The U.S. spent $9,364 per person on healthcare in 2016, compared to $4,094 in the UK, and had worse results. How can we reduce the rising cost of healthcare?
Some of the best medical care in the world takes place in the United States. But Americans spend more money for the same procedures and medications, plus time and energy on paperwork and other insurance hassles. American care is more expensive and harder to get, and our health suffers as a result, according to nonprofit research.
More than half of U.S. doctors say that insurance problems made it hard for their patients to get needed care in the last year, a study from the Commonwealth Fund reports. A third of U.S. adults said that they skipped going to the doctor, didn’t take a prescription, or didn’t receive another kind of recommended care because of cost — just in the last year. In Germany and the United Kingdom, only 7 percent of patients said cost kept them from receiving medical care.
The high costs affect Americans at a wide range of income. In the United States, 44 percent of lower income and 26 percent of higher income people reported that cost interfered with their care.
The 2017 Commonwealth Fund report, the seventh in a series that began in 2004, ranked the performance of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.
The United States ranked last, for example, on a calculation of how many people die who might have been saved by medical treatment. The number came to more than a 100 each year, for every 100,000 people, compared to fewer than 60 in Switzerland. It fell by 21 deaths in the decade ending in 2014, but more slowly than in all the other countries.
You’ll hear that the United States provides better care once you’ve been diagnosed and are getting treatment. Actually, it depends. For colorectal cancer, the five-year survival rate after diagnosis in the United States falls behind the rates in South Korea, Israel, Australia, according to 2015 figures from the Organization for Economic Cooperation and Development. Americans do worse than people in 21 other countries if they get cervical cancer. The U.S. system does well at treating breast cancer, but not by a big margin.
The U. S. system did do well on some measures in the Commonwealth Fund report, coming in third among the 11 countries on safety and fourth on prevention and engagement. Our system does a pretty good job of keeping people from dying in the hospital from a heart attack or stroke and providing mammograms and adult flu shots.
The United Kingdom, Australia, and the Netherlands beat the pack, in that order.
How can the United States catch up?
The report noted that the “highest-performing countries have universal coverage that allows people to get the healthcare they need at little or no cost.” It recommended that the United States do the same, spend more on primary care and preventive medicine, and cut paperwork.
In the United States doctors and patients waste countless hours on billing and insurance claims. The Netherlands also relies on private insurers — but it has a standardized basic benefit package, with predictable copayments. Costs fall in the middle of the pack, and the country came in first on a measure of how quickly patients get care.
“We are not the U.K., Australia, or the Netherlands, and we don’t have to be. Each of those countries follows a different path to top performance. A country that spends as much as we do could be the best in the world. We can adapt what works in other countries and build on our own strengths to achieve a healthcare system that provides affordable, high-quality health care for everyone,” said Eric Schneider, M.D., lead author and Commonwealth Fund senior vice president for policy and research.
August 01, 2017
Christopher Nystuen, MD, MBA