By continuing to browse our website, you accept our use of the cookie for statistical and personalization purposes. Learn more Mirror, Mirror 2024 is your chance to explore the impact of political decisions on health and well-being in 10 countries, including reports from the United States Fund of September 19, 2024 that compare performance in 10 countries. While each country's health system is unique, evolution over decades, sometimes centuries, together with changes in political culture, history and resources, comparisons can provide valuable information to inform political thinking. Perhaps, above all, they can demonstrate the profound impact of national political decisions on a country's health and well-being.
In addition, we also offer Home Care in Altadena CA to ensure the well-being of our community members. Despite their general classification, all countries have strengths and weaknesses: they rank highly in some dimensions and lower in others. No country is in the top or bottom in all areas of performance. Even Australia, the highest-ranked country, performs worse, for example, when it comes to access to care measures and the care process. And even the U.S.
UU. However, taken together, the nine nations we examined are more similar than they are different in terms of their highest and lowest performance in various domains. However, there is one obvious exception: the United States (see “How we conducted this study”). Record of health outcomes, particularly in relation to quantity in the U.S.
USA, USA UU. The ability to keep people healthy is a fundamental indicator of a nation's ability to achieve equitable growth. To meet this fundamental obligation, the U.S. In the United States, we also rely on published and unpublished data from transnational organizations, such as the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD) and Our World in Data, as well as on national data records and research literature.
The United States is in last place in the overall ranking (annexes 1 and 2). The three best performing countries in 2024 are Australia, the Netherlands and the United Kingdom. The two countries with the highest overall rankings, Australia and the Netherlands, also have the lowest healthcare spending as a percentage of GDP (chart). The other countries are closely grouped together, with the exception of the United States.
Access to care focuses on the affordability and availability of health services at the population level. The Netherlands, the United Kingdom and Germany perform the best in terms of overall access, and both the Netherlands and Germany rank first or close to them in terms of the two components of affordability and availability (graphic). The United Kingdom, the Netherlands, the United Kingdom, the United Kingdom In these countries, universal coverage ensures that co-payments for health services, if any, are small, ensuring both access and affordability. In the Netherlands, visits to primary care providers, maternity care and children's health care are fully covered; other health care services are covered once patients pay their annual deductible3. In the United Kingdom, K.
In the Netherlands, general practitioners (GPs) must provide 50 hours of after-work care per year, for which they receive separate compensation (as is also the case with home visits). Most GPs are also part of networks that provide care during the evenings or on weekends. In Germany, doctors are required to provide care outside working hours, and regulations vary from region to region 7.Australia, which is the best performing country in this report, performed quite poorly when it comes to access to attention. Approximately half of Australian patients who do not choose to purchase voluntary health insurance may have to wait longer to receive services.
8 Affordability is also a notable problem, although new billing incentives have led to improvements in recent years. 9 In the U.S. With a fragmented insurance system, nearly the majority of Americans receive their health coverage through their employer, 10 While Medicaid expansions and subsidized private coverage under the ACA have helped fill the gap, 26 million Americans remain uninsured, leaving them fully exposed to the system's cost controllers. The cost has also driven the growth of deductibles for private plans, leaving about a quarter of the working-age population underinsured.
In other words, extensive cost-sharing requirements mean that many patients are unable to visit the doctor when medical problems arise, causing them to skip medical tests, treatments or follow-up visits, and avoid filling prescriptions or skipping doses of your medications. Regarding the availability of care, American patients are more likely than their peers in most other countries to report that they do not have a doctor or regular place of care and that they have limited options for receiving treatment outside regular office hours. The scarcity of primary care services adds to these availability problems. The care process analyzes whether the care being provided includes characteristics and attributes that most experts around the world consider essential for high-quality care. The elements of this domain are prevention, safety, coordination, patient participation, and sensitivity to patient preferences.
It is among the best in terms of the care process, ranking second (graphic). New Zealand is in first place, followed closely by Canada and the Netherlands. Performance in the area of care processes is the result of the successful provision of preventive services, such as mammograms and influenza vaccination, and the emphasis placed on patient safety. With regard to preventive care, the history of the U.S.
Department of State could reflect the strong performance-based payment policies implemented by Medicare and other payers to reward the provision of these services.11 Administrative efficiency focuses on measures of the challenges faced by doctors in dealing with insurance issues or medical claims; the requirements for providers to report clinical or quality data to government agencies; and the time that patients spend resolving disputes over medical bills and completing paperwork. Australia and the United Kingdom are practically tied for the best results in these measures (Graphic. Excellence in administrative efficiency by minimizing payment and billing burdens. In Australia, electronic claims processing ensures instant payments from public and private payers.
