1. “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

2. HC Spending Rising Faster than GDP

3. HC Spending Rising Faster than Wages

4. 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%

5. U.S. Health Care Spending Outpaces All Other Countries

6. 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)3641527 Quality Care4752136 Effective Care2763514 Safe Care6531427 Coordinated Care4572136 Patient-Centered Care2536174 Access6.553142 Cost-Related Problem63.5 2517 Timeliness of Care6721345 Efficiency2653417 Equity4531627 Long, Healthy, Productive Lives1234567 Health Expenditures/Capita, 2007$3,357$3,895$3,588$3,837*$2,454$2,992$7,290 Country Rankings 1.00–2.33 2.34–4.66 4.67–7.00 U.S. Health Care System Ranks Poorly

7. U.S. Has Poor Access to Health Care

8. Many U.S. Citizens Have Trouble Paying for HC

9. U.S. Has High Number of Uninsured Data: Medical Expenditure Panel Survey, Household Component (Rhoades, J.A. 2006. Agency for Healthcare Research and Quality).

10. U.S. Has High Percentage of Population Uninsured Data: Medical Expenditure Panel Survey, Household Component (Rhoades, J.A. 2006. Agency for Healthcare Research and Quality).

11. Uninsured Ranks are Growing

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

13. Key: Lower rates are better (gold = best and blue = worst performance) AUSCANGERNETHNZUKUS Records/clinical information not available at time of appointment 28421116283640 Tests/procedures repeated because findings unavailable 102057142716 Problems because care was not well coordinated across sites/providers 39462247496537 Data: 2006 Commonwealth Fund International Health Policy Survey (Schoen, C. et al. 2006. Health Affairs Web Exclusive W555-509–71). 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

14. 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.

15. High Percentage of Patients With Medical Mistakes Data: 2005 Commonwealth Fund International Health Policy Survey (Schoen, C. et al. 2005. 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, 2006. www.cmwf.org/snapshots