Achieving%20a%20High%20Performing%20Health%20Care%20System:%20The%20U.S.%20Health%20Care%20System%20Compared%20to%20Other%20Countries

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Achieving a High Performing Health Care
SystemThe U.S. Health Care System Compared to
Other Countries

• Jack A. Ginsburg
• Director, Health Policy Analysis Research
• American College of Physicians
• Presentation to the National Congress on the Un
  and Underinsured
• December 11, 2007

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Criteria for a High Performance Health Care
System

• Mission to Achieve Long, Healthy and Productive
  Lives
• Assurance of High Quality Care
• Access to All
• Efficient Utilization With Minimal
  Administrative and Regulatory Costs
• Equity of Access and Quality Among Groups
• Capacity to Innovate and Improve

Source The Commonwealth Fund Commission on
a High Performance Health System. Why Not the
Best? Commonwealth Fund, 2006.
www.commonwealthfund.org
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Criteria Mission to Achieve Long, Healthy and
Productive Lives

• The US scores poorly on most measures of health
  outcomes
• Life Expectancy
• Infant Mortality
• Preventable Mortality
• of Adults with Limitations on Living

Source Commonwealth Fund, National Scorecard on
U.S. Health System Performance Chartpack, 2006.
www.commonwealthfund.org
4
Source Organization for Economic Co-operation
and Development. OEDC Data, 2007
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Life Expectancy at Birth in 2005
Source Organization for Economic Co-operation
and Development. OEDC Data, 2007
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Criteria Assurance of High Quality Care

• High Quality Care is Necessary, Appropriate and
  Clinically Effective with Minimal Avoidable
  Errors
• Measures Include
• Provision of Preventive Care
• Management of Chronic Diseases
• Care Coordination
• Provision of Patient-Centered Care
• Low Medical Errors
• Low Preventable Death Rates

Source The Commonwealth Fund Commission on a
High Performance Health System. Why Not the
Best? Commonwealth Fund, 2006.
www.commonwealthfund.org
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Commonwealth Fund Rankings of Quality of Care
in 6 Countries
Source Davis K, Schoen C, Schoenbaum SC, Doty
MM, Holmgren AL, et al. Mirror, mirror on the
wall an international update on the comparative
performance of American health care. The
Commonwealth Fund. May 2007. www.commonwealthfund.
org
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Measures of Patient-Centered Care
Source Schoen C, Osborn R, Huynh PT, Doty M,
Zapert K, Peugh J, et al. Taking the pulse of
health care systems experiences of patients with
health problems in six countries. Health Aff
(Millwood). 2005Suppl Web ExclusivesW5-509-25.
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Criteria Access to All and Equity of Access and
Quality Among Groups

• With 47 Million Uninsured the US Ranks Last on
  Access
• Other Measures Include Ability to See a Doctor
• Ease of Obtaining After Hours Care
• Out-of-Pocket Costs Not More than 10 of Income
  (5 for Low Income)
• Well Functioning Systems Have Minimal Differences
  Among Groups re. Access and Quality

Source The Commonwealth Fund Commission on
a High Performance Health System. Why Not the
Best? Commonwealth Fund, 2006.
www.commonwealthfund.org
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Rankings on Access and Equity
RANK
ACCESS EQUITY
Source Davis K, Schoen C, Schoenbaum SC, Doty
MM, Holmgren AL, et al. Mirror, mirror on the
wall an international update on the comparative
performance of American health care. The
Commonwealth Fund. May 2007. www.commonwealthfund.
org
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Criteria Efficient Utilization With Minimal
Administrative and Regulatory Costs

• Health Care Spending in the US is the Highest in
  the World in Total , as a of GDP and Per
  Capita
• Administrative and Insurance Costs Are the
  Highest
• The US Lags Well Behind in Use of EMR and
  Adoption of HIT

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Efficiency Health Spending Per Capita 2005 (US )
Source WHO, World Health Statistics, 2007
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Source Commonwealth Fund National Scorecard on
U.S. Health System Performance, 2006.
www.commonwealthfund.org
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Criteria Capacity to Innovate Improve

• High Performance Health Care Systems Have
  Infrastructures that Foster Innovation
• Investments in Research (basic, technological,
  clinical, pharmaceutical, and health services)
• Workforce Planning Capacity to Assure Sufficient
  Supply of Appropriate Health Care Professionals

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Public Investments in Health Information
Technology Per Capita 2005 (US )
Source J. Cylus and G. F. Anderson,
Multinational Comparisons of Health Systems Data,
2006, The Commonwealth Fund, May 2007.
www.commonwealthfund.org
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Conclusions

• Health Care in the US Compares Poorly With Other
  Countries on Many Measures
• No Single Country is Best on All Measures
• There are a Variety of Health Care Systems in
  Other Countries That Have Achieved Universal
  Health Insurance Coverage
• Policymakers Can Learn from Other Countries to
  Improve Health Care in the USA and to Assure
  Universal Access