U.S. Health Care: America’s Sick Health System

Here at Diabetes Flashpoints, we often discuss both problems and successes taking place in health care in the United States — from helpful changes to Medicare to fitness programs integrated with health insurance. Only rarely, though, do we compare the U.S. health-care system with systems in other countries (as we did in a pair of posts a few years ago). But now — just as an incoming president is poised to shake up the country’s health-care system — a new study shows just how badly the U.S. performs in some measures compared with other developed countries.

Released earlier this month by the Commonwealth Fund (a nonpartisan organization that studies health-care policy), the research is based on a survey of 26,863 people taken this year in 11 different countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Notably, this list of countries covers many different types of health-care systems — from more or less fully government-run health care in the United Kingdom, to government insurance with private care providers in Australia, Canada, and Norway, to a mix of public and private insurance in Germany, the Netherlands, and the United States, to just private insurance in Switzerland.

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But as an NBC News article on the study notes, the United States comes in last compared with the 10 other countries in many important measures — including emotional distress related to the health-care system, having trouble paying for care, and skipping doctor visits. What’s more, Americans pay much more for health care than residents of the other countries.

One disturbing finding is that 43% of Americans skipped medical care because of costs, more than in any other country. The lowest rate of skipping was in the United Kingdom at 8%, and the second-highest was in Switzerland at 31%. Notably, the United Kingdom has a fully public health-care system — not only does the government directly insure everyone, but most doctors are government employees — while Switzerland has a system of private insurers and providers.

There were a few small brights spots seen in the United States, such as that the percentage of Americans who skipped recommended care fell from 37% in 2013 to 33% in 2016. This slight improvement may be due to the Affordable Care Act (“Obamacare”), which went into full effect in 2014. Still, this number is far higher in the United States than in other countries. For example, only 7% of UK residents skipped recommended care, as did 8% of Dutch and Swedish residents.

Areas in which the United States did well included quick access to specialists, having conversations with doctors about healthy living, and planning for hospital discharges. But it was harder to see a primary-care provider in the United States than in most other countries, especially in the evening and on weekends. While 50% of Americans had trouble with this, only 25% of people in the Netherlands did.

For reasons that may not be entirely related to the health-care system, the number of people with multiple chronic conditions (including diabetes, cardiovascular disease, joint pain or arthritis, or asthma or lung disease) was higher in the United States than in any other country. This was true among both low-income adults and people with higher incomes, which suggests that it can’t be blamed entirely on the higher poverty rate seen in the United States.

It’s worth noting that the United States has scored poorly on similar surveys for at least 15 years, a period covering many changes in the health-care system — including government-led changes by both Republican and Democratic congresses and presidents. Yet despite occasional improvements in some measures, the United States has seen no broad improvements compared with other developed countries.

What do you think could help heal America’s ailing health-care system — would it help to have one system covering all Americans, rather than the hodgepodge of different private and public systems that currently exists? To help lower costs, should we turn to integrated provider-insurance networks, so that providers have no incentive to charge high prices for procedures or order unnecessary tests? Should the government negotiate directly with pharmaceutical companies to lower the cost of drugs under Medicare? Are you hopeful that starting in January, the new congress will help solve problems in the health-care system, or are you worried that they might make things worse? Leave a comment below!