1. Mirror Mirror Teleconference
Findings from 2017 Report
Eric C. Schneider, Senior Vice President for Policy and Research
The Commonwealth Fund
July 13, 2017

2. Health Care Spending as a Percentage of GDP, 1980–2014
EXHIBIT 1
Health Care Spending as a Percentage of GDP, 1980–2014
GDP refers to gross domestic product.
Source: OECD Health Data Data are for current spending only, and exclude spending on capital formation of health care providers.

3. Mirror Mirror 2017
PURPOSE
To learn how health systems achieve high performance by comparing performance of 11 high-income countries
DATA SOURCES
Annual International Health Policy surveys of 11 high-income countries ( )
Measures from OECD, WHO, European Observatory
Health Care System Performance Measured Using 72 Indicators Across 5 Domains
Access
Administrative efficiency
Equity
Care process
Health care outcomes
Mirror Mirror Teleconference, Eric C. Schneider, July 13, 2017

4. Mirror Mirror 2017: Highlights
The overall performance of the U.S. health care system ranks last among 11 high-income countries
This result is due to poorer performance in several areas
Access: Americans are much more likely to report financial barriers to care than those in the other countries
Administrative Efficiency: Doctors and patients in the U.S. are more likely to report problems related to insurance approvals and billing.
Equity: Disparities in performance between lower-income versus higher-income people are larger in the U.S. than the other countries
Health outcomes: The U.S. has the higher rates of mortality than other high-income countries
The U.S. performs somewhat better on Care Process
Mirror Mirror Teleconference, Eric C. Schneider, July 13, 2017

5. Health Care System Performance Scores (Overall)
EXHIBIT 3
Health Care System Performance Scores (Overall)
Higher performing
Eleven-country average
Lower performing
Note: See the methodology appendix for a description of how the performance score is calculated.

6. Health Care System Performance Rankings
EXHIBIT 2
Health Care System Performance Rankings
AUS
CAN
FRA
GER
NETH NZ
NOR
SWE
SWIZ UK US
OVERALL RANKING 2 9 10 8 3 4 6 1 11
Care Process 7 5
Access
Administrative Efficiency
Equity
Health Care Outcomes
Source: Commonwealth Fund analysis

7. International Health System Performance: Equity
Performance Index
Higher health system performance UK
NETH
Eleven-country average
SWE
SWIZ
NOR
GER
AUS NZ
CAN FR US
Lower health system performance
Note: “Performance Index” is based on the distance from the 11-country average, measured in standard deviations
Source: Commonwealth Fund analysis

8. Mortality Amenable to Health Care, 2004 and 2014
EXHIBIT 4
Mortality Amenable to Health Care, 2004 and 2014
Deaths per 100,000 population
2004
2014
Source: European Observatory on Health Systems and Policies (2017). Trends in amenable mortality for selected countries, Data for 2014 in all countries except Canada (2011), France (2013), Netherlands (2013), New Zealand (2012), Switzerland (2013), UK (2013). Amenable mortality causes based on Nolte & McKee (2004). Mortality and population data derived from WHO mortality files, September 2016; population data for Canada and the USA derived from the Human Mortality Database. Age-specific rates standardised to the European Standard Population 2013.

9. Could the U.S. Move from Last to First among High-income Countries?
Four key shortcomings of U.S. health care
Inadequate insurance coverage
Limited primary care
Administrative burdens
Income-related disparities in care
Solutions
Expand insurance coverage and maintain benefits
Strengthen primary care
Reduce administrative burdens for patients and doctors
Reduce income-related barriers and invest in social services
Mirror Mirror Teleconference, Eric C. Schneider, July 13, 2017

10. Key Takeaways
U.S. ranks last among 11 high-income countries despite spending nearly twice as much on health care
U.S. health care has the largest disparities in performance between those with lower and higher incomes
Ongoing challenges for U.S. relate to performance on access to care, administrative inefficiency, equity, and health care outcomes
To move from last to first, the U.S. should expand insurance coverage, strengthen primary care, reduce administrative burdens, and reduce disparities in care
Mirror Mirror Teleconference, Eric C. Schneider, July 13, 2017