International Health Policy Program - Thailand International Health Policy Program -Thailand Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally Phusit Prakongsai International Health Policy Program (IHPP) Ministry of Public Health, Thailand 29 July 2010
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International Health Policy Program -Thailand Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally Phusit.
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Mirror, Mirror on the Wall:How the Performance of the US Health Care System Compares Internationally
Phusit PrakongsaiInternational Health Policy Program (IHPP)
Ministry of Public Health, Thailand
29 July 2010
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ndBackground
• The US health system is the most expensive in the world.
• Comparative analyses consistently show the US underperforms relative to other countries on most dimensions of performance.
• The Commonwealth Fund Commission on a High Performance Health System employed the National Scorecard to measure and monitoring health care outcomes, quality, access, efficiency, and quality in the US in 2006 and 2008.
• This 2010 report includes information on: – health care outcomes in the 2008 US health system
scorecard,– Most recent three Commonwealth Fund surveys of patients
and primary care physicians in 2007-2009.
Healthcare spending as % of GDPOECD countries, 2008
Growth in personal health care expenditures in the US
from 1990 to 2007
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Core dimensions of Commonwealth National Scorecard
Measuring and monitoring health system performance
Efficiency
Equity Access
Quality care
Long, healthy,
and productive lives
Commonwealth
National
Scorecard
• Effective care
• Safe care
• Coordinated care
• Patient-centered care
• Cost-related access problems
• Timeliness care
1. Quality care1.1 Effective care
Source AUS CAN
GER NETH NZ UK US
PreventionPhysicians reporting it is easy to print out a list of patients who are due or overdue for tests or preventive care
2009 63(3)
18(7)
37(5)
65(2)
57(4)
90(1)
24(6)
Patients sent computerized reminder notices for preventive or follow-up care
2009 82(2)
10(7)
17(6)
48(4)
92(1)
76(3)
18(5)
Receive reminders for preventive/ follow-up care
2007 44(6)
40(7)
57(4)
58(2.5)
48(5)
58(2.5)
70(1)
Doctor asked if emotional issues were affecting health
2007 37(2)
36(3)
25(6.5)
27(5)
31(4)
25(6.5)
46(1)
Received advice from doctors on weight, nutrition, and exercise
2007 41(3)
46(2)
37(4)
24(7)
36(5)
29(6)
56(1)
Overall benchmark ranking
2 7 6 3 5 1 4
1. Quality care1.1 Effective care
Source AUS CAN
GER NETH NZ UK US
Chronic careDiabetics receiving all four recommended services*
2008 36(7)
39(6)
40(5)
59(2)
55(3)
67(1)
43(4)
Practice routinely uses written guidelines to treat diabetes
2009 87(4)
82(5.5)
77(7)
98(1)
93(3)
96(2)
82(5.5)
Patients with HT who have had cholesterol checked in past year
2008 82(4)
83(3)
88(1)
78(6)
75(7)
81(5)
85(2)
Practice routinely uses written guidelines to treat HT
2009 83(3)
81(4)
75(6.5)
90(2)
75(6.5)
96(1)
78(5)
Practice routinely uses written guidelines to treat depression
2009 71(2)
45(5)
26(7)
31(6)
65(3)
80(1)
49(4)
Has chronic condition and did not follow recommended care because of cost
2007 11(6)
7(3)
0(1)
1(2)
9(4)
10(5)
24(7)
Primary care practices that routinely provide chronic dis patients written instructions
2007 24(3)
16(6)
23(4)
22(5)
15(7)
33(1)
30(2)
* Four recommended services include HbA1C checked in the past six months, feet examined, eye exam, and cholesterol checked in the past year.
