More than half of Americans believe that patients in the US receive better quality of care than elsewhere in the world, but only 45% say that the US has the best healthcare system in the world.
In a previous post, I took a quick look at the US healthcare system and compared it to other developed countries on cost, quality and access. A recent report examines the latest scientific evidence available in comparing the US to other countries on quality of care.
Quality of care, for starters, is defined as “doing the right thing at the right time in the right way for the right person and having the best results possible.” The most important indicators of quality include life expectancy, amenable mortality, screening rates, vaccination rates, disease-specific morbidity and mortality rates, cancer survival rates, and medical error rates.
It is well known that US does not perform well on life expectancy at birth. However, when life expectancy at age 65 is considered, the US is above the average of most developed countries (the reason being that all Americans over 65 have good coverage under Medicare). On “amenable mortality,” a measure of deaths that could have been prevented with good healthcare, the US ranks dead last among 19 developed nations.
On preventative care, the evidence is a bit mixed. One study reported that the US has higher percentages of women reporting having had a pap smear and a mammography in the last two years than five other countries. Also, the US has the highest rate of cervical cancer screening rate among 22 developed countries, and above-average flu vaccination rates for senior citizens among 30 developed countries. However, childhood vaccination rates in the US are lower than the average for all developed countries.
On chronic conditions, adult hospital admission rates for asthma (an indicator of low quality care) was the second highest in the US among 17 other countries, while US-asthma mortality rates was double the average observed 25 countries. On the other hand, US diabetic patients rank high compared to other countries on receiving recommended services for their conditions.
One of the brightest spots on the American quality report card comes from cancer care. Compared to 17 European countries, the US is #1 on survival rates for cancer of the colon, rectum, breast and prostate, and among the highest on survival rates for melanoma, ovarian cancer, cervical cancer and Hodgkin’s-disease and non-Hodgkin’s disease lymphoma.
International comparisons on patient safety are problematic due to differences in reporting of errors between the countries, but some evidence suggests that the US may have more medical mishaps.
In summary, debates on whether quality of care in the US system is the best in the world should be based on more scientific and disease-specific data. On some areas, such as cancer care, we do really well. On other areas such as mortality from conditions that could be prevented and treated, we do less well.