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1. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes

Author:
Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II
Publication Date:
01-2023
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
In the previous edition of U.S. Health Care from a Global Perspective, we reported that people in the United States experience the worst health outcomes overall of any high-income nation.1 Americans are more likely to die younger, and from avoidable causes, than residents of peer countries. Between January 2020 and December 2021, life expectancy dropped in the U.S. and other countries.2 With the pandemic a continuing threat to global health and well-being, we have updated our 2019 cross-national comparison of health care systems to assess U.S. health spending, outcomes, status, and service use relative to Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom. We also compare U.S. health system performance to the OECD average for the 38 high-income countries for which data are available. The data for our analysis come from the Organisation for Economic Co-operation and Development (OECD) and other international sources (see “How We Conducted This Study” for details). For every metric we examine, we used the latest data available. This means that results for certain countries may reflect the height of the COVID-19 pandemic, when mental health conditions were surging, essential health services were disrupted, and patients may not have received the same level of care
Topic:
Health, Health Care Policy, Inequality, and Finance
Political Geography:
North America and United States of America

2. 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

3. Are Financial Barriers Affecting the Health Care Habits of American Men?

Author:
Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II
Publication Date:
07-2022
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Whether it’s stubbornness, an aversion to appearing weak or vulnerable, or other reasons, men go to the doctor far less than women do.1 While behavioral and cultural norms may have a lot to do with the care-seeking habits of American men, the fact remains that the United States is the only high-income country that does not ensure all its residents have access to affordable health care. Roughly 16 million U.S. men are without health insurance, and affordability is the reason that people most often cite for why they do not enroll in a health plan.2 Do income level and financial stress help explain why men do not get needed care and experience worse health outcomes? Using data from the Commonwealth Fund’s 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development (OECD), we compare health care accessibility, affordability, and health status for adult men in 11 high-income countries. We also examine measures of income and income-related stress, where the data allow, to understand the role income insecurity might play in American men’s relatively low use of health care.
Topic:
Health, Finance, Medicine, and Gender
Political Geography:
North America and United States of America

4. 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

5. 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

6. 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

7. 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

8. 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