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1. U.S. and Global Approaches to Financing Long-Term Care: Understanding the Patchwork

Author:
Celli Horstman, Evan D. Gumas, and Gretchen Jacobson
Publication Date:
02-2023
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Most United States adults age 65 and older will need long-term care toward the end of their lives.1 Long-term care, provided in the home, community, or in institutional settings like a nursing home, includes medical care as well as personal, nonmedical care for people who are unable to perform activities of daily living, like cooking or bathing. Some services also may support social needs for those unable to perform what are known as instrumental activities of daily living, such as shopping or medication management. In 2018, more than 5 million people in the United States used home health care, including adult day care or home health agency services, and nearly 4 million people resided in nursing homes or residential care communities.2 Despite the widespread need for long-term care, the U.S. has no national program to cover the costs of long-term care. While certain states have implemented their own programs, the resulting patchwork of funding has left many Americans with no sustainable way to pay for the services they require. Other developed countries have comprehensive, national long-term care financing systems featuring broad eligibility and high levels of financial support. In this brief, we analyze data from multiple sources on long-term care costs in the U.S., as well as spending data from the Organisation for Economic Co-operation and Development (OECD), to better understand long-term care financing strategies in 12 high-income countries. In addition to these data, we synthesized initiatives to long-term care funding in these 12 countries. (For details, see “How We Conducted This Study.”) Since the U.S. does not have a national funding strategy, we also focused on individual state approaches. International and U.S. state approaches may provide insights to policymakers seeking to advance comprehensive long-term care funding.
Topic:
Health, Health Care Policy, Inequality, and Social Services
Political Geography:
Global Focus

2. Mental Health Conditions and Substance Use: Comparing U.S. Needs and Treatment Capacity with Those in Other High-Income Countries

Author:
Melinda K. Abrams, Reginald D. Williams II, Katharine Fields, and Roosa Tikkanen
Publication Date:
05-2021
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
About one-quarter of U.S. adults report having a mental health diagnosis such as anxiety or depression or experiencing emotional distress. This is one of the highest rates among 11 high-income countries. While U.S. adults are among the most willing to seek professional help for emotional distress, they are among the most likely to report access or affordability issues. Emotional distress is associated with social and economic needs in all countries. Nearly half of U.S. adults who experience emotional distress report such worries, a higher share than seen in other countries. The United States has some of the worst mental health–related outcomes, including the highest suicide rate and second-highest drug-related death rate. The U.S. has a relatively low supply of mental health workers, particularly psychologists and psychiatrists. Just one-third of U.S. primary care practices have mental health professionals on their team, compared to more than 90 percent in the Netherlands and Sweden.
Topic:
Health, Health Care Policy, Mental Health, Drugs, and Substance Abuse
Political Geography:
United States, Europe, and Global Focus

3. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries

Author:
Laurie Zephyrin, Molly FitzGerald, Munira Z. Gunja, and Roosa Tikkanen
Publication Date:
11-2020
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
The U.S. has the highest maternal mortality rate among developed countries. Obstetrician-gynecologists (ob-gyns) are overrepresented in its maternity care workforce relative to midwives, and there is an overall shortage of maternity care providers (both ob-gyns and midwives) relative to births. In most other countries, midwives outnumber ob-gyns by severalfold, and primary care plays a central role in the health system. Although a large share of its maternal deaths occur postbirth, the U.S. is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period.
Topic:
Health, Health Care Policy, Women, and Reproductive Health
Political Geography:
United States and Global Focus

4. Do Americans Face Greater Mental Health and Economic Consequences from COVID-19? Comparing the U.S. with Other High-Income Countries

Author:
Michelle M. Doty, Eric C. Schneider, Roosa Tikkanen, Arnav Shah, and Reginald D. Williams II
Publication Date:
08-2020
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
With more than 4 million confirmed cases and 150,000 deaths as of August, the United States is failing to control the COVID-19 pandemic. At a time when many nations are reopening their economies and societies, the U.S. is struggling in its attempts to do the same. To examine the early impact of the pandemic on the well-being of adults in the U.S. and abroad, the Commonwealth Fund joined the survey research firm SSRS to interview 8,259 adults age 18 and older between March and May 2020. It is the latest in the Commonwealth Fund’s series of cross-national comparisons featuring the United States and nine other high-income countries that participate in the Fund’s annual International Health Policy Survey. The following exhibits illustrate COVID-19’s effects on people’s mental health and economic security and compare levels of public trust in national leaders in responding to the pandemic.
Topic:
Health, Health Care Policy, Mental Health, and Public Health
Political Geography:
United States, Europe, and Global Focus

5. Bundled-Payment Models Around the World: How They Work and What Their Impact Has Been

Author:
Meredith B. Rosenthal, Paul F. van Gils, Caroline A. Baan, Eline F. de Vries, and Jeroen Struijs
Publication Date:
04-2020
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
We identified 23 initiatives in eight countries that have implemented bundled-payment models, focusing on procedures such as total joint replacements and cardiac surgery, as well as chronic conditions like diabetes and breast cancer. Of the 35 studies retrieved, 32 reported effects on quality of care and 32 reported effects on medical spending. Twenty of 32 studies reported modest savings or a modest reduction in spending growth, while two studies (both based on the same initiative) demonstrated increased spending in the early years of the bundled-payment model’s implementation. Eighteen of 32 studies reported quality improvements for most evaluated measures, while other studies showed no difference in measured quality. Our study provides evidence that bundled-payment models have the potential to reduce medical spending growth while having either a positive impact or no impact on quality of care.
Topic:
Economics, Health, Health Care Policy, Income Inequality, Macroeconomics, Coronavirus, and COVID-19
Political Geography:
United States and Global Focus

6. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?

