Clinical Quality in the US Health Care System

Anyone who has worked in health care or has even a moderate interest health care has heard that the US health care system is the most expensive in the world and we don’t get much for our money.  Usually, when people make that statement, they use the World Health Organization’s ranking of the US as proof that our quality is not very good. WHO ranks the US 37th in the world for health care. This is a false argument as the WHO doesn’t really measure quality.  However, the WHO rankings do bring up the question of quality, which a good question to put to bed once and for all.  I would suggest that the US health care delivery system produces the best quality of care in the world and I have the data to prove it.


First of all, its ridiculous to think that the quality of care in the US is behind countries like Chili, Morocco, Cyprus, Columbia and Greece, all of whom are ranked higher than we are by the WHO.  I mean has anyone ever been diagnosed with Cancer in this country and said; “If only I lived in Greece.  Then I could get some really quality care.”


Rather than point out all of the problems with the WHO rankings, let me point to some data that explains and supports my position that we have the best health care quality in the world in the United States.  That may seem counter to what many people believe, because on the surface it doesn’t appear that way when you look at mortality, life expectancy or infant mortality statistics.  The Peterson Kaiser Family foundation produced a wonderful report in 2019 comparing the quality of the US healthcare system to other countries.  For this study they used the Netherlands, Australia, Sweden, Japan, Austria, Germany, France, Canada and the UK as the group of comparable countries for comparison.


The report produced some interesting and telling results.  When looking at age adjusted mortality rates, we see steadily falling rates for all of the countries studied with the US still above the comparable country average.  The Healthcare Quality and Access (HAQ) rating has the US with the lowest rating of all the comparable countries.


Another way to measure mortality rates and life expectancy is the Years of Life Lost measure.  The United States again trails all other comparable countries.

At this point you are probably wondering how I can make the argument that the clinical quality in the US is very good when we seem to fall behind all other comparable countries in these three measures?  Well, that gets us to the rest of the story.  The United States being the richest country in the world has produced a lifestyle that is extremely unhealthy.  Consider the following.


The United States leads the world in average daily caloric intake.  Of the comparable countries in the Peterson-KFF study the US had the highest obesity rate at 36.2%.  That’s right, over a third of our population is clinically obese.  None of the other comparable countries are even close to us with the average of the comparable countries at 21.7%.  That means that our rate of obesity in this country is 40% higher than the average of the other comparable countries.  We know that obesity leads to many significant health issues like diabetes and cardiac disease.


Another area where our lifestyle impacts overall health is in the area of substance abuse.  The rate of substance abuse in the US is twice that of the average from those comparable countries.  Just think about these two factors and the impact they have on our overall health as a country.  People in the US are 40% more likely to be obese and twice as likely to have a substance abuse problem than the average citizen in comparable countries.


The Peterson-KFF study looked at disease burden in their study.  They did so by measuring the Disability adjusted life years.  This is a measure of disease burden and the rate per 100,000 shows the total number of years lost to disability and premature death.  In 2017, the DALYs rate for the US was 31% higher than the comparable country average.


So, with that the data starts to become clear and paint a different picture.  We can see that the US lags behind comparable countries in mortality rates.  However, we also see that it’s not a level playing field.  As a population we are doing everything we can to die at a young age.  We suffer from obesity and substance abuse issues among other things that significantly impact our health.  My question to you is this; should we blame our health care delivery system for this or is it time to look in a mirror? I mean, blaming our health care system for individual and societal issues around things like obesity and substance abuse is a little bit like me blaming my fork for my weight problem.


I would argue that a better measure of clinical quality comes from our delivery systems results combating serious conditions and diseases.  Even here we have made life hard for our doctors and hospitals because things like obesity and diabetes are comorbidities for most other serious health issues.  Be that as it may, when looking at specific diseases and conditions we start to see a true picture of the clinical quality of our health care delivery system.


Again, from the Peterson-KFF study we see the US has a lower 30-day mortality rate for heart attack and stroke than the average of the comparable countries.  That is amazing considering that those individuals who have a heart attack or stroke in this country are much more likely to have a significant comorbidity condition than other countries.  Simply put, with a less healthy patient our doctors and hospitals still produce better results for heart attacks and strokes than the other countries.  In addition to that our mortality rate for breast, colorectal and cervical cancers are also below the average of the comparable countries.  This is again with a much less health patient population to work with.  The same holds true for the age adjusted mortality rate for all cancers.  Again, the US has lower mortality rates for all cancers than the comparable country average.


To me the picture is pretty clear.  Our wealth and lifestyle have produced some very unhealthy habits.  The fact that our statistics are not worse than they are is a credit the quality of care available in this country.  Our doctors and hospitals are keeping us alive while we are doing everything we can to die at a young age.


Again, I reiterate my statement; I don’t think anyone with cancer or other serious diseases is sorry they are in this country and would rather be treated in Greece or Columbia.


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