A new study producing sensationalist headlines about how the United States has the worst healthcare system in the developed world deploys a dubious methodology to reach that conclusion.
The Hill’s article, titled “Stunning New Report Ranks Us Dead Last in Health Care Among Richest Countries—Despite Spending the Most,” reports that; “The U.S. health care system ranked last among 11 wealthy countries despite spending the highest percentage of its gross domestic product on health care, according to an analysis by the Commonwealth Fund.”
The Commonwealth report looked at 71 measures of healthcare performance that were put in five categories: access to care, the care process, administrative efficiency, equity, and health care outcomes. The countries analyzed included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the U.S.
But their methodology is hardly air tight and seldom measures healthcare results. Some of their criticisms are also based on flawed statistics that don’t account for cross-country differences in how certain things are defined or recorded.
Access to Care: Measures healthcare “affordability and timeliness.”
It is true that U.S. spends the most on healthcare per-person by a wide margin, but there’s no problem when it comes to “timeliness.” Of wait times, in terms of the percent of people waiting one month or more for a specialist appointment, the U.S. has lower wait times than any country besides the Netherlands, Germany, and Switzerland, which have similar wait times nonetheless. The other countries have their shares of population waiting that long nearly double the U.S.
The Care Process:Â Includes “measures of preventive care, safe care, coordinated care, and engagement and patient preferences.”
This ranking has the most to do with the quality of care, and the U.S. ranked favorable here. The U.S. performed best (alongside New Zealand) on the safe care subdomain, while the U.S. and Germany had the best performance on the engagement and patient preferences subdomain.
Administrative Efficiency: Refers to how well systems reduce paperwork.
The U.S. ranks poorly here, though there’s no case for government to be made from this unless one is under the delusion that the government is less bureaucratic than the private sector.
Equity: Refers to income-related disparities in care.
This metric is irrelevant, as a nation that provides average care would rank worse than one that provides average – and also excellent care.
Health Care Outcomes: Is based on life expectancy, infant mortality, preventable mortality, maternal mortality, and avoidable mortality.
While life expectancy does give a good general picture of a nation’s healthcare quality, when lifespan differences between countries are only a year or two, other variables could be playing a role in their relative rankings (such as the U.S. having more car accidents per-capita than Europe, a higher murder rate due mostly to inner-city gang violence, and higher rates of obesity). As Dr. Scott Atlas noted in 2011, the U.S. ranked 19th globally in life expectancy, but #1 when all variables except fatal injuries are adjusted for. Even adjusting only for differences in car fatalities and homicide, the U.S. ranked #1 in life expectancy.
Infant mortality rate statistics are also “apples to oranges” because Europe employs a much stricter definition of infant mortality than the U.S. does. Most of the world (with the exception of the U.S.) defines babies as “stillborn” if they survive less than 24-hours. The “stillborn” account for 40% of infant deaths, so the U.S. would appear to have 40% more infant mortalities than the rest of the world even if every country had the same amount per-capita.
Of maternal mortality they cite a rate of 17.4 deaths per 100,000 live births in America, twice that of France, the country with the next highest rate (at 7.6 deaths per 100,000 births). Just as is the case with infant mortality, maternal mortality is measured differently in the U.S. than other countries. The U.S. defines a maternal death as one that occurs at any time from the beginning of pregnancy through one year after the end of pregnancy. However the World Health Organization’s definition, which is used by most of the rest of the world, only counts maternal mortalities from the start of a pregnancy to 42 days after the end of a pregnancy, or about one-eighth as long.
Conclusion
The Commonwealth study has severe flaws in comparing the U.S. healthcare system to others when it comes to measuring results. When results are measured they’re either in the U.S.’s favor – or twisting against the U.S. by using “apples to oranges” comparisons.
They do have legitimate criticisms when it comes to the relative high cost of healthcare in the U.S. (which Donald Trump has tried to improve by introducing price transparency and favored nation pricing for pharmaceuticals, which a judge blocked). Administrative costs are also excessively high in the U.S. relative to other countries, but there’s no evidence that a single payer system would fix this, given that the closest thing we already have to that (Medicaid) is more bureaucratic than private insurance.
Matt Palumbo is the author of Dumb and Dumber: How Cuomo and de Blasio Ruined New York, Debunk This: Shattering Liberal Lies, and Spygate
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