A report just released compares the performance of the American health care system with those of Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom. This report, which was issued by the Commonwealth Fund, a Washington, D.C.-based private foundation focused on improving healthcare, says the U.S. ranks seventh out of seven in overall healthcare system quality and efficacy, despite spending the most per capita.
Despite having the costliest health care system in the world, the United States is last or next-to-last in quality, efficiency, access to care, equity and the ability of its citizens to lead long, healthy, productive lives. According to the report, the U.S. spends the most on health care, at $7,290 per capita per year (in 2007—it’s gone up since then). That’s almost twice the amount spent in Canada and nearly three times the rate of New Zealand, which spends the least. The Netherlands, which has the highest-ranked health care system on the Commonwealth Fund list, spends only $3,837 per capita. The Netherlands? Isn’t that the place with the wooden shoes? The average person can’t even locate that on a map. And yet they are cleaning our clock. It’s like the World Cup, where the U.S. is consistently beat by countries we wouldn’t even save a seat for at a U.N meeting. Hell, Avis can claim it is number two for trying harder. The U.S. isn’t even showing up in uniform.
It isn’t that surprising that we rank low on access to healthcare since we do not have mandated universal coverage as many of these countries do. However, here’s a stark statistic for you in the land of the brave and the home of the most sophisticated technology on earth: In 2008, 14% of U.S. patients with chronic conditions had been given the wrong medication or the wrong dose. That’s twice the error rate observed in Germany and the Netherlands, according to the Commonwealth Fund’s study authors. The rates at which adults reported delays in notification about abnormal test results or were given the wrong results were three times higher than in Germany and the Netherlands. Go team! We win the gold for being the worst country for patient safety.
What is especially sad about this is that we have the means to address this problem right now today. It may be difficult to expand access to all, impossible to perfect efficiency, etc., but there is literally no reason we should have the worst patient safety record in the world. Numerous technologies exist today to eliminate patient errors in the hospital and at home. There are surgical sponges with RFID tags so we don’t leave them inside patients; there are checklists and processes (not even high tech ones) that dramatically reduce hospital acquired infections; in our own Psilos portfolio we have a company called Patient Safe Solutions that reduces medication errors in hospitals from 19% (19%!) to near zero, saving the healthcare system millions of dollars in the process. Would you go back to Starbucks if they screwed up your Frappuccino order 19% of the time? I don’t think so.
The problem with safety in the healthcare world is twofold: 1) many of the errors are cloaked in silence; we have to engender a culture of healthcare provider transparency and consumer engagement in order to change the status quo; and, 2) we have a healthcare system that has traditionally rewarded the commission of errors by paying again to fix the mistake. Again, would you pay for that defective Frappuccino? No, I thought not. And Starbucks would willingly replace it for free. And apologize. Maybe offer you a free muffin. Yet hospitals have routinely been reimbursed for the extra days of stay they cause by committing a medical error. We removed the wrong leg? Oops, sorry, enjoy your extended stay…ka-ching!
Fortunately, the federal government has started promulgating regulations that will prevent mistakes in hospitals from getting reimbursed. Kind of sad that’s what’s necessary, but at least it’s a step in the right direction. We have no such incentives yet in the outpatient side of treatment
What we really need is to summon some of that old-fashioned American chest-thumping competitiveness we apply to sports to drive us from number seven to number one. The same fanaticism that leads us to glory in the Olympics and to dominate the world in basketball, baseball and bowling could really help us out if applied to the medical side of things. Maybe we need a mascot or a theme song or a special healthcare jersey to foster that team spirit, but we should not condone a world where we are miserable when we lose in Olympic figure-skating but indifferent when we don’t make the cut in healthcare. If this were tennis, John McEnroe would be throwing his racquet across the court.
Patient safety and healthcare quality improvement (not just expanded health insurance access) must become serious public policy goals if our world is going to change for the better. We need active consumer education and expanded media coverage around this issue to drum up some serious national pride or we are going to continue to sit this one out on the bench. Number seven doesn’t make the play-offs, but this is a game we should win.