Healthcare: East or West – who is the best?

About 2 weeks ago, our dinner table conversation at home was around healthcare in general and the changing dynamics of U.S. healthcare as in many households in recent times. My 8 year old son turned towards me and asked, “Dad. Which country has the best healthcare in the world? Is it America?” That set me thinking…

There are two schools of thought in the U.S. One, which believes that U.S. healthcare system is one of the better systems in the world or perhaps even the best and the other, believes we have a long way to go. If you put on the TV or the radio, you will hear politicians out there telling you how the U.S. healthcare system is the best in the world irrespective of the escalating costs, myriad complexities of law, growing number of uninsured Americans, Medicare and Medicaid cuts and, if you, like me, tie quality of healthcare with longetivity statistics, U.S. placement as the 50th in a list of 229 countries for which it was tabulated[1]. U.S. healthcare has often been argued as one of the better systems based on some myopic stats such as lesser wait times for care compared to some of the other developed countries, better access to medical technology and vast majority of healthcare innovation happening in the U.S.

The World Health Organization (WHO) conducted the first analysis to rank the world’s health systems in 2000. Using five performance indicators to measure health systems in 191 member states, it concluded that France provides the best overall healthcare followed among major countries by Italy, Spain, Oman, Austria and Japan. United States was a dismal 37th [2]. The five indicators were: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs). In other words, the quality of healthcare systems is based upon factors such as accessibility, affordability and the level of care and qualifications achieved by the professionals working within.

WHO compared each country’s healthcare system to upper limit of what can be done with the level of available resources in that country. It also compared each country’s healthcare system accomplishments with those of others. The WHO report concluded that health and well-being of people depend critically on the performance of the health systems that serve them. However, there is disparity in performance, even among countries with similar levels of income and health expenditure. Virtually all countries were underutilizing their available resources. The goal of the analysis was to provide a comparative guide to help countries learn from each other and thereby improve the performance of their health systems.

In 2009 & 2010, The Commonwealth Fund conducted studies comparing the United States with about 10 other advanced nations through surveys of patients and doctors and analysis of other data. Its report ranked the United States on most measures of performance, including quality of care and access to it. The 2009 survey[3] concluded that there were wide differences across countries in access, healthcare technology, priorities and care quality. U.S. stands out for reporting cost-related access problems, lack of after-hours care, and lag in IT adoption.

The 2010 survey[4] reflected cross-cutting themes and implications for U.S. Reform. United States stood out for access problems because of costs, difficulty paying medical bills, insurance complexity, and disparities by income. Symptoms of weaker primary care were seen in U.S., Canada, and Sweden. Germany, Switzerland, U.S., Netherlands and U.K. showed rapid access to specialists. Swiss were notable for rapid access to primary and specialized care. According to the survey, U.S. health reforms will make a difference. This includes many elements seen internationally such as premium assistance for low and modest income people; Medicaid expansion, Benefit standards with limits on out-of-pocket spending and Insurance exchanges and standards to reduce complexity.

The Commonwealth Fund's 2011 International Health Policy Survey is currently in progress.
French medical care is deemed to be one of the best in the world. While it is true that you can get excellent care in France, it comes at a price. Individuals who are not French nationals pay extremely high rates while French nationals are taxed extremely heavily. That being said, France still has one of the longest life expectancies in Europe, with 81 years of age.

The U.S. has been on the forefront of healthcare in terms of the % of GDP spent, innovation and cutting edge advancement in medical technology. We have produced the best of drugs and innovative surgery practices, but when it comes to making them economically viable for end consumers, we have miserably failed. From an economic perspective, such medical treatments are increasingly out of reach to many Americans. Healthcare costs are multiplying with each passing year, rising twice or faster than inflation and health insurance is getting to be out of reach for more Americans. There is a major disconnect between the progress made in health technology and its affordability for Americans. Healthcare as a fundamental right is an ongoing debate in the U.S. while most of the developed countries are already there, although they have their share of issues to contend with. Most of these developed countries have universal publicly funded healthcare. Not to say, that universal healthcare is the silver bullet for healthcare woes, but it is an interesting point to note.

World healthcare ranking may not be a true indicator of our quality of care in comparison to the rest of the world based on the subjective nature of these studies. But, with the U.S. leading the world in total spending; the question arises as to whether the quality of healthcare is comparable to the amount of money spent on that care. Studies have shown that some of the reasons for United States spending a larger percentage of its GDP on healthcare include higher labor, administrative and malpractice insurance costs. These studies; though subjective, do reflect that there are no particular areas in which U.S. healthcare quality is truly exceptional. Instead, the available data depicts that the US health system performance is a mixed bag, with the United States doing relatively well in some areas, such as cancer care and medical technology and less well in others such as mortality, accessibility etc.

Although, the U.S.; like other countries has its own share of strengths and weaknesses in terms of the healthcare it imparts to its citizens; the value obtained for money spent on healthcare is drastically lower than the other countries. Important lessons can be drawn from countries doing better than the U.S. in various realms of healthcare. While US is a trendsetter in healthcare innovation and technology, these lessons will take it on the path of a true healthcare trendsetter in terms of providing efficient, accessible and quality healthcare to its citizens.

The hope is that the healthcare reform (estimated to cost nearly $2 trillion over 10 years) will decrease healthcare costs and effectively provide millions with affordable insurance options. Health reform provides an opportunity for us to build on strengths, correct weaknesses and improve our framework. Perhaps, then, the U.S. healthcare system will improve quality and care statistics to measure up to other countries.

The healthcare overhaul we have all been hearing about over the last couple of years underscores the need to take steps towards quality improvement; further, reform is needed to improve healthcare delivery, propagation of prevention over care, employment of technology and innovation to facilitate cutting edge health management, and help consumers demand focus on a health based economy than a sickness based economy which will pave the way for better health dynamics and make U.S. healthcare truly, “the best healthcare in the world.”

References:

1. The World Factbook - https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

2. World Health Organization Assesses the World’s Health Systems - http://www.photius.com/rankings/who_world_health_ranks.html

4. 2009 Commonwealth Fund International Health Policy Survey - http://www.commonwealthfund.org/Content/Surveys/2009/Nov/2009-Commonwealth-Fund-International-Health-Policy-Survey.aspx

5. 2010 Commonwealth Fund International Health Policy Survey -  http://www.commonwealthfund.org/Content/Surveys/2010/Nov/2010-International-Survey.aspx

About the Author

Rajeev Mudumba works with a leading HRO/Healthcare organization. Rajeev has over 16 years of leadership experience in the HRO, Healthcare and Technology consulting industries. His distinguished record of accomplishment and innovation includes high level strategy and ideation, precise execution and enhanced focus on efficiencies through the use of technology in business across various verticals. He can be contacted at rajeevsagar@gmail.com.