Deep Flaws Found in US Health Care

Reed Abelson, International Herald Tribune

 
NEW YORK: American medical care might be
the most expensive in the world, but it is getting increasingly difficult to
argue that it is worth every penny. A study that was to be released on Thursday
highlights the stark contrast between what the United States spends on its health
system and the quality of care it delivers, compared with health care in many
other industrialized nations.
The report, the second national scorecard prepared by an influential health
policy research group, provides evidence of just how frequently the country
falls short of its own standards of care and those of its global peers. While
the United States spends more than twice as much per capita on health care as
most other industrialized countries, including France, it has fallen to last
place among those countries in being able to prevent deaths with timely and
effective medical care, according the report by the Commonwealth Fund, a
not-for-profit research group in New York.
Access to care in the United
States has worsened as more people - about
75 million - are believed to lack adequate health insurance or be uninsured
altogether. And within the nation, the cost and quality of care varies
dramatically, the report found.
At a time when health care has dominated much of the U.S. presidential campaign, the findings provide
increasing support for the idea that the health care system in the United States
needs to be fixed.
Both presumptive presidential nominees, Senator John McCain and Senator
Barack Obama, argue that the country needs to get more value for its health
care money. And while there are sharp disagreements about what changes would be
most effective, the discussion is shifting away from a defense of the status
quo to a discussion about what steps need to be taken.
"People are now aware that you can do better," said Karen Davis,
the president of the Commonwealth Fund. "It's harder to keep deluding
yourself or be complacent that we don't have areas that
need improvement."
The report assesses the United
States on 37 core measures, updating an
analysis first done in 2006. It finds little improvement over the last two
years, with access to care becoming an increasing problem as the cost of health
care continues to rise steadily and more people - even those with insurance -
struggle to pay their medical bills. "The central finding is that access
has deteriorated," said Davis.
Even some experts quick to point to some of the country's medical successes,
as in reducing the deaths from heart disease or childhood cancers, for example,
are quick to acknowledge the need for change.
"We need to generate better value in this country," said Dr. Denis
Cortese, the chief executive of the Mayo Clinic, who is among many health
system executives leading discussions about how to improve the health
care system.
In some cases, the nation's progress was overshadowed by improvements in other
industrialized countries, which typically have more centralized health systems
in which changes are easier to put in place.
Although the United
States has reduced its number of preventable
deaths for people under 75 years old to 110 deaths per every 100,000, compared
with 115 five years earlier, other countries made greater strides. As a result,
the United States now ranks
last in preventable mortality among developed nations, just below Ireland and Portugal, according to the
Commonwealth Fund's analysis of World Health Organization data. The leader by
that measure is France,
followed by Japan and Australia.
Other countries worked hard to improve their standings, according to the
Commonwealth Fund researchers. The United Kingdom, for example,
focused on steps like improving the performance of individual hospitals that
had been the least successful in treating heart disease.
"It's really making a government priority to get top-quality
care," Davis said.
The presidential candidates both emphasize the need to shift the country's
health priorities, to provide more medical care that helps prevent people from
developing disease and to control conditions before they become expensive and
hard to treat.
The mounting evidence that the United States
needs to do better indicates the issues are not just talking points by
politicians, said Len Nichols, a health economist at New America Foundation, a
not-for-profit group in Washington
that advocates universal health care coverage. More hospital executives and
physicians understand their performance could be better, Nichols said.
The report also emphasizes how inefficient the American health care system
can be. The administrative costs of the health insurance system consume much
more of the current health care dollars than in other countries. Bringing those
administrative costs down to levels in Germany and Switzerland, where private
insurers play a significant role, would save an estimated $50 billion a year in
the United States, Davis said. "It kind of dwarfs everything else you
can do."

Many of the high costs are the result of the lack of
computerized systems that might link pharmacies and doctors' offices for
filling prescriptions or that might enable insurers to more efficiently pay
doctors' bills.

Karen Ignagni, the chief executive of American's
Health Insurance Plans, the industry's trade group, argues that many of the
higher administrative costs stem from the additional services provided by United States
insurers, like disease management programs, and the burdensome regulatory and
compliance costs of doing business in 50 states. A more uniform system could
result in savings, she said.

Few would disagree that the report indicates how
interrelated the issues of access, cost and quality are. High costs limit
access to medical care, which results in worse health problems, driving
up costs.

Other countries are able to tackle these issues more
effectively, said Cathy Schoen, senior vice president for research and
evaluation for the Commonwealth Fund.

"They are able to do more with a lower level of
expenditure," Schoen said, "and they keep
getting improvements."