In the United Kingdom, on the other hand, they are directly compensated by the National Health Service based on monthly data collected from patients' electronic medical records. We underperformed on most of our management efficiency measures. They are forced to deal with medical billing issues and, in both countries, patients are comparatively more likely to seek treatment in emergency services for conditions that can be treated in outpatient settings, such as a primary care physician's office. 15 In the complex U.S.
system of public and private payers, which includes thousands of health plans, each with their own cost-sharing requirements and coverage limitations, doctors and other healthcare providers they spend an enormous amount of time and effort billing insurers. Denial of services by insurance companies is also common, requiring onerous appeals from providers and patients. 16 The fragmentation of the provision of health services in Switzerland's many cantons and municipalities may also be hampering efficiency for both providers and patients. 17 Our equity domain reflects how people with below and above average incomes differ in their access to healthcare and their care experience.
Australia and Germany rank first in terms of equity, meaning that they are the countries with the smallest differences in access to health care and care experiences among residents with lower than average and above average incomes (graphic).It ranks last in equity, with the largest income-related differences in reported cost-related access problems and cases of unfair treatment or a sense that health professionals don't take health problems seriously because of their racial or ethnic origin. We have included several new measures of equity in this edition of Mirror, Mirror. One examined the percentage of patients who reported that they had been treated unfairly or that they had not been taken seriously when receiving medical care. The other analyzed self-reported health status as a substitute measure for health outcomes.
Two other new measures (not analyzed according to income due to sample size limitations) were based on questions from a survey asking doctors if they thought that health systems treated patients unfairly because of their racial or ethnic origin, and if their patients had ever informed them that they were being treated unfairly or that they were not being taken seriously when receiving medical care because of their racial or ethnic origin. Australia offers free care in all public hospitals, and the universal national Medicare system provides all Australians with full or partial coverage of the cost of GP and specialist visits and diagnostic tests, with additional subsidies available for private hospital care.18 Meanwhile, the country's Pharmaceutical Benefit Plan regulates and subsidizes drug costs to keep them affordable, 19 The wide variation in performance between the 10 countries included in this edition from Mirror, Mirror suggests extensive international learning opportunities. For example, nations that want to improve the equity, administrative efficiency and health outcomes of their health systems could turn to Australia for information. Those who wish to address access issues can go to the Netherlands. With regard to care outcomes, Australia, Switzerland and New Zealand deserve a study.
And to improve performance in the care process, countries could examine the performance of New Zealand and the United States, which would otherwise be lagging behind, in relation to the care process is particularly interesting. A possible explanation lies in the vigorous efforts made in recent years by public and private paying entities in the United States based on professional performance, that is, in the provision of value-based care. While criticism of these efforts is common in the U.S. In the U.S., despite comparatively high performance in the care process, health outcomes in the U.S.
They are the worst of the 10 countries included in this analysis, demonstrating that the care process may not be the primary driver of health outcomes. Additional research should examine the factors that lead to atypical U.S. strength. However, despite its track record in the care process, the U.S.
The U.S. lags behind other countries in almost every other way. Figure 4, which compares the overall performance of the 10 countries in terms of health care with their health care expenditures, dramatically shows the persistent dilemma of the United States of spending large amounts for generally poor results: the very definition of a low-value health system. The problems underlying this flaw are well documented.
Financial Barriers to Health Care in the U.S. While the successful implementation of the Affordable Care Act (ACA) has resulted in historically low uninsured rates, 26 million Americans, between 7 and 8 percent, still lack coverage. 26 All of the countries we used in the comparison in our study have universal coverage. The quality of coverage is also worse in the U.S.
Among Americans with insurance, nearly a quarter are underinsured and face high deductibles and co-payments that reduce the effectiveness of their insurance in ensuring access to needed care 27. None of the other countries included in our analysis place their covered residents in such financial danger. The health service delivery system also suffers from multiple deficits. The first is the lack of investment in primary care. The years of neglect and lack of compensation in primary care have caused, as expected, a shortage across the country of doctors who play a vital role in treating chronic diseases and reducing the need for expensive and sometimes unnecessary emergency, specialized and hospital services.
The acquisition of primary care offices by health systems and private equity investors is further disrupting an already fragile primary care capacity, with uncertain short- and long-term consequences. The fragmented nature of the U.S. healthcare system makes it difficult, even for many well-insured patients, to access convenient and effective care. A second area that can be improved is administrative inefficiency.
With thousands of health insurance products, a wide variety of benefits, and complex utilization management policies, healthcare in the U.S. In the U.S. it can be a nightmare maze for both patients and care providers. Recent trends in ownership and control have added to the dysfunction of the service delivery system.
