“If We Are So Good . . . Why Aren’t We Better?”
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“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 2010 Eric D. Kupferberg, PhD 23 September 2010
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“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 2010 Eric D. Kupferberg, PhD 23 September 2010. HC Spending Rising Faster than GDP. HC Spending Rising Faster than Wages. - PowerPoint PPT Presentation
Transcript of “If We Are So Good . . . Why Aren’t We Better?”
“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
