Ranking nations' healthcare: US isn't No. 1

A first-ever comparison of healthcare quality could give more impetus to change the US private-public system.

Americans spend twice as much on healthcare as other countries, but it turns out that they're not getting twice the quality for the price when they go to the doctor or hospital.

In the first international comparison of healthcare quality, researchers found that of the five countries studied, none is consistently the best or the worst. For instance, Australia had the best breast-cancer screening, but the worst survival rates for childhood leukemia. This was best in Canada, but that country had the worst heart-attack survival rates. And while the United States led the way in five-year survival rates from breast cancer, it was the worst for kidney transplants.

The conclusion: Each country has something to learn from the others.

"This affords the potential for unprecedented international collaboration ... that will allow countries to identify specific areas where they can improve," says Arnold Epstein, chairman of the Department of Health Policy and Management at Harvard University's School of Public Health in Boston. [Editor's note: In the original version, the quote was misstated and misattributed.]

Benchmarks set

The goal of the study is to set the first benchmarks for comparing and eventually improving healthcare outcomes around the world - as well as to see whether patients are getting what they pay for.

It's already prompted international action. The Organization for Economic Cooperation and Development (OECD) is using it as a model to create a similar study that will encompass more than 20 countries around the world.

The study is also already affecting how patients are cared for. For instance, the Canadians are looking at ways to improve their treatment for heart-attack patients.

But researchers concluded that it was the Americans who should take particular note of the findings.

"The US should be particularly concerned about these findings," says Gerard Anderson, director of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore. "If I'm spending twice as much, I'd expect to have the better outcomes." [Editor's note: In the original version, the quote was misattributed.]

But it turns out, the US was in the middle of the pack for the majority of health issues that were compared.

The study, which was financed by the Commonwealth Fund, a nonprofit foundation in New York, was not designed with any political purpose in mind. Its goal is to help find ways to improve the healthcare received by people around the world. But in the US, where spiraling healthcare costs have become a political issue, it could eventually have a profound effect.

The US is the only one of the five countries studied that doesn't have some kind of government-sponsored universal healthcare system. Instead, the US has a mix of private and public insurance programs, with private companies providing the bulk of care.

Advocates of the current system routinely cite the high quality of care compared to that in government-run health systems when justifying the significantly higher costs.

More awareness

While none of the study's authors would comment on the impact of the findings on the political debate, they did say it would raise some awareness in the short term. But if the OECD begins releasing similar reports on an annual basis, Dr. Epstein said it could have a "profound" impact on the political debate in the US.

The study could also improve the way quality is measured around the world. One of the most frustrating findings for the researchers was that, despite the rising international concern about quality healthcare, there are very "meager" resources for assessing exactly how well doctors and hospitals perform.

It's surprising "how little information is available to monitor the quality of care," says Dr. John Millar of the Canadian Provincial Health Services Authority.

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