Commonwealth Fund: U.S. health system worst in industrial world

Social inequities at root of poorer health outcomes among U.S. Blacks

Recently, the Commonwealth Fund released its 2010 study “Mirror, Mirror on the Wall” (Commonwealth Fund executive summary and full report). The report highlights the poor quality of health care in the United States compared to that of other major capitalist countries. In comparing 7 industrialized countries (Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States), the United States is #1 in health expenditures per capita at $7,290, 87% higher than second-place Canada, over twice that of the average of the other 6 ($3354) and nearly 2.5 times as much as the UK.

Spending all this money on health services doesn’t lead to better health outcomes. The Commonwealth Fund study obtained measures of Quality Care, Access, Efficiency, Equity, and “Long, Healthy, Productive Lives.” The United States ranked last among these nations in providing “Long, Healthy, Productive Lives.” While none of these countries ranks #1 in all categories, the composite score of the other six countries is higher than that of the United States. All these countries emphasize primary-care services and provide some form of universal health coverage to their populations.

The United States also ranked last on the Equity score, which is not surprising given a health system based on fee-for-service care. Clearly, those with insurance or lots of money or both have greater access to health care services in this country. Moreover, a large body of literature shows that patients who are working-class, from minority populations, or who live in rural areas receive poorer quality care. Health outcomes in these populations are much worse as a result.

As we pointed out in one of the very first postings on this blog, racial, ethnic, and social class inequities in health are the result of the social inequities that riddle our world. Being Black in America is dangerous to your health not because of any biological reasons but because of racial discrimination and economic exploitation. Improvements in the health of Black folk and other racial and ethnic minorities will come only with programs that address the social inequities spawned by racial discrimination — which include lack of access to high-quality primary-care services.

Thursday, July 1st, 2010 at 19:37