United States Still Ranks Last in Study Comparing Health Care Systems

Despite spending more than $6,000 per person per year on health care, the United States continues to rank last among six nations in a study comparing access, quality, efficiency, equity and healthy lives.

The study, "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care" (PDF file: 40 pages / 504 KB. More about PDFs.) by the Commonwealth Fund, is an update of studies in 2004 and 2005. It concludes "the U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance."

According to the study's authors, "Among the six nations studied -- Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States -- the U.S. ranks last, as it did in the 2006 and 2004 editions of 'Mirror, Mirror.' Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity."

Most noteworthy about the U.S. system is the absence of universal access to health care, something all the other countries studied have, according to the report. As a result, fewer Americans have access to a regular, primary care physician or a medical home.

"Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term 'medical home,'" the authors write. "It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes."

AAFP public and private advocacy efforts are focusing on payment systems that allow family physicians to provide a patient-centered medical home that manages and coordinates care.

Most recently, AAFP President Rick Kellerman, M.D., of Wichita, Kan., called on Congress to adopt a payment system that encourages patients to use a medical home and compensates physicians who provide a medical home.

"It is time to stabilize and modernize Medicare by recognizing the importance of, and appropriately valuing, primary care and by embracing the patient-centered medical home model as an integral part of the Medicare program," Kellerman said in testimony before the House Ways and Means Subcommittee on Health.

In addition, AAFP is working with corporations, such as IBM, to push the health care system toward reform that uses the medical home as its foundation.

"Our country needs a patient-centered primary care system -- where the personal care physician serves as an advocate who attends the total health care needs of patients before health issues become more serious and expensive," wrote Martín-Jose Sepúlveda, M.D., M.P.H., vice president for global well-being services and health benefits for IBM Corp., in an April 4 AAFP News Now guest opinion (Members Only). "Patients should have a 'medical home' where they can be treated by a personal physician who understands their overall physical and emotional needs," he said.