Author:
Roosa Tikkanen and Melinda K. Abrams
Publication Date:
01-2020
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
A 2015 Commonwealth Fund brief showed that — before the major provisions of the Affordable Care Act were introduced — the United States had worse outcomes and spent more on health care, largely because of greater use of medical technology and higher prices, compared to other high-income countries. By benchmarking the performance of the U.S. health care system against other countries — and updating with new data as they become available — we can gain important insights into our strengths and weaknesses and help policymakers and delivery system leaders identify areas for improvement. This analysis is the latest in a series of Commonwealth Fund cross-national comparisons that uses health data from the Organisation for Economic Co-operation and Development (OECD) to assess U.S. health care system spending, outcomes, risk factors and prevention, utilization, and quality, relative to 10 other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. We also compare U.S. performance to that of the OECD average, comprising 36 high-income member countries.
Topic:
Health and Health Care Policy
Political Geography:
United States, Europe, and Global Focus

7. What Is the Status of Women’s Health and Health Care in the U.S. Compared to Ten Other Countries?

Author:
Sara R. Collins, Shanoor Seervai, Roosa Tikkanen, and Munira Z. Gunja
Publication Date:
12-2018
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Women in the United States have long lagged behind their counterparts in other high-income countries in terms of access to health care and health status. This brief compares U.S. women’s health status, affordability of health plans, and ability to access and utilize care with women in 10 other high-income countries by using international data.
Topic:
Health, Health Care Policy, Women, and Reproductive Health
Political Geography:
United States and Global Focus

8. Paying for Prescription Drugs Around the World: Why Is the U.S. an Outlier?

Author:
Shawn Bishop, David Squires, and Dana O. Sarnak
Publication Date:
10-2017
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
arious factors contribute to high per capita drug spending in the U.S. While drug utilization appears to be similar in the U.S. and the nine other countries considered, the prices at which drugs are sold in the U.S. are substantially higher. These price differences appear to at least partly explain current and historical disparities in spending on pharmaceutical drugs. U.S. consumers face particularly high out-of-pocket costs, both because the U.S. has a large uninsured population and because cost-sharing requirements for those with coverage are more burdensome than in other countries. Most Americans support reducing pharmaceutical costs. International experience demonstrates that policies like universal health coverage, insurance benefit design that restricts out-of-pocket spending, and certain price control strategies, like centralized price negotiations, can be effective.
Topic:
Health, Health Care Policy, and Drugs
Political Geography:
United States, Europe, and Global Focus

9. Designing a High-Performing Health Care System for Patients with Complex Needs: Ten Recommendations for Policymakers

Publication Date:
09-2017
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Health care costs are heavily concentrated among people with multiple health problems. Often, these are older adults living with frailty, advanced illness, or other complex conditions. In 2014, the New York–based Commonwealth Fund, a private, independent foundation, established the International Experts Working Group on Patients with Complex Needs through a grant to the London School of Economics and Political Science. The group’s purpose was to outline the prerequisites of a high-performing health care system for “high-need, high-cost” patients and to identify promising international innovations in health care delivery for meeting needs of these patients. Drawing on international experience, quantitative and qualitative evidence, and its members’ collective expertise in policy and program design, implementation, and evaluation, the international working group sought to articulate the principles that underpin high performance for this complex population in health systems around the world.
Topic:
Health and Health Care Policy
Political Geography:
United States and Global Focus

10. Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities fo

Author:
Michelle M. Doty, Arnav Shah, David Squires, Dana O. Sarnak, and Eric C. Schneider
Publication Date:
07-2017
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands. Based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries’ approaches if it wants to achieve an affordable high-performing health care system that serves all Americans.
Topic:
Health and Health Care Policy
Political Geography:
United States and Global Focus

11. International Profiles of Health Care Systems

Author:
Elias Mossialos, Ana Djordjevic, Robin Osborn, and Dana O. Sarnak
Publication Date:
05-2017
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.
Topic:
Health and Health Care Policy
Political Geography:
United States and Global Focus

12. How High-Need Patients Experience the Health Care System in Nine Countries

Author:
Dana O. Sarnak and Jamie Ryan
Publication Date:
01-2016
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
U.S. health care costs are disproportionately concentrated among older adults with multiple chronic conditions or functional limitations—a population often referred to as “high-need” patients. This analysis uses data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults to investigate health care use, quality, and experiences among high-need patients in nine countries compared with other older adults. High-need patients use a greater amount of health care services and also experience more coordination problems and financial barriers to care compared with other older adults. Disparities are particularly pronounced in the United States. The comparative success of other countries, particularly in reducing financial barriers to care, may be a product of policies that specifically target high-need patients. Similarly focusing on these populations in the U.S. and effectively managing their care may improve their health status while reducing overall costs.
Topic:
Health and Health Care Policy
Political Geography:
United States and Global Focus