1. Quality care1.2 Safe care
Source AUS CAN
GER NETH NZ UK US
Believed a medical mistake was made in your treatment or care in past 2 years
2008 17(7)
16(5.5
)
12(3)
9(2)
15(4)
8(1)
16(5.5)
Given the wrong medication or wrong dose by a doctor, nurse, hospital, or pharmacist in past 2 years
2008 13(5.5)
10(4)
7(2)
6(1)
13(5.5
)
9(3)
14(7)
Given incorrect results for a diagnostic or lab test in past 2 years
2008 7(6.5)
5(4.5
)
5(4.5
)
1(1)
3(2.5
)
3(2.5)
7(6.5)
Experienced delays in being notified about abnormal test results in past 2 years
2008 13(6)
12(5)
5(1.5
)
5(1.5)
10(4)
8(3)
16(7)
Hospitalized patients reporting infection in hospital
2008 7(4.5)
6(2.5
)
6(2.5
)
5(1)
11(7)
10(6)
7(4.5)
Doctors routinely receives a computerized alert or prompt about potential problem with drug dose or interaction
2009 92(3)
20(7)
24(6)
95(1)
90(4)
93(2)
37(5)
2. Access to care
Source AUS CAN
GER NETH NZ UK US
Cost-related access problems
Did not fill the prescription: skipped recommended medical test, RX or follow-up in the past 2 years due to cost
2008 36(6)
25(3)
26(4)
7(1)
31(5)
13(2)
54(7)
Patient had serious problems paying or was unable to pay medical bills
2007 8(5.5)
4(2.5
)
4(2.5
)
5(4)
8(5.5
)
1(1)
19(7)
Physicians think their patients often have difficulty paying for medications or OOP costs
2009 23(2)
27(4)
28(5)
33(6)
25(3)
14(1)
58(7)
OOP expenses for medical bills more than 1000 USD in the past year
2008 25(6)
20(5)
13(3)
8(2)
14(4)
4(1)
41(7)
Overall benchmark ranking
6 3.5 3.5 2 5 1 7
3. Efficiency measuresSource AUS CA
NGER NETH NZ UK US
Total exp on health as percent of GDP
2007 8.9(2)
10.1(5)
10.4(6)
9.8(4)
9.0(3)
8.4(1)
16.0(7)
% of national health expenditure spent on health administration and insurance
2007 2.6(1)
3.6(3)
5.3(5)
5.2(4)
7.4(7)
3.4(2)
7.1(6)
Medical records/test results did not reach MD office in time for appointment
2008 16(4)
19(6)
12(2)
11(1)
17(5)
15(3)
24(7)
Sent for duplicate tests by different health care professionals in past 2 years
2008 12(5)
11(4)
18(6)
4(1)
10(3)
7(2)
20(7)
Visited ED for a condition that could have been treated by a regular doctor
2008 17(5)
23(7)
6(1.5
)
6(1.5)
8(3.5
)
8(3.5)
19(6)
Hospitalized patients went to ER or re-hospitalized for complications from discharge
2008 11(3.5)
17(5.5
)
9(1)
17(5.5)
11(3.5
)
10(2)
18(7)
Overall benchmark ranking
2 6 5 3 4 1 7
4. Health equity
Source AUS CAN
GER NETH NZ UK US
Rated doctor fair/poor 2007 5(5)
5(5)
3(2.5
)
5(5)
0(1)
3(2.5)
9(7)
Had medical problem but did not visit doctor because of costs in the past year
2008 0(3)
8(5)
-2(1.5
)
1(4)
20(6)
-2(1.5)
24(7)
Did not get recommended test or treatment or follow-up because of cost in the past year
2008 15(6)
6(3.5
)
3(1.5
)
3(1.5)
10(5)
6(3.5)
19(7)
Did not fill prescription or skipped doses because of cost in the past year
2008 6(2)
9(5)
7(3.5
)
0(1)
16(6)
7(3.5)
18(7)
Need dental care but did not see dentist because of cost in past year
2008 13(5)
20(6)
6(3)
2(2)
7(4)
-5(1)
28(7)
Last time needed medical attention had to wait 6 or more days for appointment
2009 3(4)
11(6)
6(5)
-1(1.5)
1(3)
-1(1.5)
13(7)
Overall ranking 4 5 3 1 6 2 7
5. Long, healthy, and productive lives measures
Source AUS CAN
GER NETH NZ UK US
Mortality amenable to health care (deaths per 100,000)
2003 71(1)
77(2)
90(4)
82(3)
96(5)
103(6)
110(7)
Infant mortality 2006 4.7(3)
5.0(4.5
)
3.8(1)
4.4(2)
5.2(6)
5.0(4.5)
6.7(7)
Healthy life expectancy at age 60 (average of women and men)
2006 24.6(1)
23.8(2)
23.0(4)
22.8(5)
23.7(3)
22.5(7)
22.6(6)
Overall ranking 1 2 3 4 5 6 7
Overall ranking of health systems among seven countries
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Summary key findings• Quality
– The US was best on provision and receipt of preventive and patient-centered care,
– However, its low scores on chronic care management, and safe and coordinated care which pull its overall quality score down,
• Access– Without universal coverage, costs related access problems
in the US were higher than other countries,• Efficiency
– The US ranks last among the seven countries, while the UK and Australia ranking first and second, respectively.
• Equity– The US ranks a clear last on nearly all measures of equity.
• Long, healthy and productive lives– The US ranks last overall with poor scores on all three
indicators of long, healthy, and productive lives.
Efficiency analysisPer capita THE at inter dollar with Life
expectancy
USA
Monitoring & Evaluation of health systems reform /strengtheningA general framework for HSPA
Data sources
Indicatordomains
Analysis & synthesis
Communication & use
Administrative sourcesFinancial tracking system; NHADatabases and records: HR, infrastructure, medicines etc.Policy data
Facility assessments Population-based surveysCoverage, health status, equity, risk protection, responsiveness
Clinical reporting systemsService readiness, quality, coverage, health status
Vital registration
Data quality assessment; Estimates and projections; In-depth studies; Use of research results; Assessment of progress and performance of health systems
Targeted and comprehensive reporting; Regular country review processes; Global reporting
Improved health outcomes
& equity
Social and financial risk protection
Responsiveness
Fina
ncin
gInfrastructure
/ ICT
Health workforce
Supply chain
Information
Interventionaccess & services
readiness
Interventionquality, safety and efficiency
Coverage of interventions
Prevalence risk behaviours &
factors
Gov
erna
nce
Inputs & processes Outputs Outcomes Impact
Health Systems
Assessment Approach of
HS 20/20
Sub-national HSPAImmunization coverage <1 year by district in SA