Commonwealth Fund レポートによれば、英国、カナダ、ドイツ、オランダ、オーストラリア、ニュージーランドの６カ国に比べて米国は最低ランクであった。
米連邦議会 医療制度改革法案を最終承認／米国医療事情 オバマ政権
U.S. scores dead last again in healthcare study
Maggie Fox, Health and Science Editor
Wed Jun 23, 2010 1:54am EDT
A patient waits in the hallway for a room to open up in the emergency room at a hospital in Houston, Texas, July 27, 2009. REUTERS/Jessica Rinaldi
A patient waits in the hallway for a room to open up in the emergency room at a hospital in Houston, Texas, July 27, 2009.
Credit: Reuters/Jessica Rinaldi
WASHINGTON (Reuters) - Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system, according to a report released on Wednesday.
The United States ranked last when compared to six other countries -- Britain, Canada, Germany, Netherlands, Australia and New Zealand, the Commonwealth Fund report found.
"As an American it just bothers me that with all of our know-how, all of our wealth, that we are not assuring that people who need healthcare can get it," Commonwealth Fund president Karen Davis told reporters in a telephone briefing.
Previous reports by the nonprofit Fund, which conducts research into healthcare performance and which promotes changes in the U.S. system, have been heavily used by policymakers and politicians pressing for healthcare reform.
Davis said she hoped health reform legislation passed in March would lead to improvements.
The current report uses data from nationally representative patient and physician surveys in seven countries in 2007, 2008, and 2009.
In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey.
Australians spent $3,357, Canadians $3,895, Germans $3,588, the Netherlands $3,837 and Britons spent $2,992 per capita on health in 2007. New Zealand spent the least at $2,454.
And yet Americans get less for their money, said the Commonwealth Fund's Cathy Schoen.
"We rank last on safety and do poorly on several dimensions of quality," Schoen told reporters. "We do particularly poorly on going without care because of cost. And we also do surprisingly poorly on access to primary care and after-hours care."
SIXTH IN QUALITY
The report looks at five measures of healthcare -- quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.
"On measures of quality the United States ranked 6th out of seven countries," the group said in a statement.
U.S. patients with chronic conditions were the most likely to say they got the wrong drug or had to wait to learn of abnormal test results.
Overall Britain, whose nationalized healthcare system was widely derided by opponents of U.S. healthcare reform, ranks first, the Commonwealth team found.
"The findings demonstrate the need to quickly implement provisions in the new health reform law and stimulus legislation that focus on strengthening primary care, realigning incentives to reward higher quality and greater value, investing in preventive care, and expanding the use of health information technology," the report reads.
Critics of reports that show Europeans or Australians are healthier than Americans point to the U.S. lifestyle as a bigger factor than healthcare. Americans have higher rates of obesity than other developed countries, for instance.
"On the other hand, the other countries have higher rates of smoking," Davis countered. And Germany, for instance, has a much older population more prone to chronic disease.
Every other system covers all its citizens, the report noted and said the U.S. system, which leaves 46 million Americans or 15 percent of the population without health insurance, is the most unfair.
"The lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen," the report reads.
(Editing by Sandra Maler)
Page last updated at 04:01 GMT, Wednesday, 23 June 2010 05:01 UK
UK health system is top on 'efficiency', says report
A doctor attends to a elderly female patient The UK was rated highly on quality of care and access to care
The UK's health care system is the most efficient, says a study of seven industrialised countries.
The Commonwealth Fund report looked at five areas of performance - quality, efficiency, access to care, equity and healthy lives.
The US came last in the overall rankings, which also included data from Australia, Canada, Germany, the Netherlands and New Zealand.
But there is room for improvement in every country, says the report.
The report, which is an update to three earlier editions, includes patients and doctors' ratings of their experiences in their own health care systems.
More than 27,000 patients and primary care doctors were surveyed across all seven countries as part of the study, starting in 2007.
'Short waiting times'
OVERALL HEALTH SYSTEM RANKING
Continue reading the main story
1. The Netherlands
2. United Kingdom
5. New Zealand
7. United States
The Netherlands ranked first overall, closely followed by the UK and Australia.
The UK performed well when it came to quality of care and access to care.
In relation to access, the study says: "The UK has relatively short waiting times for basic medical care and non-emergency access to services after hours, but has longer waiting times for specialist care and elective, non-emergency surgery."
The Netherlands ranked very highly on all waiting times measurements.
When it came to efficiency, the UK and Australia ranked first and second, respectively.
Efficiency was measured by looking at total national spending on health as a percentage of gross domestic product (GDP), as well as the amount spent on health administration and insurance.
In contrast, the US consistently underperformed in most areas of health care relative to other countries, says the study report.
These include access to care and quality of care whatever the background or income of the patient. This is despite the fact, the study says, that the US health system is the most costly in the world.
But, notably, the US differs from the other countries studied because it does not have a universal health insurance system.
However, the study authors believe that health reform legislation brought in in February 2009 will start to address this problem.
"The new legislation should begin to improve the affordability of health insurance and access to care when fully implemented in 2014," says the study.
Karen Davis, president of The Commonwealth Fund and one of the report's authors, cautions that there are limitations in assessing countries' performances using the perceptions and experiences of patients and doctors.
"They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data," she said.
"Patients and physicians' assessments might be affected by their experiences and expectations, which could differ by country and culture."
Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update
June 23, 2010
Author(s): Karen Davis, Ph.D., Cathy Schoen, M.S., and Kristof Stremikis, M.P.P.
Contact: Karen Davis, President, The Commonwealth Fund, email@example.com
K. Davis, C. Schoen, and K. Stremikis, How the Performance of the U.S. Health Care System Compares Internationally 2010 Update, The Commonwealth Fund, June 2010.
international health system comparisons Open this interactive Web feature to compare health system performance across countries.
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report―an update to three earlier editions―includes data from seven countries and incorporates patients' and physicians' survey results on care experiences and ratings on dimensions of care. Compared with six other nations―Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom―the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage―leading to improved disease management, care coordination, and better outcomes over time.
The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from the most recent three Commonwealth Fund surveys of patients and primary care physicians about medical practices and views of their countries' health systems (2007--2009), confirms findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the most recent (2008) U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.
Among the seven nations studied―Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States―the U.S. ranks last overall, as it did in the 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. The Netherlands ranks first, followed closely by the U.K. and Australia. The 2010 edition includes data from the seven countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.
The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Health reform legislation recently signed into law by President Barack Obama should begin to improve the affordability of insurance and access to care when fully implemented in 2014. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical homes." Without reform, it is not surprising that the U.S. currently underperforms relative to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.
Health Systems Overall Rankings But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. With the inclusion of primary care physician survey data in the analysis, it is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology. Health reform legislation addresses these deficiencies; for instance, the American Recovery and Reinvestment Act signed by President Obama in February 2009 included approximately $19 billion to expand the use of health information technology. The Patient Protection and Affordable Care Act of 2010 also will work toward realigning providers' financial incentives, encouraging more efficient organization and delivery of health care, and investing in preventive and population health.
For all countries, responses indicate room for improvement. Yet, the other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation's substantial investment in health.
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