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U.S. Health System Is No 'Snow White'

Despite spending more on health care than any other nation, the United States receives poor value relative to other industrialized countries, a recent Commonwealth Fund report finds. In a six-nation comparison of performance on measures of quality, access, efficiency, equity, and health outcomes, the U.S. health system ranks last, behind Australia, Canada, Germany, New Zealand, and the United Kingdom.

The poor performance of the U.S. system, the authors say, reflects its status as the only country in the study without universal health insurance coverage.

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care—the third edition of a report originally published in 2004—draws from international surveys of patients as well as primary care physicians.

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While the U.S. did well on some preventive care measures, the nation ranked at the bottom on measures of safe and coordinated care. On access measures, the U.S. ranked last overall: for example, 61 percent of U.S. patients said it was somewhat or very difficult to get care on nights or weekends, compared with 25 to 59 percent in other countries. And despite spending more than twice as much per capita on health care overall, the U.S. spends a mere 43 cents per capita on health information technology, compared with $192 per capita in the U.K.

"The U.S. stands out as the only nation that does not ensure access to health care through universal coverage and promotion of a 'medical home' for patients," said Fund president Karen Davis, the study's lead author. "Our failure to ensure insurance for all and encourage stable, long-term ties between physicians and patients shows in our poor overall performance."

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