“If We Are So Good... Why Aren’t We Better?” A Critical and Quick View of the U.S. Health Care System Forces of Change - Fall 2010 Eric D. Kupferberg, PhD 23 September 2010

HC Spending Rising Faster than GDP

HC Spending Rising Faster than Wages

U.S. Health Care Spending Outpaces All Other Countries Note: $US PPP = purchasing power parity. Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009). Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP $7,290 $2,454 16% 8%

U.S. Health Care Spending Outpaces All Other Countries

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009). AUSCANGERNETHNZUKUS OVERALL RANKING (2010) Quality Care Effective Care Safe Care Coordinated Care Patient-Centered Care Access Cost-Related Problem Timeliness of Care Efficiency Equity Long, Healthy, Productive Lives Health Expenditures/Capita, 2007$3,357$3,895$3,588$3,837*$2,454$2,992$7,290 Country Rankings 1.00– – –7.00 U.S. Health Care System Ranks Poorly

U.S. Has Poor Access to Health Care

Many U.S. Citizens Have Trouble Paying for HC

U.S. Has High Number of Uninsured Data: Medical Expenditure Panel Survey, Household Component (Rhoades, J.A Agency for Healthcare Research and Quality).

U.S. Has High Percentage of Population Uninsured Data: Medical Expenditure Panel Survey, Household Component (Rhoades, J.A Agency for Healthcare Research and Quality).

Uninsured Ranks are Growing

No Insurance = Gaps in Care Data: Commonwealth Fund Biennial Health Insurance Survey (Collins, S. R., K. Davis, M. M. Doty et al. 2006).

Key: Lower rates are better (gold = best and blue = worst performance) AUSCANGERNETHNZUKUS Records/clinical information not available at time of appointment Tests/procedures repeated because findings unavailable Problems because care was not well coordinated across sites/providers Data: 2006 Commonwealth Fund International Health Policy Survey (Schoen, C. et al Health Affairs Web Exclusive W –71). AUS = Australia; CAN = Canada; GER = Germany; NETH = Netherlands; NZ = New Zealand; UK = United Kingdom; US = United States. Responses included "often" or "sometimes." US Poor in Coordinating Care

U.S. Has Poor Quality of Care: Adverse Events per 1,000 Data: Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (Agency for Healthcare Research and Quality 2006). Rates were risk-adjusted. *Primarily related to intravenous lines and catheters.

High Percentage of Patients With Medical Mistakes Data: 2005 Commonwealth Fund International Health Policy Survey (Schoen, C. et al Health Affairs Web Exclusive W5-509–25). AUS = Australia; CAN = Canada; GER = Germany; NZ = New Zealand; UK = United Kingdom; US = United States. Sicker adults have a high incidence of chronic disease and recent intensive use of health care. Source: McCarthy and Leatherman, Performance Snapshots,