Opinion: Myth vs. Reality

Feb 01, 2007

Humphrey Taylor
Until recently there was little reliable information comparing the healthcare systems and quality of medical care in different countries. As a result, the debate about reform of the American healthcare system has been ideologically driven rather than evidence-based. This is now changing. The last few years have seen a big increase in the quantity and quality of information comparing our system with those in other developed European and English-speaking countries. This information comes from cross-national research, including nine major Commonwealth Fund surveys conducted by Harris Interactive, the Organization for Economic Cooperation and Development, and the work of health economists and policy analysts. The results are shocking. Many widely held beliefs about our healthcare system and those in other countries turn out to be false. Accurate information increases the likelihood of developing good policy. It is time for policymakers, and those who seek to influence them, to separate myth from reality.

1 Myth: The reason we spend so much on healthcare is that consumers pay so little out of their own pockets, and the government and employers pay most of the cost.

Other countries spend much less on healthcare than we do even though their consumers pay much less than Americans.

2 Myth: Americans spend more on healthcare because they consume more care, and more services are available to them.

While Americans do have many tests and more of some elective procedures, they have fewer doctors' visits and use fewer hospital beds than people in many other countries that spend much less on healthcare.

3 Myth: When patients have to pay more for their care, they cut back on marginal and unnecessary care and spend their money more wisely.

The evidence is clear that when patients have to pay more for care they cut back on both appropriate and inappropriate care. As prices rise, consumption falls and people with diabetes, asthma, hypertension, and elevated cholesterol are much less compliant in the use of effective drugs for controlling these conditions—increasing costs for their care over the long term.

4 Myth: Commercial health insurance plans are more efficient than government programs such as Medicare and Medicaid.

In no other country is the cost of administration as high as it is here. The administrative costs of Medicare and Medicaid are much lower than those of commercial health insurance plans.

5 Myth: In places with more doctors and more hospitals, competition promotes efficiency and keeps spending down.

Evidence shows that in communities with more doctors and more hospitals, the public incurs more healthcare expenses without any apparent improvement in outcomes.

6 Myth: The uninsured have access to, and receive, the same healthcare as people with insurance. They just don't pay for it.

Many studies have shown that the uninsured do not have the same access to, and do not receive, the same medical care as people with insurance, and that they have substantially worse outcomes. Indeed, they are more likely to die.

7 Myth: The quality of care is better in America than in other countries.

A growing number of cross-national studies over the last several years have found that the quality of care provided in America is, on average, no better, and often worse, than the care provided in many other countries.

8 Myth: The United States is a leader in the use of health information technology.

The data show that the United States lags behind almost all other western developed countries in the use of health information technology.

9 Myth: The United States is a leader in the use of quality measures to distinguish between better and worse care.

The same data show that the United States lags behind a number of other countries in the use of quality measures.

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