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  • Author: Melinda K. Abrams, Reginald D. Williams II, Katharine Fields, 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, Substance Abuse
  • Political Geography: United States, Europe, Global Focus
  • Author: Laurie Zephyrin, Molly FitzGerald, Munira Z. Gunja, 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, Reproductive Health
  • Political Geography: United States, Global Focus
  • Author: Michelle M. Doty, Eric C. Schneider, Roosa Tikkanen, Arnav Shah, 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, Public Health
  • Political Geography: United States, Europe, Global Focus
  • Author: Meredith B. Rosenthal, Paul F. van Gils, Caroline A. Baan, Eline F. de Vries, 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, COVID-19
  • Political Geography: United States, Global Focus
  • Author: Roosa Tikkanen, 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, Health Care Policy
  • Political Geography: United States, Europe, Global Focus
  • Author: Sara R. Collins, Shanoor Seervai, Roosa Tikkanen, 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, Reproductive Health
  • Political Geography: United States, Global Focus
  • Author: Shawn Bishop, David Squires, 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, Drugs
  • Political Geography: United States, Europe, Global Focus
  • 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, Health Care Policy
  • Political Geography: United States, Global Focus
  • Author: Michelle M. Doty, Arnav Shah, David Squires, Dana O. Sarnak, 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, Health Care Policy
  • Political Geography: United States, Global Focus
  • Author: Elias Mossialos, Ana Djordjevic, Robin Osborn, 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, Health Care Policy
  • Political Geography: United States, Global Focus
  • Author: Dana O. Sarnak, 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, Health Care Policy
  • Political Geography: United States, Global Focus