Health care: High cost does not bring high quality

Despite spending more than twice as much as other developed countries, the United States still lags behind in terms of access and quality, an international survey said Wednesday.

Insurance restrictions and health care costs make US patients more likely than people in 10 other countries to struggle to receive treatment, according to the annual survey of over 10,000 primary care physicians.

“We spend far more than any of the other countries in the survey, yet a majority of US primary care doctors say their patients often can’t afford care,” said lead author Cathy Schoen, senior vice president of the Commonwealth Fund.

Some 58 percent of primary care doctors in the United States said their patients have trouble paying for care and medication, compared to five to 37 percent in the other countries.

The study, published in the journal Health Affairs, comes as US President Barack Obama faces a pitched and prolonged battle in Congress over his plans to reform the country’s health care system.

The United States is the only industrialized democracy that does not ensure that all of its citizens have health care coverage, with an estimated 36 million Americans uninsured.

Yet the country spent about 7,290 dollars per person in 2007 — more than double expenditures by Britain, France and Germany — with no meaningful edge in the quality of care as it lags behind in life expectancy and infant mortality, according to the Organization for Economic Cooperation and Development.

Half of US doctors were found to spend “substantial” time addressing restrictions insurance companies place on the care of their patients in the study.

“The survey provides yet another reminder of the urgent need for reforms that make accessible, high-quality primary care a national priority,” said Commonwealth Fund President Karen Davis.

US physicians are at least four times more likely than their counterparts in countries like Australia, the Netherlands, Sweden and Britain to report major problems with the time spent getting patients needed care or medication due to the restrictions, it said.

“The patient-centered chronic care model originated in the US, yet other countries are moving forward faster to support care teams including nurses, spending time with patients and assuring access to after-hours,” said Schoen.

Almost all doctors surveyed from Britain, the Netherlands and New Zealand said they had arrangements for patients to see a doctor after normal business hours without having to go to the emergency room, a far more costly undertaking.

But only 29 percent of US physicians — the lowest ranking in the study — said they offered such an arrangement.

“Our weak primary care system puts patients at risk, and results in poorer health outcomes, and higher costs,” warned Davis.

Most US primary care physicians also lack health information technology to access test results for their patients, help reduce medication errors and improve care, the study found.

Only 46 percent of US doctors were found to use electronic medical records, compared to 99 percent of their colleagues in the Netherlands and 97 percent in New Zealand and Norway.

Eleven developed countries — Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Britain and the United States — were surveyed for the study.

The survey was conducted by mail, phone and online from February to July 2009.


  1. griff

    The realization of the need for change doesn’t necessarily mean that we should automatically support whatever is thrown on the table. Merely accepting change for change’s sake is what I would deem ignorant and stupid.

    Have you seen the bill? All 1990 pages of it? Please tell us what you like about it.

    Yeah our medical system sucks. That’s why I take no part in it. I have insurance for the classical reason…for unforeseen circumstances, not routine care or outlandish and dangerous prescription drugs. I know how to take care of myself and haven’t been to a doctor in over ten years.

    And that is the gist of the problem, in my view. We pollute ourselves for a lifetime and then expect to be magically cured of all our ills by the wonders of modern science. Better living through chemistry? Hardly.

    Our system isn’t designed to cure people but to “manage illness.” Make us all lifelong slaves to the medical-industrial complex. When’s the last time you heard of any one being cured of anything? When have you ever heard of some one getting off a medication once they were cured? Never, but you see every day where medications actually lead to more illness, which in turn leads to more medication.

    This pathetic bill will not only perpetuate this already out-of-control system, but it will give the government more power and control over it and in fact, us. In fact, the leading cause of death in this country is doctors.

  2. MightyMo

    What’s so new about this? This is exactly the sort of news Republicans love to deny happens in America, simply turn a blind eye towards it and then lie through their teeth. This has been a problem for years, it’s certainly not Rocket Science, and shouldn’t be new to any American. Strangely, when someone like Micheal Moore highlights the problem, conservatives are up in arms about it being untruthful. Our medical system sucks, plain and simple. We pay a fortune for it and get nothing in return. Like all things American, this is a business that is based on nothing more than dollars, peoples lives are only a necessary burden. What surprises me isn’t that so many people are willing to make money off of their fellow citizens, or that so many are willing to stand up and cover it up in order to keep making more money, but that so many of us who are paying the price for this failed healthcare system are too stupid to want to change it. I guess fear and ignorance are awfully strong emotions.

