Most people believe the most expensive healthcare options are usually the best. But according to a 2014 report by The Commonwealth Fund (CWF), which has studied the healthcare systems of over 10 wealthy countries, there seems to be a considerable discrepancy between expense and quality.
The international survey has a wide spectrum of data that includes, among other indicators, number of patients, physicians and a variety of medical practises in each country. The report also includes previous data and health scorecards from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD). The report ranks each healthcare system by five categories: Quality, Access, Efficiency, Equity and Healthy Lives. The data from each indicator is compiled and interpreted to develop an Overall Rank.
It’s not hard to imagine that developing countries with generally low Gross Domestic Product (GDP) and who lack a centralized healthcare system rank extremely low on an international scale. What is hard to imagine is that extremely wealthy developed nations don’t always have the best healthcare and that significant improvements are needed in all five categories as defined by the CWF. It’s also surprising, perhaps, that countries with arguably the “best” healthcare systems in the world actually rank very low on this scale — in some cases, almost at the very bottom. When developed nations are compared to one another, it’s revealed that many healthcare systems are suffering and, without taking the necessary steps to improve overall quality, will continue to rank very low in an international context.
To be sure, no country’s healthcare system is be perfect. Still, the average patient in the developed world might be unpleasantly surprised to know that their nation’s healthcare might be considered, by experts, to be among the worst among their fellow developed nations. When all the facts are considered, every system has room for improvement. The follow 10 healthcare systems are ranked according to their overall performance, as the CWF aim to compare America’s healthcare system with financially similar developed countries. Here they are ranked from the best – the United Kingdom – to the very worst. Read on to find out where your country’s healthcare provisions come in.
11. United Kingdom
The United Kingdom ranks first as the best healthcare system among wealthy nations. The country’s healthcare is administered universally by the National Health Service (NHS), so there are no direct costs to patients. According to the CWF report, it scores the highest among the Efficiency, Access and Quality categories. It also ranks first in Coordinated Care, without which the costs of treatment would be increased. Eighty-seven percent of patients receive information for follow-up appointments, and the country is one of the best for engaging patients on a regular basis.
Switzerland does extremely well in the Equity category of treating every patient equally regardless of class or income-level. They outrank most countries for the timeliness of treatment and allow the most access to elective or non-emergency surgeries. Just below the United Kingdom, Switzerland often puts a patient’s needs and preferences at the forefront of their care. Patients are generally happy with Switzerland’s healthcare, reporting that they usually receive relevant and helpful information from specialists.
Sweden ranks high in some categories (and sub-categories) as defined by the CWF, but low in others. For Efficiency and Healthy Lives, it ranks second and first, respectively. However, for Coordinated Care Measures (such as follow-ups and complication prevention), Sweden ranks very last. In terms of patients receiving relevant information from specialists, Sweden scores only fifty-nine percent. This is low in comparison to the United Kingdom where virtually every patient reports often receiving good information.
Like every country on this list except the United States, Australia has a universal healthcare system. Australia does well in delivering recommended treatments for chronically ill patients, but ranks low in certain categories like Access. Among the sub-categories of Access, such as Cost-Related Problems and Timeliness of Care, Australia falls down at an overall rank of 9, and 6, respectively. Although showing signs of improvement in these categories since the last major study, Australia still remains around the middle of the best to worst healthcare systems.
Although Germany provides universal health coverage with little costs and delays in delivering services, it is “markedly below international leaders” when quickly alerting patients of potentially serious complication. Germany also ranks last among Sweden for the best possible Coordinated Care. However, eighty-two percent of German patients receive good information from specialists and doctors; however, this is relatively low when compared to other countries.
Despite the Netherlands having quick access to medical services under a universal system, the country generally ranks quite low for healthcare when compared to other countries. A large percentage of doctors report they have solid information with which to provide patients applicable, relevant feedback. The Netherlands ranks high in sending and receiving medical alerts, and they are about average when keeping costs low for patients seeking care. Although they are a very wealthy European nation, the Netherlands finds itself with generally low scores in the CWF study.
5. New Zealand
According to the CFW’s Overall Rank, New Zealand ties with Norway for their healthcare. New Zealand’s health system was essentially public since the 20th century, but, in the last 30 years, insurance has been introduced which intersects public and private healthcare options. However, according to the CFW study, sick adults in New Zealand reported some of the highest rates of medical errors. In comparison to Sweden, Switzerland and the United Kingdom, residents in New Zealand are more likely to experience a discrepancy in care based on their social class and income level. In the Equity category, New Zealand scores only slightly better than the number one country in this list.
Norway ranks very last in healthcare Quality which includes the effective, safe and coordinated patient care. Additionally, patients in Norway report the highest number of incidences of medical errors. Like Germany, Norway is also far behind other countries in rapidly alerting patients of potential errors or emergency infections. Only twenty two percent of physicians in Norway report receiving alerts in comparison to ninety three percent in the Netherlands. Noway also ranks among the lowest in efficient and clear communication between physicians, hospital administrators and patients.
France, although ranking high in the Healthy Lives category, ranks alongside Norway in how well they communicate with patients on both a short and long-term basis. They also rank very low for Patient Engagement and Patient Preferences, making it difficult for patients to receive the type or method of care that suits them best.
Despite the misconception that patients will have long wait times for services in a universal healthcare system, the Netherlands and the United Kingdom rank the highest for Access to Care. However, Canada’s healthcare system in particular has considerably long wait times. Even worse, sick adults in Canada are the most likely to suffer delays in being notified about abnormal test results. They also rank last for timeliness of patient care. Although Canada is one of the wealthiest countries in the world, it ranks second-to-last among wealthy countries for their healthcare system.
1. United States
The United States, although ranking as one of the richest countries in the world, ranks the lowest for healthcare, according to the CWF. Their healthcare is also, notably, privatized and among the most expensive in the world. It seems that the pitfalls of the privatised systems are many and varied, as the U.S. ranks the lowest in almost every performance scale. For coordinated care, the U.S. ranks only sixth. For the fair and equal treatment of its patients (Equity), it ranks last. Although the U.S. has improved the safety of their care since previous reports, they still rank only seventh in this category. According to the CWF, the claim that the U.S. has the best healthcare in the world is “simply not true”.
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