First category I don't care what patients think about anything, the only objective measures are in regards to diabetes, asthma, and CHF and preventative measures.
The preventative measures were easy - we rocked those:
Talked with provider about things in life that cause worry or stress in the past two years, among those with a history of mental illness - 4th place but only 10% behind first place which was 74%
Talked with provider about healthy diet, exercise and physical activity in the past two years - 1st place by a lot, we hit 59%, next best was 41%.
Talked with provider about health risks of smoking and ways to quit in the past two years, among smokers - 1st place
Talked with provider about alcohol use in the past two years - 1st place at 33%, next best was 25%
Women age 50-69 with mammography screening in the past year - 1st place
Older adults (age 65 plus) with influenza vaccination in the past year - 4th place, 1st place was 75%, we were 68% so very close
Diabetes we have the most of in the OECD by a pretty large margin (
OECD iLibrary | Diabetes prevalence) so its not a shock we have more complications with diabetes. Our CAD burden, the leading cause of CHF, is significantly higher than most of the OECD so not surprise we're worse off their (and we have more CAD because of aforementioned diabetes and obesity). Our worse asthma outcomes are almost entirely due to cost of inhalers which were cheap before the EPA made them reformulate which re-earned their patents. That one does piss me off on both ends. Interestingly, German is worse on the DM and CHF measures. I can't figure out why but that's worth noting I"m sure.
Second category the only objective measure is whether PCPs use electronic clinical decision tools to improve safety. It doesn't say if those tools actually improve safety, just whether they are used. My EMR has them, I don't think they help.
Third category is more an indictment on our lack of EMR inter-operability (which was promised during the Obama years). Even hospitals on the same system often can't communicate (because Epic charges more for that to happen). That should be an easy fix, not sure why its not.
Fourth category is fluff.
Affordability is obviously a problem for us. A large part of it is that our patients do demand the best and newest of everything. American's don't do well with rationing. Its more complicated of course, but basically stuff is more expensive here. No one denies that. Its the why that we do.
Timeliness is a whole other issue:
-Have a regular doctor or place of care - Last place. As a PCP this is 100% a patient-drive issue. I have people come in all the time saying "I never get sick so why would I go see a doctor" or "I haven't seen a doctor in 15 years", both from people with very good insurance.
-Regular doctor always or often answers the same day when contacted with question - Middle of the pack, and that's fair.
-Saw a doctor or nurse on the same or next day, last time they needed medical care - Middle of the pack here as well and that is a problem but not the way you think. We have urgent care on every corner, if you need a same day or next day doctor, its easy to manage. Might be a cost issue (doesn't say why) which goes back to the first point.
-Somewhat or very difficult to obtain after-hours care - Middle of the pack again. Same as above
-Waited two hours or more for care in emergency room - Middle of the pack. Given how much non-emergency stuff goes there, no surprise. The 2 times I took my kids in, we had a room in under 20 minutes. Y'know, cause they were actually sick.
-Doctors report patients often experience difficulty getting specialized tests (e.g., CT, MRI) - Middle of the pack but overshadowed quite a bit by NZ, Canada, and France. Wouldn't have called that.
-Doctors report patients often experience long wait times to receive treatment after diagnosis - 2nd best, Switzerland apparently is awesome.
-Waited two months or longer for specialist appointment - 3rd place, I'll take it.
-Waited four month or longer for elective/non-emergency surgery - Tied for 2nd place
-Practice has arrangement for patients to see doctor or nurse after hours without going to ED - Last place, no surprise there as many/most places in Europe require their doctors to work nights/weekends. See the recent doctors strike in the UK.
So basically in this category we did great in Time but bad on Price so we got put in last place.
-I'm skipping administrative efficiency for the obvious reasons except to note that France did worse than us in every category there but one and the Dutch were similar. Not sure why that is.
-Also skipping equity measures because that's ridiculous.
Now outcomes, that's an important one:
-30 day in-hospital mortality rate following acute myocardial infarction, deaths per 100 patients - 3rd place, I'll take that
-30 day in-hospital mortality rate following ischemic stroke, deaths per 100 patients - 1st place
-Breast cancer five-year relative survival rate - 1st place
-Colon cancer five-year relative survival rate - 3rd place, likely due to our lower rates of screening and thus more advanced cancer.
We fail both Mortality Amenable to Health Care and decline in that same number.
-Infant mortality, deaths per 1,000 live births - Last place, but that's almost entirely due to how these things are reported. Our birth-30 day mortality is right in the middle of the pack. What gets us is that infant mortality is defined in this study as birth to 1 year. Our SIDS rate and abuse rates are much higher than most of OECD countries.
-Adults age 18 to 64 with at least two of five common chronic conditions - Last, see diabetes and obesity rates in this country compared to everyone else
-Life expectancy at age 60 in years - Middle of the pack.
So we came in last in most categories, I think unfairly.
We do well at fixing acute problems, timeliness, and prevention. We don't do well on cost, inter-operability in most forms, and anything relating to lifestyle issues. If we did something about our obesity epidemic, lots of these numbers would get better on their own (see
@Nutmeg 's diabetes thread for that).
The biggest reason we score poorly is cost. That's a very complicated issue for a variety of reasons, but if that's taken out as a metric our system is at worst middle of the pack and actually quite good at a number of things.