2 weeks Ago
The 2024 Paris Olympic summer games have come and gone. Some 10,714 athletes from 206 counties participated in 32 sports in 329 events. Competition, at any level, provides an excellent opportunity to see how well one does.
Since competing in the first modern Olympic games in 1896, the U.S. has done well.
Led by swimmers, the U.S. team topped the medal charts for the fourth consecutive summer Olympics with a total of 126 medals, breaking their own record for the most hardware.
While the U.S. excels in the summer Olympic games, the opposite is true in the “Health Olympics”; that is, how the U.
S. compares to other industrial countries in health system performance. Since 2004, the Commonwealth Fund, a policy-focused independent, nonpartisan organization, compared the health system performance in 10 industrial countries — Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, United Kingdom, and the U.
S. — to provide insights for improvement. The Commonwealth Fund analysis included 70 health performance measures in five areas.
These were 1) access to care focusing on the affordability and availability of health services, 2) care process looks at what most experts around the world consider to be essential to high-quality care. Elements of this domain are prevention, safety, coordination, patient engagement, and sensitivity to patient preferences, 3) administrative efficiency focuses on challenges doctors have in dealing with insurance or medical claims issues; requirements for providers to report clinical or quality data to governmental agencies; and patients’ time spent resolving medical bill disputes and completing paperwork, 4) equity reflects how people with below-average and above-average incomes differ in their access to health care and their care experience and 5) health outcomes refer to those outcomes most likely to be responsive to health care interventions including life expectancy at birth, excess deaths due to the COVID-19 pandemic, and deaths with preventable and treatable causes. How did the U.
S. do? Consistent with past studies, overall, the U.S.
ranked last. Not only was the U.S.
an outlier on performance but spent nearly twice as much as any other country. Although next to best in care process, we were last in access to care, and next to last in administrative efficiency, equity and health outcomes. The U.
S. has the shortest life expectancy and the highest rates of avoidable deaths. If the U.
S. was in the “Health Olympics”, not only would it not be on the medal platform but would be eliminated in the preliminary heats. Several key takeaways: No country ranked first across the board.
While every nation has a different system with areas of higher or lower performance, each has found a way to outperform the U.S. while including universal coverage and spending less.
A common misnomer is that universal access and cost-control implies government ownership and operation. Not so. Most other nations provide universal access, greater administrative efficiency, cost control and higher consumer satisfaction than the U.
S. within the parameters of a public and private delivery system. For example, as in the U.
S., most French and German citizens receive health care coverage through their workplace. Most physician services are provided by private practice practitioners paid by a fee-for-service, not salaried, financed through private insurers not the government.
Even in publicly financed systems, most physicians are not government employees. For example, in the public single-payer financed system of Canada, more than 90 percent of practicing physicians are self-employed and paid by fee-for-service. Similarly, in the British National System, general practitioners are not government employees but contract to provide services.
How do different countries with different systems outperform the U.S.? The answer is simple but achieving it is not.
Many industrial countries have long ago reached a consensus that health care is a social good and a right that should be collectively financed and available to all citizens regardless of their ability to pay. In contrast, the U.S.
views health care primarily as a private commodity good based on ability to pay. No doubt, the U.S.
has among the best care in the world, if you can afford it. However, without a significant paradigm shift, lack of affordability will remain a pervasive problem. With a fragmented complex insurance system frustrating to both providers and consumers, millions remain uninsured and an even greater number of underinsured are subject to high deductibles and cost sharing unable to access the system, skipping medical tests, treatments, medication doses or not filling prescriptions.
Tinkering at the margins will not suffice. Based on past performance, there is every reason to believe that the U.S.
will continue to do well in future athletic Olympics. Unfortunately, without significant change to how our society views health care, the U.S.
, just as certainly, will remain off the podium of the Health Olympics..
