There is no hard evidence supporting that health care delivered in the U.S. is “truly exceptional,” according to an analysis of available quantitative sources on health quality from the Urban Institute.

The issue of access barriers to health care is given some deep consideration. The U.S. is one of three countries which has a ‘sizable’ portion of citizens lacking health insurance coverage, along with Mexico and Turkey. For many quality measures, the report finds, “quality and access are intrinsically linked.”

Specifically, both uninsurance and under-insurance can lead to health consumers skipping medicines, suggested lab tests, and appointments with physicians — due to cost.

In nations with longer queues for services, health citizens may have lower perceptions of quality, but actual clinical outcomes in these countries are not found to be compromised.

However, once an uninsured person in the U.S. accesses care, their treatment was found to be of equal quality to those (insured) people who receive care in the U.S., according to a study by Asch et. al. published in Health Affairs in 2004.

How Does the Quality of U.S. Health Care Compare Internationally?, by Elizabeth Docteur and Robert Berenseon, combs through the available evidence on quality of care in the U.S. The paper looks at cross-country differences in life expectancy, outcomes (including cancer, prevention, chronic conditions), overuse of health services, and patient safety.

Health Populi’s Hot Points: The bottom line, after the authors cite 57 footnotes of researched papers, is that there isn’t support for the claim that “we’re number one” when it comes to quality of health care in the U.S.

While the data are incomplete and collected in different ways, the U.S. health system is, at best, a “mixed bag,” the report finds. While cancer care is among the best in the world, according to various reports, other chronic and acute conditions fall far short of global benchmarks.

The two main ways the U.S. health system differs from care delivered elsewhere are (1) high costs and (2) the level of the uninsured population.

Yet, I heard several pronouncements yesterday (Sunday) morning on the political news talk shows (Face the Nation, Meet the Press, and This Week with George S.) that our health system is the best in the world.

“A less-than-fully informed public comes at a cost in that assertions of excellence divert attention from the need to inspire and foster systematic quality improvement activities,” Docteur and Berenson conclude. Docteur knows best.

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