The
Broken U.S. Healthcare Delivery System
Most of us live relatively
“normal” lives. We get up in the morning
and do what we normally do and have little time to think about the healthcare
delivery system. We see our doctor for
our annual physical and occasionally must seek out care for health concerns
that emerge.
We may have a general notion
that healthcare costs are high, but few of us really think about how high it is
and how the quality of our care compares to other industrialized nations. Brace yourselves. What I am about to share with you is
shocking beyond belief. I have spent my
entire adult life dedicated to the healthcare industry and am embarrassed at
these findings.
In 1970 the U.S. devoted 6
percent of its Gross Domestic Product (GDP) on healthcare and comparable
industrialized nations devoted 5 percent of their GDP on healthcare. I do not know that this is even
statistically significant. In the
current year (2021) the U.S. is devoting 18 percent of its GDP on healthcare
while comparable nations at are at ten percent.
This is a huge difference.
The first thing that
occurred to me was, well we may pay more for healthcare, but it is obviously
far superior to other comparable nations.
Not so. With clear exceptions, the outcomes of U.S.
healthcare is a national disgrace. Read
and weep.
In a study commissioned by
the Commonwealth Fund, 100 leading industrialized countries healthcare system
were evaluated and ranked. France was
ranked number one. United States was
ranked 37th just ahead of Slovenia.
Having access to healthcare is seen as a fundamental human right by many
people. Lack of quality healthcare can result in a poor quality of life and
lower life expectancy than countries with a stable and accessible healthcare
system. Countries with efficient and effective health care systems have overall
better health outcomes.
How is the quality of
healthcare determined? Several factors determine the level of healthcare
quality in each country. These include the care process (preventative care
measures, safe care, coordinated care, and engagement and patient preferences),
access (affordability and timeliness), administrative efficiency, equity, and
healthcare outcomes (population health, mortality amenable to healthcare, and
disease-specific health outcomes). A study by The Commonwealth Fund used these
metrics to rank 11 countries based on their quality of healthcare. The
top-ranked countries are the United Kingdom, Australia, and the Netherlands.
Healthcare outcomes are
changes in health that result from specific measures or investments. Healthcare
outcomes include amenable mortality, readmission, and patient experience. The
Healthcare Access & Quality (HAQ) Index ranks healthcare outcome scores on
a scale of 0 to
100, with 100 being the
best. Countries with the best healthcare systems in the world have scores
between 90-96.1. The Netherlands holds the highest score of 96.1.
What countries have the best
healthcare in the world?
Switzerland's health care is
universal, and health insurance is required for all persons living in
Switzerland. Unlike other European countries, Swiss healthcare is not tax-based
or financed by employers. Individuals pay for it through their contribution to
Swiss healthcare schemes. There are no free state-provided health services.
Still, basic health insurance coverage covers 80-90% healthcare costs,
including outpatient treatment, emergency treatment, prescriptions, maternal
medicine, vaccinations, post-operation rehabilitation, and more. Switzerland
combines private, subsidized private and public healthcare systems to provide
its citizens with an extensive network of qualified doctors, best-equipped
medical facilities and hospitals, and no waiting lists.
Finland's healthcare system
is believed to be one of the best in the world. Healthcare in Finland is a
highly decentralized, three-level, publicly funded system. Municipalities are
responsible for offering their residents healthcare services. Funding comes
from two sources: municipal financing based on taxes used to provide primary
healthcare services and National Health Insurance (NHI), which is financed with
compulsory fees. NHI funds private healthcare, occupational healthcare, and
outpatient care. In a European Commission survey, 88% of Finnish respondents
stated that they were satisfied with their healthcare.
Disease burden is higher in
the U.S. than in comparable countries:
Age-standardized
disability-adjusted life year (DALY) rate per 100,000 population, 2017:
·
United States 24,307
·
Comparable Country 18,533
After
a steady decline in premature death rates, the U.S. has experienced a recent
uptick:
Overall
age-specific potential years of life lost per 100,000 population, 1990-2017:
·
United States 14,000
·
Comparable Country 8,900
is
possible to drag this out by looking at surgical errors, nosocomial infections,
life expectancy, maternal health, and others.
It simply gets more depressing.
There are clear exceptions
in U.S. quality. I will name just
one. Kaiser-Permanente regularly ranks
as one of if not the best providers of the full range of medical and hospital services.
There are also organizations
that are prepared to help physicians and hospital to provide “perfect care” not
just good care. I will single out the
best, Value Capture, LLC based in Pittsburgh, Pennsylvania.
So, there is hope for a
brighter future, but the current circumstance is hard to look at without acquiring
indigestion.
Jan Ricks Jennings, MHA,
LFACHE
Senior Executive
Senior Management
Resources, LLC
JanJenningsBlog.Blogspot.com
412.913.0636 Cell
724.733.0509 Office
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