Three years later, US ranks last in healthcare performance (yes again)

Just look at this graph. There’s a wide gap between U.S. and other high income countries. In healthcare spending. It’s been widening since 1980.

Now see the graph below. Even with that kind of spending, U.S. fares poorly. A lone dot on the side. Highest on spend. Lowest on performance.

These graphs are part of the latest research by The Commonwealth Fund. A think tank whose mission is to “promote a high performance health care system”.

U.K., Australia and the Netherlands rank on top. U.K. ranks high on all areas except Health Care Outcomes. Australia leads in Administrative Efficiency and Health Care Outcomes. The Netherlands leads in Care Process, Access, and Equity.

U.S. was last in 2014 too.

Even if you’re lucky to be born in a country that outspends everyone else in healthcare, you aren’t likely to be any healthier. Nor are you likely to live longer.

The gap is disturbing.

Isn’t that so odd?

Here’s an extract from the report:

Compared to the other countries, the U.S. performs relatively poorly on population health outcomes such as infant mortality and life expectancy at age 60.
The U.S. has the highest rate of mortality amenable to health care and has experienced the smallest reduction in that measure during the past decade.

Read the report: Mirror, Mirror 2017:International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

The Commonwealth Fund surveyed data on 72 measures. Across these five areas:

1) Care Process

2) Access

3) Administrative Efficiency

4) Equity

5) Health Care Outcomes

In our company, we live through the problems of healthcare administrative inefficiency every single day. Here U.S. scored -1.21 compared to Canada’s 0.08.

We started our operations 13 years ago. Billing claims to various insurance companies on behalf of doctors. A challenged we felt we could help with using better technology and processes.

Back then I would’ve said it’s inevitable. That healthcare administration would be a lot more efficient. Automated. That things would greatly improve in the future.

If anything, the game is more complicated today.

The simple act of getting doctors paid correctly from insurance companies is messy. 54% of the U.S. doctors surveyed think so. They cite administrative issues related to insurance as a major problem. Compare that to 9% in Norway.

New laws don’t help matters much. A law called MACRA went into effect on Jan 1st, 2017. Half a year later, doctors are still grappling with it. Struggling to make sense of the 2,398 pages long mandate.

Such regulatory hurdles make the business of medicine difficult.

Private insurance companies seem to love this administrative complexity. Because the more complex the process, the greater the delays in payment. Complexity also means greater chances of errors and claim denials.

Most doctors (or hospitals) don’t have the bandwidth to pursue delayed or denied payments. Lesser payouts to doctors mean better cashflows to insurance companies. Better profitability to their shareholders.

Where have we arrived?

Doctors struggle to stay in practice. Most hospitals are burdened by losses. Technology rollouts run into hundreds of millions of dollars. Insurance rules find newer ways to deny and delay payments. Regulations create bottlenecks instead of solving them.

Ultimately patients suffer.

With no coverage. They don’t seek treatment at the right time. End up in emergency rooms because it’s only there they can’t be denied care. Delayed care increases the number of tests and procedures to keep the patient alive.

Most of that money we spend on last-minute healthcare never comes back. Not even in the form of healthier patients.

(In the survey, U.S. scored -1.61 compared to Switzerland’s 0.09. When asked, “Visited ED for a condition that could have been treated by a regular doctor”).

That burden adds up. From the individual to the entire economy.

In the end, we are stuck in an endless merry-go-round. Just not that merry.

Where’s the holy grail?

For good or for worse, several parts of the world follow the U.S. healthcare system. From managed care to Health IT standards, other countries take a cue from the U.S. model. And why not? U.S. is where most medical innovation happens.

That’s why this survey isn’t just a U.S. problem. It’ll soon be everybody’s problem. Expanding The Commonwealth Fund’s survey to other countries would reveal the real global Healthcare Frankenstein.

The good thing about these problems is that they leave plenty of room to innovate and change.

The holy grail — if there’s one — lies in rethinking and redoing healthcare. From the ground up. Individually. Systemically.

One patient.

One doctor.

One hospital.

One policy.

One entrepreneur.

At a time.

When the buck stops with us. With healthcare, it surely will.

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Praveen Suthrum is the president and cofounder of NextServices. is our Health IT platform. He writes at redo|healthcare.


Originally published at https://www.linkedin.com on July 18, 2017.