"Quality of Care from Doctor"
Again an opinion rating, but at least its an opinion of quality. US is tied for 4th out of 11 countries listed.
"Blood Pressure in Normal Range Among Patients with Heart Disease and/or Hypertension"
A measurement of outcome, and not adjusted for differences that people might have going in to treatment, or non-medical circumstances and decisions made after treatment, but still probably a halfway decent measurement. US is in the middle.
"Overall Ranking"
Obviously an their opinion about overall quality, but then most of their criteria, either in the 206 charts (or at least the 10 pages out of 29 of charts that I looked at) or in listed in this specific chart are not about quality. Efficiency isn't about how good the care is, if twice as much was spent for a marginal improvement in care, efficiency might be low, but the care would still be better. Equity isn't a measure of quality either. "Long, Healthy, Productive lives" is largely do to things besides medical care (and even more so due to things outside of medical insurance). Expenditures per capita isn't a measure of quality care either.
"Mortality Amenable to Health Care"
Could be related to quality, but then they don't cover many types of conditions and there is no attempt to adjust for any differences outside of medical care and insurance differences. US does very poorly in their rankings of this measurement.
Deaths Due to Surgical or Medical Mishaps per 100,000 Population, 2006
Obviously an issue relevant to quality. And US is tied for last. OTOH the US is in a three way tie for last out of only seven countries listed. Where the other countries dropped to make the US look worse, or was it just a lack of data? New Zealand shows a rate of zero which makes me doubt their data. Drop them off and the US is a three way tie for last out of only six countries. Also different years are used for different countries. Seems like there is problems with the data here. Also you would have the same issue I raised before, possible differences in definitions, and in reporting rates for errors.
Life Expectancy at Age 65, 2006
Perhaps better than life expectancy at birth because of different ways of counting live births. Also it might reduce differences from murder and even car accidents. Still life expectancy needs to be adjusted for a ton of things to be a decent proxy. No adjustments are made here. US is mediocre to poor compared to the other countries in this list.
"Physician Views of the Quality of Care Their Patients Get Throughout the Health Care System"
First its an opinion poll, where differences in expectations and other issues can be more important than direct perception of the facts about quality. Also importantly its not even an opinion of quality but of changes in quality. Results are all over the map which would give further reason to doubt the usefulness of this measure.
"Practice Routinely Receives Data Comparing Clinical Performance to Other Practices"
"Practice Routinely Receives and Reviews Data on Patient Satisfaction and Experience"
"Practice Routinely Receives and Reviews Data on Patient Clinical Outcomes"
Three measurements of the review system not directly of quality. Also measures "receives data" or "receives and reviews data" without any measurement of the quality and usefulness of the data. UK best in all three (but then they have the worst of the listed countries in life expectancy at age 65). US above average in all three.
"Does Your Practice Have a Process for Identifying Adverse Events and Taking Follow-Up Action?"
Similar to the last three except that its a measurement of something that could more directly effect quality. Again UK number one and US above average.
"Practice Routinely Gives Patients Written List of All Medications"
Similar to the last one. Could effect outcomes. OTOH the differences are huge, and the actual quality differences don't seem to match up to these measurements. UK gets 83 percent Netherlands gets 4 percent. If this was a highly significant measure then the Netherlands would be an awful place to get care (as would New Zealand and to a lesser extent Australia) but I don't think that's the case. US is slightly above average.
"Doctor Routinely Gives Chronically Ill Patients Written Instructions on Managing Care at Home"
Similar to the last one except less variance. US is in third. Italy is well above everyone else.
"Practice Routinely Sends Patients Reminders for Preventive or Follow Up Care"
Another similar measure. This time NZ is at the top rather than at the bottom. Large variance. US a bit below average.
"Percent of Population with Self-Assessed Good or Very Good Health"
Potentially a somewhat useful measurement. But its about outcomes (or actually patient perception of outcomes), not quality of care. Also only four countries listed. The different number and selection of countries for each question is a definite weakness of this study). The US is first, but I'm not sure if this is an important measurement.
"Coordination of Specialist Care"
US slightly worse than average (the number is higher than average but higher is worse here). Germany who did very poorly on some other measurements (worst on doctors opinion about the quality of the system) does best here. This might be a relevant and useful measure, but its probably a rather limited one both in terms of the importance of area it measures, and the limited detail in that area. |
