Biggest Loser Again: The U.S. Healthcare System Takes Last Place for Healthcare Quality

The United States healthcare system placed dead last for overall healthcare quality in a new Commonwealth Fund report that compared the U.S. healthcare system’s performance with 10 other industrialized nations. Commonwealth has conducted four similar studies since 2004 and each time the U.S. has been ranked at the bottom of the pack. That’s one heck of a losing streak.

The most recent report was based on 2011 data. Despite spending $8,508 per person on healthcare – more than any other country – the U.S. performed poorly on most of the performance indicators. Here’s a summary:

  • Quality – the U.S. ranked in the middle on healthcare quality measures, which included effective care, safe care, coordinated care, and patient-centered care.
  • Access – the U.S. ranked last on every measure of cost-related access. In fact, more than one third of adults reported forgoing recommended care because of cost.
  • Efficiency – high health expenditures and administrative costs helped push the U.S. to the bottom spot on indicators for efficiency. Administrative hassles, avoidable ER use, and duplicate medical testing contributed to the low efficiency scores.
  • Equity – Americans with below-average incomes were much less likely than their counterparts in other countries to visit a doctor when sick, leading the U.S. to rank last on measures of equity. One-third or more of lower-income U.S. adults admitted to skipping medical care, tests, and medications because of costs.
  • Healthy Lives – the U.S. ranked last again due to poor scores on infant mortality, mortality amendable to medical care, and healthy life expectancy at age 60.

Despite the dismal scores in recent years, Americans should be cautiously optimistic that its healthcare quality ranking will improve next time around. Note that the latest findings were based on 2011 data — a full year before the implementation of the Affordable Care Act. As more Americans become insured, access to care metrics should improve. Expanded coverage will also minimize some of the inequities that have led many lower income Americans to forgo care, as well as give more patients access to preventative care.

The accelerated adoption of health IT will also impact the quality of U.S. healthcare. Historically other countries have led the U.S. in the adoption of modern health IT systems that enhance care coordination and reduce administrative hassles. With the passage of ARRA in 2009, healthcare providers have had increased financial incentive to implement advanced technologies and the gap with other countries is now narrowing.

More providers are using EMRs and adopting tools to electronically exchange clinical data. Remote and underserved communities are embracing telemedicine technologies, making access to specialist care more timely and affordable. Technological advancements and widespread health IT adoption will eventually result in more effective and efficient healthcare.

Improving healthcare quality will take time, but the U.S. is making significant strides to advance the cause. Here’s hoping that meaningful advancements come soon so that the U.S. can relinquish its Biggest Loser crown.

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Michelle Ronan Noteboom

Michelle Ronan Noteboom specializes in healthcare IT communications, marketing, and strategy. She spent seven years as an independent contributor for HIStalk and HIStalk Practice writing under the name "Inga" and as a freelance writer for various publications and health IT vendors. Michelle previously spent 22 years in healthcare sales IT working for Misys Healthcare Systems.

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