Study Examines Quality in Five Countries, Including United States
Although the United States spends about twice as much per person on health care as Australia, Canada, England and New Zealand, the overall quality of care is no better, according to a study in the new issue of Health Affairs, the Wall Street Journal reports (Lueck, Wall Street Journal, 5/5). The study was financed by the Commonwealth Fund and led by Peter Hussey, a doctoral candidate at the Johns Hopkins Bloomberg School of Public Health and Gerard Anderson, a professor at the school system (Marks, Christian Science Monitor, 5/5). Researchers examined 21 quality indicators such as cancer survival rates and incidence of infectious diseases in the five countries (Wall Street Journal, 5/5). The United States was the only participating country without some form of universal health system (Christian Science Monitor, 5/5). The study found that no single country performed the best or worst overall. The United States scored highest for five-year breast-cancer survival rates and screening for cervical cancer and had the lowest incidence of measles and the lowest smoking rate, tied with Canada. However, the United States also had the worst five-year survival rate for people who had undergone kidney transplants, as well as the highest incidence of hepatitis B, according to the study authors (Wall Street Journal, 5/5). The United States was also the only country to have a rise in deaths from asthma, according to the study, which examined health data through the year 2000 (AP/Long Island Newsday, 5/4). The Journal reports that the study did not identify reasons for the quality variation and "made no determinations about which of the varying health systems performed the best" (Wall Street Journal, 5/5).
According to the Christian Science Monitor, the goal of the study is to "set the first benchmarks for comparing and eventually improving health care outcomes around the world." The Organization for Economic Cooperation and Development is already using the research as a model to create a similar study designed to include more than 20 countries. Arnold Epstein, a co-author of the Health Affairs study and chair of the Department of Health Policy and Management at Harvard University's School of Public Health, said, "The United States should be particularly concerned about this report. If I'm spending twice as much, I'd expect to have better outcomes" (Christian Science Monitor, 5/5). David Cutler, a professor of economics at Harvard, said, "We need to get rid of all the stuff that's not worth it but not say that therefore we don't want to be spending more over time." Dr. Donald Palmisano, president of the American Medical Association, said the study did not take into account some factors, including differences among patient populations and the impact of lengthier waiting times for procedures in other countries (Wall Street Journal, 5/5). The study is available online.
According to a related Health Affairs study, the "fragmented U.S. payment system" is a major reason for higher health care costs in the United States, according to the Journal. The study, led by Hussey, Anderson and Uwe Reinhardt, a professor of political economy at the Woodrow Wilson School of Public and International Affairs at Princeton University, found that the mix of public and private coverage in the United States "weakens the demand side of the health sector and makes for high administrative costs," the Journal reports (Wall Street Journal, 5/5). The study said that health insurance is likely to become increasingly unaffordable for lower-income workers, and lawmakers will be forced to choose between "some form of universal health care and a system in which there is a stark difference in the quality of care based on ability to pay," AP/Newsday reports (AP/Long Island Newsday, 5/4). The study is available online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.