THE COMMONWEALTH FUND Mirror Mirror on the Wall

THE COMMONWEALTH FUND Mirror, Mirror on the Wall: How the Performance of the U. S. Health Care System Compares Internationally 2010 Update Karen Davis and Cathy Schoen President and Senior Vice President for Research and Evaluation The Commonwealth Fund June 22, 2010 kd@cmwf. org cs@cmwf. org www. commonwealthfund. org

2 Mirror, Mirror on the Wall: 2010 Update • Earlier editions of report produced in 2004, 2006, and 2007 • Data from 2007 -2009 Commonwealth Fund International Health Policy Surveys of Patients and Physicians • Seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States • Ranked across five areas: – Quality – Efficiency – Access to care – Equity – Long, healthy, productive lives • The United States continues to spend the most and rank last • The Affordable Care Act will begin to align the U. S. system for higher performance THE COMMONWEALTH FUND

3 International Comparison of Spending on Health, 1980– 2007 Total expenditures on health as percent of GDP Average spending on health per capita ($US PPP) $7, 290 16% 8% $2, 454 THE COMMONWEALTH FUND Note: $US PPP = purchasing power parity. Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

4 Overall Ranking Country Rankings 1. 00– 2. 33 2. 34– 4. 66 4. 67– 7. 00 AUS CAN GER NETH NZ UK US OVERALL RANKING (2010) 3 6 4 1 5 2 7 Quality Care 4 7 5 2 1 3 6 Effective Care 2 7 6 3 5 1 4 Safe Care 6 5 3 1 4 2 7 Coordinated Care 4 5 7 2 1 3 6 Patient-Centered Care 2 5 3 6 1 7 4 6. 5 5 3 1 4 2 6. 5 Cost-Related Problem 6 3. 5 2 5 1 7 Timeliness of Care 6 7 2 1 3 4 5 Efficiency 2 6 5 3 4 1 7 Equity 4 5 3 1 6 2 7 Long, Healthy, Productive Lives 1 2 3 4 5 6 7 $3, 357 $3, 895 $3, 558 $3, 837* $2, 454 $2, 992 $7, 290 Access Health Expenditures/Capita, 2007 Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009). THE COMMONWEALTH FUND

Quality: Wrong Medication or Wrong Dose in Past Two Years, Among Sicker Adults, 2008 5 Percent reporting wrong medication or wrong dose in past two years AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2008 Commonwealth Fund International Health Policy Survey. THE COMMONWEALTH FUND

Access: Sicker Adults Reporting Cost-Related Access Problem in Past Two Years, 2008 6 Percent reporting access problem* AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. * Access problems included: not filling a prescription or skipping does; not getting a recommended test, treatment, or follow-up; or not visiting a doctor when having a medical problem. Data: 2008 Commonwealth Fund International Health Policy Survey. THE COMMONWEALTH FUND

Efficiency: Sicker Adults Sent for Duplicate Tests by Different Health Care Professionals in Past Two Years, 2008 7 Percent reporting duplicate tests AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2008 Commonwealth Fund International Health Policy Survey. THE COMMONWEALTH FUND

Equity: Sicker Adults Not Filling Prescriptions or Skipping Doses Because of Cost in the Past Year, Differences by Income, 2008 8 Percentage point difference between below- and above-average income AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2008 Commonwealth Fund International Health Policy Survey. THE COMMONWEALTH FUND

Long, Healthy, and Productive Lives: Mortality Amenable to Health Care, 2002 -03 9 Deaths per 100, 000 population* * Countries’ age-standardized death rates before age 75; includes ischemic heart disease, diabetes, stroke, and bacterial infections. Data: E. Nolte and C. M. Mc. Kee, “Measuring the Health of Nations: Updating an Earlier Analysis, ” Health Affairs, Jan. /Feb. 2008 27(1): 58– 71. Source: Commonwealth Fund National Scorecard on U. S. Health System Performance, 2008. THE COMMONWEALTH FUND

10 How the Affordable Care Act Will Help The new law will: • Expand access to affordable health insurance for those without coverage, with 32 million uninsured gaining coverage when the law is fully enacted in 2014 • Improve affordability of coverage for those who have it, including millions of Americans who are currently underinsured who will be protected against high medical costs and medical debt • Slow the rise in health care costs for individuals, families, and employers while not adding to the federal debt. According to a report released in May by The Commonwealth Fund and the Center for American Progress, the law has the potential to slow the annual growth rate in health spending from 6. 3 percent to 5. 7 percent • Begin to orient the U. S. health care delivery system toward more effective, efficient, and patient-centered care THE COMMONWEALTH FUND Source: K. Davis, A New Era in American Healthcare, (New York: The Commonwealth Fund, June 2010).