World health ranked; we don't feel so good

April 13, 11:30 AMSouth St. Paul ExaminerRob Shirk

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At work in America

My neighborhood has some medical issues. So does yours.

Nine years ago, the World Health Organization  made the first real effort to rank the health systems of 191 countries. France and Italy took the top two spots; the United States was a miserable 37th. Better than Slovenia, not quite as good as Costa Rica. More recently the highly regarded Commonwealth Fund has compared the United States with Australia, Canada, Germany, New Zealand and the United Kingdom through surveys of patients, doctors, and other data.

Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. There is around 45 million Americans with no health insurance whatsoever and millions more with poor coverage.

Fairness. The United States ranks absolutely last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. If you ain't got that do-re-mi, you're likely to postpone prescriptions or preventive care among a host of other things so when you do find yourself in an emergency room you will be a more difficult and expensive patient to work with.

Access. People in other countries face a much longer time for elective surgery or to see a specialist. We get you in faster than anyone except Germany. The main problem in America is the economic barriers and costs faced by the uninsured or underinsured. Still, it's hard to see a doctor at night or on the weekends no matter how much you rake in.

Healthy lives. Rankings are in the low teens to around 20th. We are the best at getting people to stop smoking. However, we are fat. Numero uno in the obese department. Too much Booya, I guess.

Quality. Yay! In a comparison with five other countries, Australia, Canada, Germany, New Zealand and the United Kingdom, the Commonwealth Fund ranked the United States first in providing the “right care”. Boo! We still came in last because we're inept at coordinating aftercare. We also kill more patients at hospitals than anyone else. That last one pretty much put us in dead last.

Life and death. In a comparison the other Commonwealth Fund countries,  the Americans had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, but worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, we ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Several factors can affect these results.

Patient satisfaction. We don't like ourselves very much, or do we? Polls in Europe and North America seven to nine years ago showed only 40% thought the system is good. In more recent Commonwealth Fund surveys of five countries, American attitudes are the gloomiest with a third of the adults surveyed calling for rebuilding the entire system.

On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so who knows?

Information technology.  Amazingly, we suck. Much of our health care system is still operating in the dark ages of paper records and handwritten memos. American primary care doctors lag years behind doctors in other advanced nations in having electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot mistakes and stick to clinical guidelines.

The problem is so bloated and massive that it is hard to know where to begin. The Barack Obama administration, already burdened with fixing the American economic meltdown, has vowed to be the major player in getting us out of the number thirty seven hole and get us up near the top in medical care with the technology factor one of the first to be fixed.


 

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