A Portrait of A Portrait of a Failing Health System
Almost exactly twenty years ago, in September of 2004, I took a break between my 3rd and 4th year of medical school to head over to London to study International Health Policy. (Yes, I feel absolutely ancient saying that). It was a course made up half of those in healthcare and the other half in economics. We studied comparative health models and all things associated, including finance, regulation and the other types of industries that sprout around it.
Two distinct things I took away from that year:
🔷 Clinicians and economists do not look at the health system in the same way, with potentially dire consequences for patients. You need clinicians to be part of policy and regulatory input. Nothing cemented my desire to head back to medical school and practice medicine more than that course.
🔶 The US system is an outlier in most measures. And not in a good way.
Well, The Commonwealth Fund recently released their Mirror, Mirror 2024 report presenting a comprehensive analysis of healthcare systems across 10 high-income countries. It looks at global healthcare performance and reveals the pressing issues that demand attention.
Twenty years after being a student at the LSE, lo and behold, the US is still an outlier in the worst way.
Listen to this incredible quote from the report: "The U.S. continues to be in a class by itself in the underperformance of its health care sector." 🧐
Some of the key findings and why that is:
1. U.S. Spending vs. Health Outcomes: A continued Paradox
Despite being the highest spender on healthcare, the U.S. has some of the worst health outcomes, particularly in areas such as life expectancy and rates of preventable deaths. This disconnect between spending and outcomes signals inefficiency in the system.
The report shows that the U.S. spends nearly twice as much per capita on healthcare as countries like the UK and Australia but has lower life expectancy.
2. U.S. Healthcare: Last in Overall Ranking but High in Care Processes (!)
Despite ranking last overall, the United States shows strength in care processes, coming in second after the UK. This category includes aspects like patient engagement, quality of care, and preventive measures
What does that mean: We excel in cancer screening and management, demonstrating that when people can access healthcare, it tends to be high quality. Still, the overall ranking is dragged down by poor affordability and equity issues.
Btw, this category did NOT exist 20 years ago. Or even 10 years ago. Being great in care process is fine but it won't matter if no one can afford it.
3. Affordability is almost non-existent in the US
The U.S. has the highest healthcare costs, but also the largest barriers to accessing care, particularly for low-income individuals. Out-of-pocket expenses and high insurance premiums limit access, there are hospital deserts and hospital stays can bankrupt patients.
What does this mean: A study cited in the report shows that 42% of Americans skipped or delayed care in 2023 due to costs, compared to just 8% in countries like the UK and Australia where care is largely free at the point of service (so when a patients need health services, they are covered).
4. Equity is still an issue
Equity remains a significant issue. This time it isn't only the United States but also New Zealand, where income-based disparities in access to care are most pronounced. In contrast, Germany and Australia have more equitable healthcare systems and provide consistent care across income groups.
In the U.S., life expectancy is 6 years lower in low-income groups compared to wealthier counterparts. In contrast, Australia has a more consistent health outcome across different income brackets due to its universal coverage model. I hate to say it, but our use of tech for only the wealthiest is making this worse.
It's not all doom and gloom. There are some good outcomes noted and things to take away.
5. Australia, Netherlands, and the UK are top performers.
Australia’s universal healthcare model ensures that most services are funded by the government, making healthcare affordable and widely accessible. This contributes to Australia’s high ranking, especially in categories like primary care and preventive services. Everyone uses the 'long wait lists' as examples for how this doesn't work. But everyone gets care.
6. Australia and the UK also demonstrate administrative efficiency
Administrative simplicity is a key strength in high-performing systems like Australia and the UK. They have streamlined their processes to make it easier to access care and reduce costs with healthcare administration. There is zero chance the US would ever win in this. We have an entire industry built around our admin inefficiencies.
In Australia, the centralized billing system allows doctors to be paid directly by the government, minimizing paperwork for patients. Meanwhile, the U.S. ranks poorly, where complex insurance processes create administrative burden for both patients and providers. le sigh.
These findings, yet again, emphasize the need for systemic reforms, particularly in the U.S., where the high costs of healthcare do not translate into better health outcomes. But there are still the same reforms we needed.
I get it. Healthcare is hard to reform. Examples from other countries are not always applicable. The US, however, has examples of every single type of health care system within it. We can at least start there. Especially since countries that perform well provide valuable lessons in universal access, affordability, and administrative efficiency.
For a deeper dive into the data and country-specific analysis, explore the full report here.
#health #medicine #healthequity #equity #healthcare