  3. Concerned Citizen

    What’s clear is that so called “free-market” medical industry policies (written by insurance and hospital campaign contributors) do not serve the American public. “Extending coverage” by pumping billions of dollars into an already bloated insurance industry is a short term band aid. It does not solve the underlying problems of inefficient distribution of services, high costs, and a profit driven industry dominated by entrepreneurs and middlemen. What’s unfortunate is that high quality non-profit clinic models successfully operating today are all but ignored. BOTTOM LINE: the U.S. healthcare profession must refocus to exclusively deliver high quality medical and dental services at a reasonable cost, no longer just to enrich “provider” corporations (insurers, doctors and hospitals). Unless present bills in Congress remove the profit motive and improve underlying management fundamentals, once the smoke clears we will continue to rank 37th in efficiency, and No. 1 in cost.

  4. MightyMo

    I didn’t waste my time looking, but it wouldn’t surprise me if Zimbabwe or the Sudan could actually have numbers that are better than ours in key areas. But realistically I don’t actually believe that. What I do beleive though is that you chose those two countries because you know as well as I do that you couldn’t use a half way decent country to compare to because they would have better numbers in many areas. It’s kind of like saying you should be proud to live in New Orleans, it’s much safer than Port-au-Prince (It is isn’t it??).

  5. almandine

    My point was your rhetoric… which, as I noted, was blatantly absurd. Unless, of course, you’ve never found it necessary to access US health care.

    Just a mouth going yada, yada, yada…

  6. woody188

    Not for profit does not mean no one gets paid. Some non-profit CEO’s make fairly decent six figure salaries.

    Not everything is about money either. There are some genuine people still around.

  7. almandine

    Hey Woody –

    So do we include enough income to finance a couple weeks of vacation every year or 2 as profit? Tuition for the kids? Would that be genuine? If it’s not about money, but there is still more money involved than any of us “other folks” would have immediate access to, is that different?

    Is calling a particular business model “non-profit” mere obfuscation?

  8. woody188

    All very good questions which I certainly don’t have the answers to. However, I did work for the Humane Society for a time and we all did get pay checks. It wasn’t much, and no paid vacation or health benefits as I was part-time. I do think the full-time employees did receive health benefits and a week or two of vacation.

    We adopted out hundreds of good animals and destroyed 60,000+ animals every year in our county alone running off of donations, adoption fees, and volunteers. And before anyone gets their panties in a bunch, feral cats aren’t like your pretty kitty. Think Tazmanian devil crazy spinning teeth and claws.

    We were able to do this as a non-profit so it didn’t cost tax payers anything other than the tax revenue from our sales. We did pay payroll tax just like any other company. It’s typically sales tax and business income tax that is exempt. There is a small amount the business can keep like a rainy day fund, but most revenue above costs must be spent. This was never a problem for us as we were always in the red. There were times they talked about having to shut down but Kroger or some other corporate donation would always come through at the last minute.

    The county shelter is tax payer funded and costs a lot more to operate. We used to talk about what sort of things we could do if only we had their funding.

    Just saying there is room for non-profit companies. Where would PBS be without them?

  9. logtroll

    My fact sheet:

    Health insurance and healthcare are two entirely different things. Both need to be reformed, separately.

    I don’t like the reforms being proposed, especially where they include propping up corrupt insurance companies.

    I don’t think the government operates efficiently, but if it managed paying for healthcare, at least there would be no “profit motive” on managing the flow of money for healthcare.

    I don’t think insurance companies operate efficiently. I think (as the article mentioned) that their “profit motive” adds immensely to the cost of healthcare through the ever-present and costly battle to get paid (healthcare providers) vs not-paying (insurance companies seeking profit, which is their motive, after all).

    Anyone who who plays the socialism card regarding universal healthcare has their head up their ass a measurable distance (procedure not covered by any insurance plan).

    Anyone care to compare fact sheets?

  10. Carl Nemo

    Hi logtroll,

    I’m going to give you the benefit of the doubt concerning your referenced “fact sheets”.

    Lately I’m both fearful and depressed concerning the future well-being of our Republic; in that statistics, fact sheets, editorials or whatever seemingly blur into one huge cloud of “white noise insanity” to support statist, socialist positions concerning our national future…!

    We’re all going to die regardless of whatever healthcare plan is implemented. The powers that be; based on this evil, crippled healthcare legislation, seemingly are going to make our journey to the grave far less pleasant than our endearment to life itself…no?!

    Carl Nemo **==

  11. logtroll

    Mr. Nemo,

    My lay diagnosis fer what ails ya, is that you’ve contracted ideologicitis. Once again, an ideologyectomy is not a covered procedure by most profit motivated insurance companies… but look on the bright side, no copay!

    I strongly suspect that there are some alley docs, with dirty coattail hangers that would do the job on the cheap. Still capitalism, but with lower profit expectations.

