey)

Uninsured at time of survey

No Insurance = Gaps in Care

Data: Commonwealth Fund Biennial Health Insurance Survey (Collins, S. R., K. Davis, M. M. Doty et al. 2006).

Key: Lower rates are better (gold = best and blue = worst performance) AUS CAN GER NETH NZ UK US

Records/clinical information not available at time of appointment 28 42 11 16 28 36 40

Tests/procedures repeated because findings unavailable 10 20 5 7 14 27 16

Problems because care was not well coordinated across sites/providers

39 46 22 47 49 65 37

Data: 2006 Commonwealth Fund International Health Policy Survey (Schoen, C. et al. 2006. Health Affairs Web Exclusive W555-509–71). AUS = Australia; CAN = Canada; GER = Germany; NETH = Netherlands; NZ = New Zealand; UK = United Kingdom; US = United States. Responses included "often" or "sometimes."

US Poor in Coordinating Care

U.S. Has Poor Quality of Care:Adverse Events per 1,000

21.7

3.32.0

22.8

3.52.1

23.3

3.82.3

24.4

3.82.3

0

5

10

15

20

25

30

Pressure ulcers (duringhospital stays of 5 days

or longer)

Accidental puncture orlaceration during

procedures

Infections due tomedical care*

2000 2001 2002 2003

Data: Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (Agency for Healthcare Research and Quality 2006). Rates were risk-adjusted. *Primarily related to intravenous lines and catheters.

High Percentage of Patients With Medical Mistakes

Data: 2005 Commonwealth Fund International Health Policy Survey (Schoen, C. et al. 2005. Health Affairs Web Exclusive W5-509–25). AUS = Australia; CAN = Canada; GER = Germany; NZ = New Zealand; UK = United Kingdom; US = United States. Sicker adults have a high incidence of chronic disease and recent intensive use of health care.

Source: McCarthy and Leatherman, Performance Snapshots, 2006. www.cmwf.org/snapshots