Massive consolidation through hospital mergers or hospital acquisitions of doctors' offices, among other examples, has allowed large providers to negotiate higher prices with private insurers, a key factor in the overall increase in care costs in the U.S. U.S. 28. No other country relies to such an extent on the unregulated private market to allocate vital health care resources. Beyond funding and service delivery, social policies and influences outside health care greatly affect the health of Americans and place additional pressure on the health care system.
Gun violence and drug overdoses, for example, take an enormous toll in terms of morbidity and mortality, especially among young men. For centuries, racial discrimination has greatly harmed economic prospects and the health of people in the United States. In addition, the general lack of an adequate social safety net to mitigate the threats of hunger, homelessness and poverty also affects tremendously to the health of Americans. During COVID, the lack of funding and the decentralization of the national public health system, which falls to most public health authorities in state and local governments, proved to be a huge obstacle to an effective national response.29 A second reform of the service delivery system would address the uncontrolled consolidation of health care resources in local markets, helping to increase prices and making insurance less affordable for Americans, 31 In this regard , the proliferation of investor-owned entities that buy and sell primary care offices such as commodity trading deserves close scrutiny because of its long-term impact on the cost and quality of care.
32 Although the U.S. health system has many unique characteristics, there are lessons to be learned from countries that manage to ensure access to affordable, quality care. That's why the Commonwealth Fund studies health systems around the world, seeks innovations in policies and practices, and compares the performance of health systems across the U.S. Mirror, Mirror is unique in that it relies heavily on survey measures designed to capture the perspectives of patients and professionals, the people who receive healthcare in each country. Nearly three-quarters of the measures in the report are derived from patient or physician reports on the performance of the health system.
In addition to the survey elements, standardized data were obtained from recent reports from the Organization for Economic Cooperation and Development (OECD), Our World in Data, the World Health Organization (WHO), from mortality data by country, available to the public and non-public, from peer-reviewed publications and from the United States Agency for Research and Quality of Health Care. Some are specific to our analysis, while others are inherent to any effort to evaluate the overall performance of the health system. No international comparative report can summarize all aspects of a complex health system. As described above, our sensitivity analyses suggest that the comparative rankings of countries that are in the middle of the distribution (but not at the extremes) are somewhat sensitive to small changes in the data or indicators included in the analysis, but these changes do not remove these countries from the middle group of the distribution.
Second, despite improvements in recent years, standardized transnational data on the performance of health systems are limited. Commonwealth Fund surveys provide unique and detailed data on the experiences of patients and primary care physicians, but they do not capture the important dimensions that could be obtained from medical records or administrative data. In addition, patients' and doctors' evaluations may be affected by their expectations, which may differ by country and culture. Incorporating survey data into standardized data from other international sources allows us to evaluate population health outcomes and specific diseases, especially with regard to the impact of the COVID-19 pandemic.
Some issues, such as hospital care and mental health care, are not well addressed in currently available international data. In addition, it is very difficult to characterize the performance of these institutions through surveys because no one person has a complete perspective on that performance, and surveying several respondents from representative samples of institutions is logistically difficult and extremely costly. Third, we base our evaluation of the overall performance of the health system on five domains: access to care, the care process, administrative efficiency, equity, and health outcomes, which we weigh equally to calculate each country's overall performance score. We recognize that there is a limitation surrounding the care process, since we do not measure the quality of acute care, especially in hospitals. Work related to this topic is under way, but would always be limited by the possibility of generalizing them due to the limitations of studying all imaginable diagnoses.
We also recognize that other elements of system performance, such as innovative potential or public health readiness, are important. We continue to look for feasible standardized indicators to measure other domains. The COVID results, included for the first time in this report, reflect some aspects of public health readiness and system resilience, but are also limited in many ways. Fourth, in defining the five domains, we recognize that some measures could plausibly fit into several domains.
The assignment of measures to the domains was extensively reviewed internally and externally with an expert advisory panel. To substantiate action, countries' performance must be examined at the level of individual measures, in addition to the domains we have built. The availability subdomain includes nine measures that summarize how quickly patients can get information, make appointments, and get emergency care outside of business hours. The 2024 report includes two new measures on the percentage of people surveyed who waited less than a week to receive a consultation with a specialist and waited less than a month to undergo non-emergency surgery after being told that they needed it.
