1. Mirror, Mirror on the Wall: How the Performance of the U. S
Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update
Karen Davis and Cathy Schoen
President and Senior Vice President for Research and Evaluation
The Commonwealth Fund
June 22, 2010

2. Mirror, Mirror on the Wall: 2010 Update
Earlier editions of report produced in 2004, 2006, and 2007
Data from Commonwealth Fund International Health Policy Surveys of Patients and Physicians
Seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States
Ranked across five areas:
Quality
Efficiency
Access to care
Equity
Long, healthy, productive lives
The United States continues to spend the most and rank last
The Affordable Care Act will begin to align the U.S. system for higher performance

3. International Comparison of Spending on Health, 1980–20073
International Comparison of Spending on Health, 1980–2007
Average spending on health per capita ($US PPP)
Total expenditures on health as percent of GDP
$7,290
16% 8%
$2,454
Note: $US PPP = purchasing power parity.
Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009). 3

4. Overall Ranking 4 Country Rankings 1.00–2.33 2.34–4.66 4.67–7.00 AUS
AUS
CAN
GER
NETH NZ UK US
OVERALL RANKING (2010) 3 6 4 1 5 2 7
Quality Care
Effective Care
Safe Care
Coordinated Care
Patient-Centered Care
Access
6.5
Cost-Related Problem
3.5
Timeliness of Care
Efficiency
Equity
Long, Healthy, Productive Lives
Health Expenditures/Capita, 2007
$3,357
$3,895
$3,558
$3,837*
$2,454
$2,992
$7,290
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). 4

5. Quality: Wrong Medication or Wrong Dose in Past Two Years, Among Sicker Adults, 20085
Percent reporting wrong medication or wrong dose in past two years
AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.
Data: 2008 Commonwealth Fund International Health Policy Survey.

6. Access: Sicker Adults Reporting Cost-Related Access Problem in Past Two Years, 20086
Percent reporting access problem*
AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.
* Access problems included: not filling a prescription or skipping does; not getting a recommended test, treatment, or follow-up; or not visiting a doctor when having a medical problem.
Data: 2008 Commonwealth Fund International Health Policy Survey.

7. Efficiency: Sicker Adults Sent for Duplicate Tests by Different Health Care Professionals in Past Two Years, 2008 7
Percent reporting duplicate tests
AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.
Data: 2008 Commonwealth Fund International Health Policy Survey.

8. Equity: Sicker Adults Not Filling Prescriptions or Skipping Doses Because of Cost in the Past Year, Differences by Income, 2008 8
Percentage point difference between below- and above-average income
AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.
Data: 2008 Commonwealth Fund International Health Policy Survey.

9. Long, Healthy, and Productive Lives: Mortality Amenable to Health Care, 2002-039
Deaths per 100,000 population*
* Countries’ age-standardized death rates before age 75; includes ischemic heart disease, diabetes, stroke, and bacterial infections. Data: E. Nolte and C. M. McKee, “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs, Jan./Feb (1):58–71.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.

10. How the Affordable Care Act Will Help10
How the Affordable Care Act Will Help
The new law will:
Expand access to affordable health insurance for those without coverage, with 32 million uninsured gaining coverage when the law is fully enacted in 2014
Improve affordability of coverage for those who have it, including millions of Americans who are currently underinsured who will be protected against high medical costs and medical debt
Slow the rise in health care costs for individuals, families, and employers while not adding to the federal debt. According to a report released in May by The Commonwealth Fund and the Center for American Progress, the law has the potential to slow the annual growth rate in health spending from 6.3 percent to 5.7 percent
Begin to orient the U.S. health care delivery system toward more effective, efficient, and patient-centered care
Source: K. Davis, A New Era in American Healthcare, (New York: The Commonwealth Fund, June 2010).