Ruminations: Health Delivery Laggards

"No two nations are alike when it comes to health care. Over time, each country has settled on a unique mix of policies, service delivery systems, and financing models that work within its resource constraints. Even among high-income nations that have the option to spend more on health care, approaches often vary substantially. These choices affect health system performance in terms of access to care, patients’ experiences with health care, and people’s health outcomes. In this report, we compare the health systems of 11 high-income countries as a means to generate insights about the policies and practices that are associated with superior performance."

"With the COVID-19 pandemic imposing an unprecedented stress test on the health care and public health systems of all nations, such a comparison is especially germane. Success in controlling and preventing infection and disease has varied greatly. The same is true of countries’ ability to address the challenges that the pandemic has presented to the workforce, operations, and financial stability of the organizations delivering care. And while the comparisons we draw are based on data collected prior to the pandemic or during the earliest months of the crisis, the prepandemic strengths and weaknesses of each country’s preexisting arrangements for health care and public health have undoubtedly been shaping its experience throughout the crisis."

"For our assessment of health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, we used indicators available across five domains."
Commonwealth Fund: Mirror, Mirror 2021: Reflecting Poorly

CommonwealthFund

The Commonwealth Fund has issued a new report on the status of health care delivery in a number of indices, focusing on the success and failures of eleven advanced, wealthy countries and comparing their ability to satisfy the needs of their various communities to the health delivery performance of the United States. The institution itself is based in the United States, a private foundation whose focus is on health care.

The study was based on critical criteria which included access to care, care process, administrative efficiency, equity and health-care outcomes. This data led researchers through careful examination of the criteria, to analyze various wealthy-advanced countries' strengths and weaknesses, comparing outcomes from country to country and assigning each comparative rankings in the various categories.

Of the eleven countries that came under study, the United States was ranked dead last in proficiency in all critical areas of health delivery studied. Its studied partner in North America, Canada, ranked just above the U.S.; where the U.S. came in last, Canada was assessed to be one notch above the U.S. All other nations were ranked higher in competency and delivery. With the U.S. standing at 11th place, and Canada 10th, the top health delivery performer was Norway overall.

The Netherlands ranked at second place, Australia third, followed by the United Kingdom, Germany, New Zealand, Sweden and France. Switzerland came in just a notch above Canada, at ninth place. With the exception of the United States, all other ranked countries use universal healthcare as their delivery system, or a system approximating it; either a fully socialized or partially socialized system incorporating both public and private health care provisions.

An early report dated 2020, published by the Fraser Institute, a Canadian think-tank which compared performances of countries with universal health care, similar findings were obtained. While the U.S. study looked at 11 countries, the Fraser Institute compared Canada with all other wealthy countries offering universal access to health care; 28 in all. The criteria used included spending rate, availability, use, access to resources, quality and clinical performances and health status (life expectancy and mortality).

With the use of 2018 data, the final year for which comparable data across countries was then available, Canadian spending on health care as GDP percentage adjusted for age, came in second behind only Switzerland. High spending failed to result in good outcomes, however. The number of doctors per thousand population left Canada at 26. Switzerland was 7th, yet the two countries were matched for high spending on medical delivery.

The Canadian record on access to nurses, acute beds and psychiatric beds placed Canada at 7th place for long-term care beds, high spending level aside. Both studies make it abundantly clear that the United States' health-care performance is the worst performing country, spending hugely but resulting in poor outcomes, and Canada is right behind its neighbour. And when Canada's performance is rated alongside other wealthy countries, its poor performance in health-care delivery is outstanding.

Income-related disparities in health-care outcomes were the most egregious in Canada, second to the U.S. "Compared to the other countries, the United States and Canada had larger income-related inequities in patient-reported experiences", the Mirror, Mirror 2021 report pointed out. The existence of a fully socialized system does not necessarily translate to a level playing field.