Any idea what the conclusions of that study are?
rwjf.org
Summary and Conclusions
Taken collectively, the findings from international studies of health care quality do not in and of themselves provide a definitive answer to the question of how the United States compares in terms of the quality of its health care. While the evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S.health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.
Instead, the picture that emerges from the information available on technical quality and related aspects of health system performance is a mixed bag, with the United States doing relatively well in some areas — such as cancer care — and less well in others — such as mortality from conditions amenable to prevention and treatment. Many Americans would be surprised by the findings from studies showing that U.S. health care is not clearly superior to that received by Canadians, and that in some respects Canadian care has been shown to be of higher quality.
To be sure, there are limitations to the current evidence base. In particular, there is no data or evidence by which to answer the question of whether the United States is a place where one finds health care that exceeds the quality of the best care available elsewhere in the world — in other words, whether the “best U.S.health care is the best in the world.” Although it is often held that the U.S. strength lies in state-of-the-art, technically oriented care, especially focused on “rescue” care, rather than care for more routine acute and chronic conditions, studies typically do not compare the “best” care offered in different countries. Further, there remain other aspects of health care for which we have no quality measures or inadequate data for comparisons.
Existing studies also fail to tell us much at all about the reasons for the apparent differences in quality observed across countries, although numerous hypotheses have been put forward (e.g.,differences in the use of health information technology,differences in the coordination of care and the fragmentation of health care delivery, variations in reliance of incentives for providers and consumers to provide and select care based on consideration of quality). We do know, however, from a five-country survey of primary care physicians52 that U.S. physicians’ practices are more limited in information capacity, provide less patient access outside of traditional work hours, and are among the least likely to work in teams or to receive financial rewards for quality, all factors that could bear on the quality of primary care furnished.
Taken together, these studies do provide a strong basis for determining whether proposed health reform initiatives might threaten or, alternatively,strengthen the current level of U.S. quality. While evidence is not conclusive, it is clear that the argument that reform of the U.S. health system stands to endanger “the best health care quality in the world” lacks foundation. Like other countries, the United States has been found to have both strengths and weaknesses in terms of the quality of care available, and the quality of care the population receives. The main ways in which the United States differs from other developed countries are in the very high costs of its health care and the share of its population that is uninsured.
In the light of the fact that the United States spends twice as much per person on health care as its peers, those who question the value for money obtained in U.S. health expenditures are on a firm footing. The evidence suggests that other developed countries achieve comparable quality of care while devoting at most two-thirds the share of their national income.
Faced with the evidence, one might well ask why it is that assertions of the superiority of U.S. health care are so common. Technical definitions and popular conceptions of quality include many different dimensions and there may not be agreement about which dimensions are most important. For example, people who make the claims that the United States has the “best quality of care” in the world may be prioritizing a degree of access to medical technology and innovation which they believe to be unique to the United States. Perhaps media attention paid to outcomes for a select few (e.g., multiple organ transplant recipients, high-risk delivery of multiple births) has cast into shadow the average outcomes of the majority of Americans with more routine, yet serious, conditions and other health care needs.
But a less-than-fully informed public comes at a cost in that assertions of excellence divert attention from the need to inspire and foster systematic quality improvement activities. Furthermore, there seems to be a routine genuflection to the widespread belief of U.S. quality excellence, even among experts. In an environment where even insured Americans receive only about half of the services that experts consider necessary, there is a strong argument for placing quality firmly on the health reform agenda.53 In short, health reform can be seen as an opportunity to systematically improve quality of care, rather than as a threat to existing levels of quality.
Health reform provides an opportunity to build on strengths and correct weaknesses, work towards aims for improvement, such as those defined by IOM in Crossing the Quality Chasm,54 that care be safe, effective, patient-centered, timely, efficient and equitable. The IOM continues to push for quality improvement based on the evident gap between what is done and what should be done, what can be achieved and what is achieved, but international comparisons have not played a major role in pushing forward that message. On the contrary, unsubstantiated claims that, despite any shortfalls, the United States Health reform provides an opportunity to build on strengths and correct weaknesses, work towards aims for improvement, such as those defined by IOM in Crossing the Quality Chasm,54 that care be safe, effective, patient-centered, timely, efficient and equitable. The IOM continues to push for quality improvement based on the evident gap between what is done and what should be done, what can be achieved and what is achieved, but international comparisons have not played a major role in pushing forward that message. On the contrary, unsubstantiated claims that, despite any shortfalls, the United States has the “best” quality of care in the world are sometimes put forward to support views that reforms are unwarranted on quality grounds and even risky — particularly those reforms that would modify U.S. health financing, coverage or delivery arrangements in ways similar to those used in other countries.
On the basis of this review it is safe to say that U.S. health care is not pre-eminent on quality; furthermore, one can surely argue that U.S. health care quality is not at risk from the kinds of health reform proposals receiving attention. On the contrary, our findings strengthen arguments that reform is needed to improve the relative performance of the U.S.health system on quality. If reform accomplishes no more than extending insurance coverage to the more than 45 million Americans without insurance, it will be an important step forward,but more is needed to ensure health care quality improvement. To the extent it is possible to improve health care delivery through reforms that strengthen incentives to apply knowledge and meet quality standards, employ technology to reduce errors and ensure appropriate care, and help consumers and patients demand better quality, even more might be achieved. |
