How Does the Quality of U.S. Health Care Compare Internationally?

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Abstract

In a review of published literature, authors Elizabeth Docteur and Robert Berenson, explored the question, How Does the Quality of U.S. Health Care Compare Internationally? The findings don't provide a definitive answer but suggest no support for the oft-repeated claim that "U.S. health care is the best in the world." The U.S. does relatively well in some areas, including cancer care, and less well in others, including conditions amenable to prevention and coordinated management of chronic conditions. The authors conclude that concerns that health reform could compromise currently excellent care are unwarranted; health reform can only help.

Introduction

There is a perception among many Americans that despite coverage, cost and other problems in the health care system, the quality of health care in the United States is better than it is anywhere else in the world and might be threatened by health reform. In fact, 55 percent of Americans surveyed last year said U.S. patients receive better quality of care than do those in other nations, even though only 45percent said they thought the United States had the world’s best health care system. And while Americans overwhelmingly support government action to increase coverage and reduce the costs of health care, a recent poll found that 63 percent worry that the quality of their own care would get worse if the government ensured health care for all. Another poll found that as many as 81percent of Americans have such concerns.

Participants in the current reform debate refer to the relative quality of U.S. health care as providing support for their views, and perceptions of health-care quality — what it is and where it can be found — are often at the heart of disagreements over what form of health reform the country should adopt. But hard facts to support claims are often missing, and it is clear that quality of care experts, policy makers, health care providers and the general public all have different ideas as to which aspects of health care signify its quality and which ones are most important.

This brief brings together available evidence on how quality of care in the United States compares to that of other countries and comments on the implications of the evidence for the health reform debate. By exploring how the quality of our care compares internationally, we can address the underlying attitudes and concerns that people have about health reform. For example, if claims that the United States has the best quality of care in the world — overall or in particular respects — were well supported by the evidence, it would caution us against adopting forms of health reform that threaten those attributes of our health system responsible for this standing. But if quality of care is not remarkable — or may be even lagging — there should be less reluctance to change. In addition, a more explicit need for health reform to address quality improvement

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