The U.S. Healthcare System is not the best in the World!- But It Could Be -1/4 -
Comparing the Access and Quality of the U.S. Healthcare System to Other Developed Countries
The U.S. healthcare system, characterized by high spending and advanced medical technologies, is often praised for its innovation and cutting-edge care. However, when compared to the healthcare systems of other countries, particularly developed countries, significant disparities in access, quality, and efficiency emerge. Understanding these differences requires examining the criteria used to measure healthcare system performance, including access to care, quality of care, system efficiency, and equity.
The U.S. Healthcare System
The U.S. spends more on healthcare than any other nation, accounting for approximately 18% of its GDP (OECD, 2021). The US GDP in 2021 was $23.6 trillion for a population of 332million ($13,900 per capita!). Despite spending a multiple of that spent per capita by other developed countries, the U.S. healthcare system's performance on various metrics is rated lower.
The primary issues are: the fragmented insurance system, which includes private health insurance with Federal and State government programs (Medicare and Medicaid) and employee insurance benefits; the high out-of-pocket costs for the US poor; the distance and time to reach a hospital particularly in rural areas; the lack consistency in providing the standard-of-care; and poorer outcomes in a number of the metrics as compared to other developed countries. This is in spite of the U.S. having, perhaps, the best medical technology, the best specialists, and access to the widest range of drugs.
Access to Care
Approximately 9% (30million) of Americans were uninsured in 2020, though the Affordable Care Act (ACA) reduced the uninsured rate from 16% in 2010 (Kaiser Family Foundation, 2020). (The current US President has proposed to change or eliminate the ACA.) In any case, insurance coverage does not guarantee access, as many individuals are still burdened by high deductibles, out-of-pocket expenses, and co-payments. Furthermore, while urban centers typically have advanced healthcare facilities, some rural areas in the U.S. face physician shortages and long travel times to access care. Meanwhile, the number of hospitals in the US has continued to decline.
Quality of Care
Despite high spending, health outcomes in the U.S. are mixed. Life expectancy at birth is lower than in many other developed countries, and infant mortality rates are relatively high (OECD, 2021). The U.S. has excellent survival rates for certain cancer treatments and high-tech treatments for other diseases and for trauma, but these benefits are often inaccessible to lower-income groups. Moreover, the U.S. healthcare system struggles with inefficiencies, such as very high administrative costs ($3000-$4000/per capita per year) and high prices for prescription drugs, medical devices, and medical treatment (Chernew et al., 2020).
Criteria for Comparison
When comparing healthcare systems, it is not helpful to compare the access and care of the population to those whose combination of wealth and insurance coverage allows them to receive the best care in the best locations from the best doctors. Instead, the following criteria are usually used to determine a country’s relative access, quality and effectiveness when compared to other countries:
Access to Care: This includes both the availability of healthcare services and the ease with which individuals can access them. Key factors include insurance coverage, wait times for services, geographic distribution of healthcare facilities, and financial barriers to receiving care. It also includes or excludes non-citizens and legal or illegal residents depending on the study.
Quality of Care: Quality is typically measured using several indicators, including mortality rates, patient satisfaction, the effectiveness of treatments, and the frequency of medical errors. Outcomes such as life expectancy, infant mortality, and rates of preventable diseases are also commonly used indicators of healthcare quality.
Health System Efficiency: This refers to the relationship between healthcare spending and health outcomes. Countries with efficient healthcare systems provide high-quality care at lower costs, while inefficient systems may generate poor outcomes despite high spending. The US cost is three to four times the cost of any other country so the US scores very low on efficiency.
Equity: Equity in healthcare is concerned with ensuring that all segments of the population, regardless of income, race, or geography, have equal access to the same level of care and health outcomes. Studies vary in including and excluding certain segments of the population.
