U.S. Health Care lags in quality, access - says Health Day News

Copied from earlier writings elsewhere
Originally published 24 Jun 2006

From Medicine.net, a report by Steven Reinberg, HealthDay Reporter, April 4 says that even though the United States spends more than twice as much per capita on health care as some other western nations, it trails them in such measures as efficiency, equity, and patient safety and access to care, according to two new reports.

..."There's a persistent myth that U.S. health care is the best in the world," said Dr. Donald M. Berwick, president and CEO of the Institute for Healthcare Improvement. But, he added, "The U.S. is far from the best health-care system in the world, even though it's by far the most expensive." The reports were prepared by The Commonwealth Fund, a nonprofit group that works to improve health care in the United States. They looked at differences in health care in Australia, Canada, Germany, New Zealand, the United Kingdom and the United States.

"What is disturbing about these findings is that while the U.S. ranked first on health-care spending in the world, we are often last in measures of quality of care," said Commonwealth Fund President Karen Davis. "Higher spending doesn't mean that we receive more or better care -- we simply pay more."

The reports are titled, Mirror, Mirror, on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens, and The U.S. Health Care Divide: Disparities in Primary Care Experiences by Income -- Findings from the Commonwealth Fund 2004 International Health Policy Survey.

...the United States ranked worst in

• patients experiencing a lab test error, including wrong tests or delays in being notified about abnormal test results.
• patients leaving a doctor's office without getting important questions answered.
• patients' ability to get care on nights and weekends.
• number of patients who have to go to the emergency room for a condition that could have been treated by a regular doctor.
• differences between below- and above-average income patients not filling prescriptions or skipping doses due to cost.
• patients not filling prescriptions
• skipping recommended tests, treatments, or follow-up
• not visiting a doctor when needed due to cost.

On  the plus side, the U.S. ranked first on

• preventive services, such as Pap tests and mammograms
• providing counseling on diet and exercise.

Davis said. "We can do better. We have the wealth, the health-care institutions, the dedicated professionals, the technological process, the medical research and the ingenuity required to make the U.S. health-care system the best in the world."

In the other report, some uncomfortable statistics emerged:

• 22% of U.S. patients with a below-average income rated their doctor as "fair" or "poor," compared with 7 percent of patients with above-average incomes.
• 76% of uninsured adults went without needed care because of cost in the last year. 
• "The U.S. is unique among advanced industrialized nations for failure to provide basic universal coverage to insure access and remove the fear of financial consequences in bills when ill," said Cathy Schoen, a senior vice president at the Commonwealth Fund.
• "The broad health-care divide by income and the growing gap between us and other countries is putting the workforce and the nation at risk." Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.

SOURCES for the article: Donald M. Berwick, M.D., president and CEO, Institute for Healthcare Improvement, Boston; Karen Davis, president, The Commonwealth Fund, Cathy Schoen, senior vice president, The Commonwealth Fund, New York City; David L. Katz, M.D., M.P.H., associate professor of public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Commonwealth Fund reports, Mirror, Mirror, on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens, The U.S. Health Care Divide: Disparities in Primary Care Experiences by Income -- Findings from the Commonwealth Fund 2004 International Health Policy Survey, April 4, 2006

Full article at http://www.medicinenet.com/guide.asp?s=ef&k=medicinenet.com&a=60890  and Copyright © 2006 ScoutNews LLC. All rights reserved.

*See also a related article at the same location: http://www.medicinenet.com/guide.asp?s=ef&k=medicinenet.com&a=62268

I've highlighted the main points of this article to spur further discussion on this topic. Clearly, the Republican Party is the main problem, but the Democrats are gun shy about pushing this topic hard, after the near meltdown over this in the early part of the Clinton years. The medical lobby is VERY powerful, and very well funded, but the obvious answer is to note that Medicare has been chugging along for a few decades and they have yet to kill it off, try as they might. The fact of the matter is that many doctors and health clinics have grown used to Medicare and know how to deal with it, and often appreciate its approach vs. that of the major private health plan insurers.

Medicare's forms are simpler and less micromanaging than the private companies. Because it's the government, there is a greater sense of doing right by the patient instead of the bottom line. Hard to imagine that the government program outshines the private enterprise approach (from the anti-government view) but this is not an isolated view.

So, let's consider opening Medicare to younger folks and see what the economies of scale can bring to health care costs. We need something to balance the inordinate power and control wielded by conglomerate healthcare providers, who have no interest in controlling costs (i.e. profit margins.)