A measure of the use of digital health was moved from the domain of the care process to the availability subdomain. The preventive care subdomain includes four survey topics related to advising health professionals on healthy behaviors, including a new measure on the use of telehealth to assess mental and behavioral health needs, three OECD measures on mammograms and vaccination against influenza and measles, three OECD measures of the rates (standardized by age and sex) of avoidable hospital admissions for three prevalent chronic diseases (diabetes, asthma and insufficiency) congestive heart disease) and a new measure to complete the initial COVID-19 vaccination protocol from Our World in Data. The wording of a survey question was changed to include all qualified respondents, and not a subsection of respondents, as in the previous edition of this report. The patient participation and preferences subdomain consists of 15 measures that evaluate the provision of patient-centered care, including effective and respectful communication between the doctor and the patient and care planning that reflects the patient's goals and preferences. The area of administrative efficiency includes four measures. Three evaluate patients' and primary care doctors' reports of the time and effort spent resolving paperwork or administrative issues, as well as disputes related to the documentation requirements of insurance plans and government agencies.
One of the measures reported by patients assesses obstacles to care due to the limited availability of the regular doctor. Two measures were combined because of their high correlation. The 2024 report included two additional measures of discrimination, reported by primary care physicians, in the area of equity. These two measures were not stratified according to reported income, since international surveys do not ask primary care physicians about patients' income. Respondents were then instructed to reflect on their pre-tax income and were asked: “By comparison, is your household income well above, somewhat above average, somewhat below, or far below average? Respondents who indicated that their income was “somewhat below” or “well below” the average were classified as “lower or average income”, while those who reported income “much higher” or “somewhat above” the average were classified as “higher income”.
We also included the World Health Organization's measures on the excess of deaths associated with the COVID-19 pandemic among people under 75 and people over 75 to quantify the impact of the pandemic on mortality. Williams II, Vice President of Innovations in International Health Policy and Practices, Commonwealth Funding System Reform, Care Delivery, Care Coordination, Quality of Care, Equity, Coverage and Access to Health, Care Environments, Patient-Centered Care, Primary Care, Access to Care, Medicaid Expansion, Costs and Expenses, Consolidation, Affordability, Affordable Care Act, Public Health, International and International Surveys. MoneyGeek is dedicated to providing reliable information to help you make informed financial decisions. Each item is edited, verified and reviewed by industry professionals to ensure its quality and accuracy. Publicity and editorial outreach Rhode Island is the largest state in the U.S.
Its residents enjoy convenient access to medical services, ensuring first place in terms of accessibility. Utah and Wyoming have the most cost-effective health care systems in the U.S. The states with the best health care in the United States are those where people are generally healthier, have access to health care services, and are least likely to be uninsured. The best states for health care are found across the country, from Hawaii to Rhode Island.
That said, four of the top 10 states on our list are in the Northeast, while three are in the West. Within these three categories, we break down the best and worst states into several data points about outcomes, costs, and access to health care. Below is a summary of those findings and the best and worst states for each data point. Deb Gordon, co-founder and CEO of Umbra Health Advocacy, has held executive roles in insurance and healthcare technology services.
She is the author of a book entitled “The Health Care Consumer's Manifesto”, based on her research as a principal investigator at the Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School. His work has been published in JAMA Network Open, the Harvard Business Review blog, USA Today and RealClear Politics, among others. Because they manage an entire network of facilities, health systems have the power to influence industry practices and set the standard for clinical performance and quality of programs. HCA Healthcare has more than 40,000 staffed beds across its network, making it the largest healthcare system in the U.S.
The top 10 health systems by number of staffed beds manage more than 1200 hospitals and 175 000 hospital beds. Headquartered in Nashville, Tennessee, HCA Healthcare was one of the first healthcare systems in the country when it was established in 1968. For healthcare organizations, this information enables competitive benchmarking, helping them to compare their resources and operational efficiency with industry leaders. Companies that sell medical devices, pharmaceuticals, or healthcare technology can use this data to identify key players with the most purchasing power and prioritize their sales efforts accordingly. Looking at several metrics, such as the number of hospitals, net patient revenues, number of staffed beds, number of memberships, and more, the reasonable conclusion is that HCA Healthcare is by far the largest healthcare system in the U.S.
In addition, policymakers and administrators can use these classifications to analyze trends in hospital consolidation, resource distribution, and general healthcare accessibility. An IDN is a network of health care centers and providers within a specific geographic region that offers a full range of health services, from preventive care and primary care to specialized and complex care. The Department of Veterans Affairs is the second largest health system in the country, with more than 25,000 beds in its hospitals, followed by Universal Health Services, with 21,394 beds. Analyzing the largest health systems based on net patient revenues, staffed beds, and network size provides valuable information for healthcare organizations and companies focusing on this sector. Whether for sales, investments, or policy planning, this information provides a strategic advantage for navigating the changing healthcare landscape.
Data on postoperative pulmonary embolism in discharges from hip and knee arthroplasty were calculated by the Health Care Cost and Utilization Project of the Agency for Research and Quality of Health Care. By classifying health systems based on key financial and operational metrics, companies and healthcare leaders can make informed decisions and based on data.
