U.S. trails peers in healthcare quality ranking, care access

Access to care

The U.S. healthcare system falls supremely short in the access to care domain, which is measured by both the affordability and availability of care. The nation's poor performance is potentially because of its lack of universal health insurance coverage mandates.

Health insurance fragmentation, high deductibles and premiums and the small but relatively notable uninsured rate in the U.S. keeps healthcare somewhat out of reach for folks. High healthcare costs are among the leading barriers to accessing healthcare, the Commonwealth Fund researchers indicated.

In addition to affordability woes, medical care in the U.S. also simply has limited availability.

For example, the U.S. has the highest rate of people saying they don't have a usual source of care. A poorly funded primary care landscape and limited after-work appointment availability also make it hard for Americans to access healthcare.

Care process

The report did have one bright spot for the U.S.: the care process domain, as measured by prevention, safety, coordination, patient engagement, and sensitivity to patient preferences. The U.S. was the second-highest-performing nation in this category.

This good performance is likely driven by the nation's keen focus on patient safety. Since the November 1999 publication of the seminal report "To Err is Human," the U.S. has prioritized process changes that would protect patient safety. Although it took a hit during the pandemic, most reports indicate that patient safety has rebounded and that the country is back on track to eliminate preventable patient harm.

The U.S. also has a high rate of preventive care access, the Commonwealth Fund added. In particular, the nation successfully connects patients with preventive mammograms and flu vaccinations, likely a byproduct of Medicare's pay-for-performance policies.

Administrative efficiency

The report showed that the U.S. also has a problem with administrative efficiency, coming in as second-worst among other high-income nations.

The administrative efficiency category examined the process for medical billing and claims submission from both the patient and provider perspectives. In the U.S., administrative issues plague both parties.

For example, patients are often caught in the crossfire of trying to pay medical bills and find the appropriate place for care. In the U.S., patients have a high likelihood of seeking medical care in the emergency department, even when that treatment would have been more appropriate in a low-acuity setting, like an urgent care or primary care clinic.

Providers, too, face issues with administrative efficiency, mostly driven by the complex web of publicly insured, privately insured and self-pay patients. Various cost-sharing and coverage limitations also beleaguer clinicians, who must often challenge coverage denials for patients to access care.

Health equity

Alongside New Zealand, the U.S. is bottom-tier in terms of health equity.

This is driven by the high rate of low-income people who say they can't afford medical care and the number of people reporting healthcare discrimination. Although not included in this year's analysis, the Commonwealth Fund also determined that the U.S. has a high rate of healthcare professionals who observe unfair treatment of certain patient groups in the medical setting.

Australia, Germany, and the United Kingdom performed the best on health equity, a trend that is likely driven by those nations' caps on out-of-pocket healthcare spending, mandatory health insurance coverage and cost of coverage being income-based.

Health outcomes

U.S. health outcomes are abysmal, the report showed. Americans have the shortest life spans, the highest rate of preventable deaths and the highest rate of excess deaths due to the pandemic among people under age 75.

All said, the U.S. ranks last in four of the five health outcome measures included in the analysis. Among other things, poor health outcomes are made evident by the ongoing substance use crisis in the U.S. plus the high rest of gun violence.

Recommendations

The researchers indicated that limited access to comprehensive health insurance coverage is driving the nation's poor performance. Expanding coverage to the uninsured and reforming insurance such that it protects consumers from high out-of-pocket costs will be key moving forward.

More investments in a flailing primary care landscape, tamping down on healthcare consolidation, addressing social determinants of health and closing health disparities will likewise be critical moving forward.

According to Reginald D. Williams II, vice president of international health policy and practice innovations at the Commonwealth Fund, these types of reports are fruitful because they offer insights into how to do things well. Although the U.S. falls behind on many aspects of healthcare, its high-performing peer nations offer a roadmap to better healthcare.

"'Mirror, Mirror' underscores the importance of international comparisons, offering evidence and inspiration to improve America's health system," Williams said in the press release. "While other nations have successfully met their populations' health needs, the U.S. health system continues to lag significantly. This report shows that by adopting proven strategies and making smart investments, America can enhance its health system to better meet the needs of its people. There's no reason we can't elevate our standing if we choose to do so."

Sara Heath has covered news related to patient engagement and health equity since 2015.