01 / 07 / 2014
Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally,
The Commonwealth Fund, 18 June 2014
Karen Davis and colleagues from the US-based Commonwealth Fund have examined eleven healthcare systems in this new version of a report previously published in 2010. They have ranked the UK first overall and first across a whole host of categories encompassing quality care (effective, safe, coordinated and patient-centred), access (cost-related problems) and efficiency. However the UK fared less well in the ‘Healthy Lives’ category, where it was placed 10th, only ahead of the US, which was also ranked 11th overall. Davis et al highlight that the UK’s overall top ranking was also achieved on the second lowest spending per capita across the 11 countries under review, at $3,405, only more than New Zealand ($3,182).
Many of the results were determined from findings in Commonwealth Fund surveys undertaken with both patients and clinicians, supplemented by outcomes data from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD). Key findings include the following:
- The UK achieved the best percentages in 2011 and 2012 surveys covering aspects of chronic care provision. For example there were only 16 per cent of cases where doctors or pharmacists had not undertaken a review of medication with patients in the past year, compared to 62 per cent in Norway, 58 per cent in France and 55 per cent in Sweden.
- There was a more mixed picture noted on prevention, with the UK first for areas such as patient records for those due or overdue tests, but also fifth in relation to patients receiving reminders.
- The UK was placed first in relation to incorrect doses or results, medical mistakes and the provision of guideline-based interventions. However it was joint 9th for the reporting of infections “in hospital or shortly after” (2011).
- This category was again wholly decided by survey findings. The UK fared best across a number of issues, including medical history information, follow-up visits after a period in hospital and a patient contact through which to ask questions about care or treatment.
- In contrast, the integration between primary and secondary care was a concern in this area, with the UK in 7th place for issues such as the provision of appropriate information post-referral and post-discharge.
- The UK was ranked first or second in nine of eleven areas covered in this section, first for doctors explaining things clearly, patient involvement in specialist decisions and encouragement to ask questions by the regular doctor.
- This covered two main areas, namely cost-related access and timeliness of care. The UK was the highest-ranked for the former, primarily because of care being provided free at the point of use.
- In relation to timeliness, the UK was placed third, with the category again determined by surveys alone. For example, while 31 per cent of UK patients reported it was ‘very’ or ‘somewhat difficult’ to access out-of-hours care, that was the lowest percentage across the eleven countries, with proportions as high as 65 in Sweden and 64 in France. By contrast, 21 per cent of UK doctors reported that patients often experience long waits after diagnosis, which placed the NHS joint fifth in that area.
- The Commonwealth Fund define an efficient system as one that “seeks to maximise the quality of care and outcomes given the resources committed, while ensuring that additional investments yield net value over time.”
- The UK was placed first overall and first within a range of areas at a lower level, including the proportion of patients visiting emergency departments for conditions treatable in primary care (16 per cent in 2011) and primary care practices utilising clinical IT (68 per cent in 2012).
- It is worth noting that the figures used for health administration and insurance expenditure were taken from 1999 for the UK.
- The UK was placed second, only behind Sweden, in this category, which compares survey findings between those on below and above average incomes.
- Among the areas that the UK fared best on were those related to treatment restrictions due to cost, overall rating of care quality and waiting times for specialist appointments. However the widest discrepancy for UK patients was waiting times in emergency care, where 24 per cent of those on below-average incomes waited more than two hours, compared to 11 per cent of those on above-average incomes.
- Davis et al bemoan that “scarce cross-nationally comparable data on health outcomes limit this dimension to only three indicators.” The indicators are mortality amenable to healthcare, infant mortality and healthy life expectancy at age 60, with the UK ranked ninth, eighth and ninth respectively.
- France is ranked top overall in this category, with the UK only placed above the US overall.
- It should be noted that amenable mortality figures are from 2006-07, with the other two areas reliant on figures from 2011.