Health survey ranks U.S. last among rich peers

For the fifth time in a decade, the United States is the sick man of the rich world. But recent health reforms and increased health technology spending may provide a cure in the coming years.

That's according to the latest Commonwealth Fund survey of 11 nations, which ranked the world's most expensive health care system dead last on measures of "efficiency, equity, and outcomes." So too in 2010, 2007, 2006 and 2004.

The United Kingdom got the golden apple for 2014, with Switzerland a close second.

The U.S. ranking reflects poor scores on measures of healthy lives—"mortality amenable to medical care," infant mortality and healthy life expectancy at age 60.

The highest U.S. score was a 3, for "effective care." The USA also outranked its peers on preventive care and on speedy access to specialists.

But the nation fares poorly on "access to needed services" and on getting prompt attention from primary care physicians.

The other eight countries surveyed were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway and Sweden.

What do the healthier cousins have that the United States does not? Universal health care, the Commonwealth Fund points out. Nonetheless, Canada limped just ahead of its southern neighbor in the survey.

"Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes," the fund writes in its summary.

Though the Affordable Care Act "is increasing the number of Americans with coverage and improving access to care," the latest survey relied on data from before the law was implemented fully. Still, the ACA "will further encourage the efficient organization and delivery of health care, as well as investment in important preventive and population health measures."

Some highlights:

U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles. Other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems. ...

Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. ... Meanwhile, the U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology. ...

Many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, but the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, and with the enactment of health reform, the United States should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years. ...

The survey included questionnaires from patients and doctors, along with data from the World Health Organization and the Organization for Economic Cooperation and Development. It also contains results from recent Commonwealth Fund surveys of patients and primary care doctors and how they view their countries' health systems.