Nursing in the U.S.A

Study: Expensive U.S. Health Care Fails to Put System at Head of Quality Pack

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By Kelly Phillips, staff writer

While officials often tout the United States as having the best health care in the world, it came out roughly in the middle of the pack on many indicators in a recent comparison with four other English-speaking industrialized countries.

“The extra money Americans are spending on health care doesn’t necessarily buy them better quality care,” said Peter Hussey, lead author of the study and a doctoral candidate at Johns Hopkins Bloomberg School of Health.

The United States fared better than the other four countries—Australia, Canada, New Zealand and England—on only a few indicators and worse on others.

Most indicators placed the United States roughly in the middle.

The study “How Does the Quality of Care Compare in Five Countries?” is the first to look at quality indicators that reflect actual medical treatment between countries, Hussey said. The Commonwealth Fund International Working Group on Quality Indicators published its study in the May 4 issue of Health Affairs.

“There is no one country to go to for the best medical care,” Hussey said. “What we did find was that each of the five countries has at least one area where they are the best and at least one area where they’re the worst. So it’s really uneven.”

The study was sparked “because we’ve known for a long time that the U.S. spends a lot more on health care than other countries, and we don’t do as well as some other countries on things like life expectancy or infant mortality,” Hussey said.

The results may surprise some, but confirm the suspicions of others, the author said.

“For me personally, it was a surprise,” Hussey said. “I would think the U.S. would have the best health care system.”

The authors found a few areas of particular surprise at the United States’ poor showing, including some of the cancer survival rates, Hussey said.

While breast cancer survival rates placed the United States on top for that measure, the country was in the middle for survival rates for other cancers.

Hussey also would have expected the United States to top other countries on survival after kidney and liver transplants.

“These are the kind of high-tech surgeries in which we expect the U.S. would do better,” Hussey said. “Actually, the U.S., did worse than most of the other countries.”

The five countries used in the comparison were chosen because they are English-speaking and their health ministers participate in an annual meeting. Researchers wanted to make sure the indicators were closely related to medical care interventions and that data for the indicators were already available.

Hussey said the indicators may not be “the definitive set” for quality, but said it was the best they could do with available quality data.

The United States scored well on these indicators: survival after a breast cancer diagnosis, screening for cervical cancer and flu vaccinations among the elderly.

Among the lowlights for the United States: survival after a transplant and mortality due to asthma among those aged 5 to 39.

As for the latter, “You would hope this is something that would never happen,” Hussey said.

Instead, the mortality rate is higher now than it was 10 years ago, he said, while it has been decreasing in the other countries.

Among other highlights of the report, according to Hussey:

· England consistently performed poorly on survival rates for most of the cancer indicators. “But they did well on most indicators of avoidable events—asthma mortality, suicide rates and diseases like hepatitis B,” Hussey said.

· Canada logged the highest case fatality rate after heart attack among the countries studied.

To read the entire study, click here.

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