So How Does Health Care in the United States Compare to Other Countries?

Listen to the common wisdom about the state of health care in the U.S. and it's easy to conclude that we're on the verge of catastrophe.  Academics say we have a "non-system," politicians bemoan the "lack of coordination" and the policymakers condemn "unsustainable" costs. When our health care is compared to that of the Burgundy-sipping French, the olive-oil loving Italians and the bicyle-riding Dutch, our commentariat are ashamed that we Americans haven't joined the rest of the civilized world in offering high value care to its citizens.

Is it really that bad?

To find out, the Disease Management Care Blog looked at these data from the Organisation for Economic Co-operation and Development. Take the test below and decide for yourself if the experts really have it right.  Answers are at the bottom.

1. Which country, as of 2009, had the highest percentage of persons who reported that their health is good?

A. Switzerland
B. Iceland
C. United States
D. New Zealand

2. Name the country that has the highest rate of obesity and the 2nd highest rate of diabetes?

A. Mexico
B. United States
C. Canada
E. New Zealand

3. An excess of physicians can drive increased health care costs.  Which country has the highest number of physicians per capita?

A. Netherlands
B. United States

4. Which country has the greatest number of MRI and CAT scanners per capita?

A. United States
B. Australia
C. Japan
D. Israel

5. Which country has the highest Cesarean section rates per 100 live births?

A. Italy
B. United States
C. Switzerland

6. Does the U.S or Canada have a higher percentage of women getting pap smears?

A. Canada
B. United States

7. Does the U.S or Belgium have a higher percentage of women age 50-69 getting  mammograms?

A. Belgium
B. United States

8. While the Slovak Republic leads the world in asthma admissions per 100K, which country is close behind in 2nd place?

A. Korea
B. United States
C. Poland

9. True or false: The United States' rate of hospital admissions for uncontrolled diabetes is above the OECD average.

A. True
B. False.

10.  While the U.S. leads the OECD with a 20% rate of skipping a provider visit or going without a prescription, which country is in second place with a 17% rate?

A. Germany
B. Netherlands
C. France

11. While the U.S. spends more per capita for health care, health care costs are rising all the OECD countries:

True or False: from 2000 through 2009, the rate of increase in the U.S. health care costs was above the OECD average of 4.0%

12. While Americans make up the largest percentage of DMCB readers, which country in the last month came in second?

A. India
B. Canada
C. Great Britain

+++++++++++++

Answers:

1. C The U.S. So, while we spend more, it can be argued that we are getting our money's worth

2. B The U.S. There may be lots wrong with the U.S. care system, but the U.S. also has a higher burden of disease. Toss in high trauma rates and other impacts from poverty and it can be argued that importing a new health system may not translate into greater health.

3. A The Netherlands.  In fact, both countries are below the OECD average.

4. C Japan, but the U.S. is second in the world in the per capita rate of scans.  We apparently use our scanners a lot more!

5. A Italy is higher. C-section rates are skyrocketing world wide.

6. B The U.S. is 78.7%, while Canada is 75.3%

7. B. The United States. In fact, Belgium is below the OECD average

8. B. This is one area where the U.S. should be doing better.

9. B. False.  Denmark and Sweden, by the way, are above average.

10. A Germany, which has universal insurance.

11. B. False  While absolute costs are a significant issue, the rate of cost increases also keep politicians and regulators awake at night. The U.S. rate was a relatively tame 3.3%, behind Belgium, the Netherlands and the United Kingdom, all of where were above average.

12. Everybody sing....."O Canada, our home and native land....."

Health Care Reform in the U.S. vs. Other Developed Countries.

Your doctor will see you now!

If only the U.S. health care system had the democracy of the French, the efficiency of the Germans, the primary care of the Brits and the common sense of the Swiss. Then we'd be able to see our beret-wearing PCPs ad lib, receive care in 9 minute aliquots, mutter "bullocks!" when we're told we're too old for dialysis and then die old and quietly at home.

Victor Fuchs, writing in the Jan 2 edition of JAMA, has a slightly different perspective.  He notes that American history is dominated by waves of immigrants who came here to escape oppression. We are far more distrustful of government.  We are also less likely to support redistributive public policies. That may be partly due to a more heterogeneous population that is less sympathetic to the less fortunate when they fall outside the right social or demographic class. Last but not least, our system of government is quite inefficient compared, say, to a parliamentary system.

That's why:

1. Government spending on health care is comparatively lower: 46% in the U.S. vs. 75% in Organization for Economic Co-operation and Development (OECD) countries.  As a result, a) administrative costs are fragmented, and b) there is less ability to negotiate prices with providers and suppliers

2. There is a different mix of services: in the U.S., less top-down control means more high tech, specialists and amenities with relatively less reliance on physicians and hospitals to render health care services.

What is the way forward?  Dr. Fuchs recommends that future health reform efforts not be modeled on Europe.  Instead, Americans should scale back their expectations and focus on what is necessary, not desireable.

If government is to assume a greater share of health care costs beyond the current 46% level, it should probably worry about funding basic care, not all care.  In addition, Americans are less likely to support total equality; they want to preserve the option of "buying up" when they can afford it.  Last but not least, future reform is going to have to find a middle ground between all the advocacy groups, stakeholders and special interests that dominate the mix of services.

Image from Wikipedia