Money Can't Buy U.S. Health
July 25, 2000 -- The U.S. health care system went to the doctor and didn't get a perfectly clean bill of health, according to some recent reports. In fact, people in the U.S. do not have "anywhere near the best health in the world," despite the high cost of health care in the country, according to Barbara Starfield, MD, MPH, in her recent commentary in the Journal of the American Medical Association.
Starfield, who is a professor of health policy and management at Johns Hopkins University in Baltimore, uses several sources to indict the U.S. health care system. One is a recent report from the Institute of Medicine, called "To Err is Human," that suggests that between 44,000 and 98,000 Americans die each year because of medical errors.
Another recent report cited by Starfield is a World Health Organization report comparing the U.S. with 25 other industrialized countries using several measures of health, such as child survival to the age of five years. The U.S. ranked 15th.
"Our report represents a composite of five measures," says Michele Beusenberg, an analyst with the World Health Organization in Geneva, Switzerland. "In relation to spending, health outcomes were poor in America. That's one reason America didn't come out too high in the rankings. We have observed a trend that sometimes the more money you spend, the less efficient the system gets. It's necessary to find the right balance, although trying to develop more efficient systems is sometimes tricky."
And Starfield's own research compares U.S. health care with that of 12 other industrialized nations and finds the U.S. lurking surprisingly close to the bottom, at 12th overall. The U.S. came up in last place for some factors, such as newborn death rates and overall infant death rates.
"The real explanation for relatively poor health in the United States is undoubtedly complex" and has many possible contributing factors, according to Starfield. She speculates that lack of a strong primary care medical system in the U.S. may play a role, since five of the seven countries she studied that came out on top have strong primary care systems. Another possible factor could be the vast income inequality in the U.S., which is associated with poorer health outcomes.
Whatever the reasons for the low U.S. ranking, Starfield recommends further research into "the nature and operation of the [U.S.] health care system," including looking at the relationship between treatment-caused and physician-caused complications.
So what's the prescription for an ailing health care system?
"The solution to our medical problems is not a quick fix," says Janet Corrigan, PhD, chair of the board of health care services at the Institute of Medicine in Washington, D.C., and one of the editors of the "To Err is Human" report. "It will require fundamental reorganization of health care services. We need to make the best use of medical technology, we need better ways to translate the medical knowledge base into best practices, and we need better systems at the delivery level than we currently have. The need for information is crucial."