Ezra Klein of The American Prospect, analyzes the findings of the newly released Commonwealth Fund survey on health care attitudes and experiences from patients in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. He finds the following ten problems
1. America spends the most, but 16% of the population do not have any insurance.
2. We don't pay doctors according to the quality of their care.
3. Our wait times are low because many of us aren't getting care at all. In just the past year, a full 25 percent of us didn't visit the doctor when sick because we couldn't afford it. Twenty-three percent skipped a test, treatment, or follow-up recommended by a doctor. Another 23 percent didn't fill a prescription. No other country is even close to this sort of income-based rationing. In other countries, the disadvantaged wait longer for their care, and so show up in the data tracking wait times. In our country, they disappear from that measure, because they never get the care at all. You don't wait for what you're not receiving.
4. Most of us don't have a regular physician. Of everyone surveyed, Americans were the least likely to report a doctor or general practitioner they routinely saw. As a result. Americans are the most likely to say their doctor doesn't know important information about their medical history, which has obvious implications for care quality, medical errors, etc.
5. Our care isn't particularly convenient. On same day appointments, only 30 percent of Americans report that they can access a doctor on the very day they need one, as opposed to 41 percent of Britons and 55 percent of Germans. And a full 67 percent of Americans -- more than in any other country -- say it's difficult to get care on nights, weekends, or holidays with resorting to the emergency room, where care is costlier and, if your injury is not grievous, less efficient.
6. Our doctors don't listen to us. Americans are the least likely to report that their doctors explain things in ways they understand or say doctors spend enough time with them (56 percent of us say they do, as compared to 70 percent of Germans). We're the most likely to report that test results or medical records were unavailable during our scheduled appointments and, along with the Germans, the most likely to say that our doctors ordered tests that we'd already had done.
7. We have high rates of chronic conditions. Our high rates of chronic disease are a massive cost-driver, attributable, according to the research of Ken Thorpe, for about 2/3rds the rise in health spending over the past few decades.
8. But we're not treating the chronically ill patients properly. We're far and away the likeliest to report spending more than $500 out-of-pocket on prescription drugs annually. That's a problem, as higher out-of-pocket costs mean more of us going without prescriptions, which means less maintenance of conditions and, thus, more cost when our chronic illnesses balloon into catastrophic health events. Indeed, 42 percent of Americans with chronic conditions -- the exact same percentage who report paying more than $500 for drugs -- report skipping care, drug doses, or doctor's appointments due to cost. That's cheaper for them in the short-term, as they can spend some of the money on food or rent. It's more expensive for us, however, as we pick up the huge bill when they end up in the hospital in full cardiac arrest.
9. We're frequent victims of medical, medication, and lab errors. 20 percent say they've experienced atleast one error over the past year. For those of us with chronic diseases, the rates are even higher. There are many reasons for this, ranging from our low adoption rate of electronic medical records to our splintered care system. Studies show that our high rate of lawsuits is due to our high rate of medical error.
10. Most of us are dissatisfied with our current system. Of all the countries surveyed, Americans are the least likely to report relative satisfaction, and the most likely to call for a fundamental rebuilding of the health care system. Only 16 percent of us are happy, to 26% in Canada and the U.K., 42% in Netherlands. 34 percent of Americas want to completely rebuild the system, to 12 percent of Canadians and only 15 percent of U.K. residents. So paying more than twice as much as anyone else, we have the lowest satisfaction with our health care system. Americans who have to forgo care are less satisfied than Canadians who simply have to wait for elective surgeries. Our shorter doctor visits, more impersonal caregivers, higher rates of medical errors, and inability to find primary care after 6 P.M. have left us frustrated.
Update 1
Shannon Brownlee has written widely acclaimed book, Overtreated, describing the problems ailing the American Health CAre industry. David Leonhardt, has called it the best Economics book of 2007. It draws on the study of Dr Jack Wennberg, and diagnoses and then offers prescription on "how to spend less on health care while not making the population any less healthy."
Update 2
Uwe Reinhardt has explains the reasons for the high health care costs here, here, here, here, here, here and here. The US spends 40% more on health care per capita than its GDP per capita would predict and this excess spending amounted to $570 billion in 2006 and about $650 billion in 2008. The latter figure is over five times the estimated $125 billion or so in additional health spending that would be needed to attain truly universal health insurance coverage in this country!
The McKinsey Global Institute estimated that excess spending on "health administration and insurance" accounted for as much as 21% of the estimated total excess spending ($477 billion in 2003). Brought forward, that 21% of excess spending on administration would amount to about $120 billion in 2006 and about $150 billion in 2008. It would have been more than enough to finance universal health insurance this year. The McKinsey team estimated that about 85% of this excess administrative overhead can be attributed to the highly complex private health insurance system in the United States.
Update 3
NYT has this series on the high health care costs in the US. David Leonhardt has this sum up of the literature. Uwe Reinhardt writes about the mounting price of health care’s status quo and how hospitals get paid.
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