  12. Carl Nemo

    My friend in thought; to me, it’s better to die in an alley from a painful untreated cancer than to give up freedom for a bowl of modern era healthcare pottage…!

    Btw, I liked your thoughtful, incisive reply; ie., taken as a thrust to my aged armor. : ) On your recommendation I’m going to beat the backstreets of Portland, Oregon tonight to hopefully find a septic “coathanger job” to relieve me, concerning my tumorous resistance to socialized tyranny. : ))

    Carl Nemo **==

  13. logtroll

    Bob’s yer uncle.

    BTW-2, me brudder-in-law is a doc, living in the Pearl District. My guess is he’s incompetent with bent #9 wire, but he might be willing to whip you with an old bicycle chain some night, no charge, if you think that would help?

    Joust kidding, old knight. Tilting at windmills, tilting at pinball, they both keep one off the streets.

  14. dtotire


    Portion of an article from Al Jazeera on health care in America. A good synopsis

    The paradox of US healthcare (Article from Al Jazzera)

    Sun Nov 01st 2009, 04:12 PM
    The paradox of US healthcare
    By Andrew Kennis

    In the meantime, the US continues to be the country with the highest proportion of uninsured people in the developed world. It also has the distinction of spending a greater portion of its total economic output on healthcare than any other developed country – just over 17 per cent of its gross domestic product (GDP) last year.

    On average, the US spends twice as much as other developed countries on healthcare.

    But even though US citizens pay more for healthcare, they get less of it, resulting in a lowly 37th place ranking among healthcare systems in the world, according to a study by the World Health Organization based on quality and fairness.

    In terms of the infant mortality rate, a common marker for the overall state of healthcare systems, the US was outranked by all of the following countries according to the CIA’s World Factbook: Sweden (3rd), Japan (4th), France (7th), Norway (10th), Germany (14th), Israel (17th), Denmark (21st), United Kingdom (31st), Canada (35th), Taiwan (39th), Italy (41st) and even a few underdeveloped countries, including Cuba (43rd).

    How can this paradox of the US spending the most and getting the least for its healthcare occur in the country with the world’s largest economic output?

    Claudia Schaufan, an Argentine physician and professor of comparative health policies at the University of California in Santa Cruz, explains that the common characteristics of healthcare systems in the developed world have to do with the universality of coverage and the lack of for-profit entities.

    The key behind each of these systems is that they all outperform the US in terms of their infant mortality rates, administrative costs, the extent of population with coverage and the proportion of GDP spent on healthcare.

    Furthermore, there are no documented instances of citizens going bankrupt because of medical care in these systems while, conversely, some studies have shown as many as 700,000 Americans suffer that fate annually.

    ‘Making a buck

    One grouping of healthcare systems can be described as socially insured and multi-payer (Germany, Switzerland, Japan, Israel, Belgium and Austria), another as socially insured and single-payer (Taiwan and Canada), and a third as nationally insured and delivered (United Kingdom, Spain, all of Scandinavia, Italy and Iceland).

    Socially insured and multi-payer systems feature health insurance delivered by non-profit insurers. Those who are unemployed or cannot afford to pay for the insurance, receive governmental assistance so that universal coverage is achieved.

    Certain multi-payer countries have a wide choice of insurance programmes, as is the case in Germany. When you choose a private, non-profit insurer – Germany has 240 of them – the government pays a portion of the costs based on your income.

    Developed countries with one national insurer that is funded publicly – often described as single-payer – have a healthcare system that is delivered by either private (as is the case in Canada) or publicly-run institutions (as is the case in all of Scandinavia).

    While these systems differ in their specific characteristics, the similarities are more important, according to Schaufan.

    “Everyone has health insurance and there is no significant for-profit aspect in any part of the medical sector … nobody in these systems ‘makes a buck’ at the expense of the health of patients,” she says.

    Learning from others

    Taiwan, which spends three times less than the US on healthcare, developed its current healthcare system in the mid-1990s, when the majority of citizens were uninsured and policymakers collectively decided the health system needed to be radically overhauled. However, the Taiwanese looked to other countries to forge their own system.
    Asked what the proposed US reforms show in terms of learning from other examples, Naoki Ikegami, a leading Japanese healthcare economics professor, says simply: “Not much, because there has to be a willingness to learn and if anything, US leaders have isolated themselves from learning about other healthcare systems.”

    Professor Ikegami’s co-author on numerous scholarly publications, John Campbell, an American-born political science professor, says: “The reforms being proposed in the US simply do not fix or get at the heart of the problem, which is price containment and unsustainable healthcare costs.

    “The US would stand to gain a lot from going to a single-payer system, where costs could easily be contained and controlled.”