Study finds the U.S. health system fails the comparison test, especially for lower-income Americans

The U.S. health care system isn’t working well for all Americans, but it’s especially problematic for those with middle and lower incomes. More so than in other wealthy countries, Americans’ income level determines the health care they receive.

That’s according to Dr. Eric C. Schneider, the lead author of a new report from The Commonwealth Fund, which ranked the United States’ health care system at the bottom in a comparison of 11 wealthy countries.

These disparities in care between the rich and the rest of the country could be even further exacerbated if Congress moves forward with a repeal of the Affordable Care Act, Schneider said. While it’s still early to see the full impact of the ACA in the recent study, he says health reform has sent the United States in the right direction.

“While we’re on the right path, we still have a long way to go,” he said. “The report illustrates just how profoundly behind we are.”

What the report found

The report pulled data from the 2014-2016 Commonwealth Fund International Health Policy Surveys. It used five measures — care delivery, access, administrative efficiency, equity and health care outcomes — and analyzed 72 indicators within those categories.

Despite spending the most on health care — the U.S. spent $9,364 per person in 2016, according to the report — the United States landed at the bottom of the countries ranked, which included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. The top overall performer, the United Kingdom, spent $4,094 per person.  

Schneider said he and his co-authors were particularly surprised by the fact a high-income American was more likely to report problems affording care than a low-income person in the United Kingdom.

In the U.K, for example, 7 percent of people with lower incomes and 4 percent of those with higher incomes said that costs kept them from accessing health care. In the United States, 44 percent of lower-income people and 26 percent of higher-income people said the same.

Schneider also pointed out that a “staggering” 54 percent of U.S. doctors reported having trouble getting patients treatment because of insurance coverage restrictions. That’s compared to just 6 percent in Norway and Sweden.

“We tend to think the problems are focused on the poor and the lower income but they’re pretty pervasive for everyone,” he said.

While mortality rates in other nations are falling, it was particularly alarming to see a reversal of this trend in the United States for some segments of the population, a pattern researchers said was “aggravated by the opioid crisis.”

One relative bright area for the United States — it fell in the middle in this category — was for what the researchers call “care process,” with the country excelling “on measures that involve the doctor-patient relationship, wellness counseling, and preventative care such as mammograms and adult flu shot rates.”

When it comes to health outcomes, the United States ranked last overall. However, despite the overall low score, Americans did fare well on some clinical measures, such as lower in-hospital mortality rates for a heart attack or stroke.

“Once a person gets into a hospital and receives a diagnosis, our systems are good at rescuing them,” Schneider said. “The question is to be better at preventing disease in the first place and managing it before it becomes a problem.”

Big opportunities for the U.S. to improve

Along with spending more on primary care, the United States could improve the health system by investing more in social services that could improve a population’s overall health, such as housing, transportation, education and nutrition, he said.

The U.S. could also improve efficiency, reducing the hefty paperwork burden providers face and make the system easier for patients to navigate with better care coordination and delivery.

There’s not one path to success — the countries surveyed finance their care in different ways — but they tend to share one thing in common: universal health coverage.

“There is no single magic bullet out there, but the principles are universal coverage, strong primary care, reducing administrative burdens and hassles and taking steps to address inequalities,” Schneider said.

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