International Healthcare Quality

I got an email forward the other day about everything wrong with the Obama administration. Of course these emails never stop, no matter who is president. The content just changes based on which issues the current president is campaigning. Obviously, health care is a huge topic nowadays, with the introduction of the PPACA (even though we're still yet to see any real changes from the impact of the law). That aside, the Right is absolutely furious with the Left for their desire to implement a national health system. or the US version of national health care, since really a national health system varies greatly from country to country. This is of course something all those opposed to the new PPACA refuse to acknowledge. They instead prefer to deal in absolutes- "National Health Care is Bad,"  instead of maybe "This specific National Health program in this country is Bad."  

Oh well.  You can really only do so much when educating people about the various international health systems and their successes or failures. The bottom line is, many, many things affect each country's healthcare delivery system, such as politics, culture, the system itself, the list is never ending; but this is an extremely hard thing to explain to someone who is really only interested in backing his or her political leanings and has little interest in the actual quality of healthcare a certain system may offer.

Anyways- here's the part of the email that pertains to healthcare:

There are actually two messages here.  The 1st points out the incredible benefits of “Universal Healthcare” and is very interesting; the 2nd is absolutely astounding - and explains a lot.


1.A recent "Investor's Business Daily" article provided very interesting statistics from a survey by the United Nations International Health Organization.

Percentage of men and women who survived a cancer five years after diagnosis:
U.S.      65%
England       46%
Canada   42%

Percentage of patients diagnosed with diabetes who received treatment within six months:
U.S.      93%
England       15%
Canada   43%

Percentage of seniors needing hip replacement who received it within six months:
U.S. 90%
England   15%
Canada   43%

Percentage referred to a medical specialist
who see one within one month:
U.S.      77%
England   40%
Canada    43%

Number of MRI scanners (a prime diagnostic tool) per million people:
U.S.      71
England       14
Canada   18

Percentage of seniors (65+), with low income, who say they are in "excellent health":
U..S.  12%
England       02%
Canada    06%

What a bleak outlook. You'd think people in England and Canada are just sitting in the streets waiting to die after reading an email like that!

Now, I have to say, I have no idea whether those statistics are accurate. I tried to google that report and couldn't locate one that produced those same numbers, but for all I know it could be accurate. Let's assume it is (I doubt it, but let's just assume..) - there's still one big problem with this email.  If the point of that part of the email was (and it was)  to suggest that National Health Care results in poorer quality than the United States' current health system, they've made a crucial mistake:  more countries besides England and Canada have national health care, and not only that, but they have much higher quality healthcare systems than the US does. 

This  is one of my favorite reports on the comparison of health care systems internationally. It's not the newest report (at about ten years old),  but it is my favorite for the amount of countries in the comparison as well as the graphs it uses. Speaking of which...

So here we see the MRI scanners available per million of the population.  This rather puts that MRI statistic included in the email into perspective, does it not?  Yes- the US is leading England and Canada. However, it is so to speak having it's butt kicked by Japan- a country with a national healthcare system.

This is just one example.  The report does not include statistics on hip replacements or treatment availability of diabetes, but it does include numerous other statistics in which the US is trailing a pack of other countries that have national healthcare systems. 

As stated above, it is very difficult to not only measure and compare these systems that are so different for so many reasons, but to then rank them and explain which is best and why. One of the most common things you hear those in favor of resisting national healthcare in the US say, is that "our system is the best,"  but what does this mean? What does "best"  really represent here? Best at what?  Best at spending money? Absolutely.

As you can see, the US spends more than double the ten country average- and this was ten years ago.  The costs have soared in the past ten years, I shudder to think what this graph would look like today. Based on this graph, you would think we must have the best healthcare, after we spent all that money on it!  Not quite.

And there you have it- the United States, trailing the pack.

Now, these are only statistics from one report, a reputable one no less, but that's not to say that the United States couldn't have improved it's healthcare delivery in the past decade. We do know however, that the US still spends more on healthcare than any other country, and we are still not leading the pack. 

It's important to understand the definition of quality, and how we determine whether a healthcare system is high quality or not.  To do this, let's remember the six aims of quality as defined by Berwick:

Now; other international systems aside- how does our own system achieve these aims? 

Safe-  given the colossally high rate of nosocomial infections occurring at hospital's everyday, I'm not quite confident that we can say we have a very safe healthcare delivery system here in the US.

Efficient- I don't need to say anything here. Our system is anything but efficient at this point, unfortunately.

Timely- the people sitting in ER waiting rooms for hours on end may not feel our delivery system is very timely. Then again, if the email except above has any merit, wait times in England and Canada aren't so hot either.

Patient Centered-  I feel if you ask many patients about their experiences with a doctor or medical professional, I doubt many of them would say they felt valued or in control. Typically most patients leave a doctor's office feeling confused and annoyed after having waited an hour in the waiting room and then another hour in the office to see the physician, only to be rushed back out onto the street after five minutes with a prescription they can't read.

Equitable- With 50.7 million Americans uninsured, I'm not sure that you could consider our health system equitable.



So where does this leave us (besides maybe depressed)?    To be honest, it's hard to say.  Are the other countries out there with better healthcare than us? Absolutely. Will their system work here?  Maybe, maybe not.  Looking at statistics, Japan has some of the highest ranking healthcare available today- but look at their country, look at their people.  Statistics used to rank healthcare often include mortality and morbidity- Japan's culture is that of a healthy population:  they have long lifespans, healthy eating habits, etc.  This certainly could have an effect on the success of their healthcare delivery system.  Their people are also notoriously hardworking; could this be part of why their largely employer-based insurance system is so successful?  Possibly.  

 The truth is, there are numerous factors that play a role in measuring the healthcare quality of a nation, but there are some undeniably truths that we cannot avoid.  The bottom line is, healthcare in the United States has huge room for improvement, and continuing on with the current system is simply not a viable economic option.  Whether or not they like the idea of National Healthcare, Americans will be forced in the near future to accept that maybe their system isn't the "best" as they like to believe. Hopefully going forward we will see less emails like the one above, and more viable solutions offered to try and solve our healthcare problems.

(I won't be holding my breath though)