“if we are so good... why aren’t we better?” a critical and quick view of the u.s. health care...
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![Page 1: “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,](https://reader036.vdocument.in/reader036/viewer/2022062309/56649d355503460f94a0d024/html5/thumbnails/1.jpg)
“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
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HC Spending Rising Faster than GDP
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HC Spending Rising Faster than Wages
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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%
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U.S. Health Care Spending Outpaces All Other Countries
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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
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U.S. Has Poor Access to Health Care
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Many U.S. Citizens Have Trouble Paying for HC
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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).
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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).
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Uninsured Ranks are Growing
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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).
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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
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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.
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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