Americans Spend More On Health Care But Are Not Healthier

Despite spending more for health care, Americans do not have the best medical care in the world, according to researchers from the Johns Hopkins Bloomberg School of Public Health and other institutions.

The study is the first to use a universal set of standards to compare the quality of health care in the five countries surveyed. The researchers found that no country scored the best or worst overall and that each country was the best and worst in at least one area. The study is published in the May/June 2004 issue of the journal Health Affairs.

Peter S. Hussey, lead author of the study and a doctoral candidate in the Department of Health Policy and Management, said, “It is well known that the United States spends much more on health care per capita than other countries, and it is commonly assumed that we have the best health care system in the world. However, the results of our study show that the United States performs better than other countries in only a few areas, while performing worse in others. This raises the question of what Americans receive for all of the money devoted to health care.”

The international group of researchers worked together as The Commonwealth Fund International Working Group on Quality Indicators. Data on 21 health indicators that reflect the quality of medical care in Australia, Canada, New Zealand, the United Kingdom and the United States were collected and examined. Five-year cancer survival rates, 30-day case-fatality rates after heart attack or stroke, breast cancer screening rates and asthma mortality rates are a few of the indicators the researchers studied. The researchers broke the 21 health indicators into three categories, which include survival rates for various cancers and transplants, avoidable events such as suicides, asthma and smoking rates and process indicators that include vaccination and screening rates.

The United States had the highest breast cancer survival rate, the highest cervical cancer screening rate and the lowest smoking rate. For breast cancer survival rates, the United States (86 percent) was 11 percentage points better than the worst country, which was the United Kingdom. For cervical cancer screening, the United States (93 percent) was 26 percentage points better than the United Kingdom, the worst country. The United States tied with Canada for having the lowest smoking rate.

The United States performed more poorly on indicators including asthma mortality rates and survival after kidney and liver transplants. The United States is the only country where asthma mortality rates have been increasing over time; they are now higher than in the United Kingdom and Australia. The survival rate after kidney transplant in the United States (83 percent) was 11 percentage points lower than in Canada, the country with the highest rate.

One noteworthy pattern was in the United Kingdom. It scored the lowest in five of the nine survival rate indicators and highest in five of the eight avoidable event indicators. This means that the United Kingdom is exceptional at preventing avoidable health issues such as pertussis or hepatitis B, but has the lowest cancer survival rate of the five countries studied.

“Each country in our study has areas of care where it can learn from the other countries and areas where it could teach others. That tells us that there are opportunities for improvement in the quality of health care in all five countries. We hope our study will be expanded upon so that it can be used to judge overall health system performance around the world,” Hussey said. He also noted that Americans were spending more on health care, but not receiving extra benefits or having better health care experiences.

Hussey, and colleague Gerard F. Anderson, PhD, a professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, also co-wrote a second article about Americans spending the most per capita on health care. In the article, which is also in the May/June issue of Health Affairs, they address why Americans pay much more for health care than their foreign counterparts. Dr. Anderson, Hussey and co-author Uwe E. Reinhardt, PhD, with the Woodrow Wilson School of Public and International Affairs at Princeton University, found that the second-highest spending country, Switzerland, spent only 68 percent as much as the United States on health care per capita.

“How Does The Quality of Care Compare In Five Countries” was co-authored by Peter S. Hussey, Gerard F. Anderson, Robin Osborn, Colin Feek, Vivienne McLaughlin, John Millar and Arnold Epstein.

The study was supported by The Commonwealth Fund