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How does United States health care compare to other countries?

The United States has a unique health care delivery system. Unlike other industrialized countries which all have some form of top-down, government-run system, the structure of medical care in the U.S. has evolved organically over the past 80 years. Half of all Americans receive their health insurance from their employer or their spouse’s employer. Over 40 percent of Americans receive their health insurance from the government through Medicare, Medicaid, and Obamacare.

Advocates of a single-payer system in the U.S. believe this existing hybrid system is detrimental to patient care. They argue that the government has the power to control and improve individual medical outcomes, as well as controlling health care costs.

The two organizations that are most often cited in assessing international health care rankings are the World Health Organization and the Commonwealth Fund.

The World Health Organization’s paper looked at all 191 countries in the world and is arguably the most often quoted by media organizations. Officials there ranked the U.S. 37th, behind Greece, Columbia, and Morocco. They ranked communist Cuba 39th, to put their study method in perspective.

The researchers at the Commonwealth Fund studied 11 industrialized countries. They ranked the United States last, with smaller countries, Australia, Norway, and Switzerland, ranking one through three respectively.

The critical issue in both studies is the emphasis on the supposed “equity” in a country’s health care delivery system. The WHO study put percentages on its criteria. At least 62.5 percent of its ranking is based on a country having a single-payer, or at least a government-run, health care delivery system in which every citizen has health insurance, although not necessarily access to good care. The U.S. does not have a single-payer system and was therefore punished in the rankings before the study was even published.

The Commonwealth Fund paper did not place percentages on its criteria. Yet, it is very clear that emphasis was again put on “equity” in the system and countries were ranked accordingly. Of course, simply having health insurance does not guarantee timely access to necessary care.

The most important aspect of a country’s health care delivery system is its responsiveness and success in treating specific diseases. When a person becomes ill, the critical issue is the medical system’s ability to reduce the morbidity and mortality of that patient.

Cardiovascular disease, such as heart attack and stroke, remains the leading cause of death globally and in the United States. Research from the Kaiser Family Foundation shows that the 30-day mortality rate after admission to the hospital for a heart attack patient is 4.9 percent in the U.S. compared to a 5.8 percent average for five other industrialized countries. The stroke numbers are similar with a 4.1 percent mortality rate in the U.S. compared to an average of 6.4 percent in five similar countries.

The combination of all cancers is the second leading cause of death for virtually all countries. The Concord-3 study is one of the largest international cancer reports. Researchers examined records of 37 million patients and looked at five-year survival rates for 18 different types of cancer in both adults and children. Again, the U.S. ranked either first or in the top five countries in the most common types of cancer – breast, prostate, and lung.

The U.S. does fall behind other industrialized countries in certain health areas, such as premature death, longevity, and maternal mortality. The U.S. also has a high incidence of major physical trauma, such as gun violence and car crashes, as well as a significant rate of suicide. These trauma issues definitely contribute to poor longevity numbers in the U.S. However, they are a consequence of serious social problems and should in no way be a reflection on the health care delivery system.

Data from the Center for Disease Control and Prevention show that 74 percent of Americans are overweight and 43 percent are obese. Weight problems are associated with heart attacks, stroke, type II diabetes, and certain types of cancer. Maintaining an ideal body weight is a life-style choice and, again, should not reflect on the quality of a country’s health care delivery system.

Outcomes in the U.S. for the treatments of the leading causes of death rank the country either at the top or very near the top in benefits to patients when compared to other industrialized countries. A fair measurement of the effectiveness of health care delivery should be based on clinical outcomes, not ideological bias.

– Dr. Roger Stark is a retired physician and was a co-founder of the open-heart surgery program at Overlake Hospital in Bellevue, Washington. He is a Senior Fellow at Washington Policy Center. For an expanded publication with references, please see his study “Assessing the quality of health care in the United States; how the U.S. compares with countries around the world.”


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