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Determined to Despair

June 17, 2014
4:18 pm

If you’re following health news this week, the predominant message you’re getting is that the United States health system is in exceedingly bad shape, at least compared to other prosperous nations around the world.  The left-leaning Commonwealth Fund released one of its periodic reports telling us that the U.S. ranks last in healthcare quality, access and other selected categories compared to ten other developed nations including Canada and the United Kingdom.

The report has received broad visibility from media outlets, most of which have reported the Commonwealth findings as presented without challenging or even questioning the report’s methodology.  Thus, we’re left with the understanding that healthcare in the United States is far inferior to those nations with systems in which government plays a much stronger role.

There are some, though, who have closely reviewed Commonwealth’s work and are saying the situation for the United States is not as relentlessly grim as the Fund is telling us.

Philip Klein in the Washington Examiner writes that the Commonwealth report is “rigged” to favor countries with government-run universal healthcare system, noting that the study gives high priority to “equity” while leaving out consideration of medical innovation.

He wrote, “It’s an ideological decision to view equity as one of the most important factors in judging a health care system, just as it is for the study to leave out a factor such as medical innovation, which would work to the advantage of the U.S., or choice, which would work against the centralized NHS (the U.K.’s National Health Service).”  Klein also writes that the U.S. ranks ahead of the U.K. in five-year survival rates for 22 of the 23 types of cancer, another success story in this country that didn’t find its way into the Commonwealth Fund methodology.

And Avik Roy, opinion editor for Forbes, wrote in National Review that the Commonwealth study relies not on hard data, but rather subjective surveys.  He wrote, “While it is interesting to look at such surveys, it is simply not serious to draw hard conclusions from them.  U.S. consumer culture is famously more demanding than that of other developed countries; while Americans still defer to their doctors and pharmacists, they do so appreciably less than Europeans do.  They are more likely to suspect error, and far more likely to sue if they believe an error has been made.  An international poll that does not even attempt to normalize for these cultural differences is not informative.”

Thus, Roy notes, Commonwealth gives the United Kingdom higher marks than the United States on timeliness of care even though the U.K. is notoriously poor in this department and certainly well below the U.S., where waiting times for care are significantly less than those in other countries.

There is no question that there is significant room for improvement in the U.S. healthcare system, and those involved in all sectors of healthcare are working every day to achieve higher standards.  The Commonwealth report, though, paints a darker picture than is justified by reality.

Research and Healthcare’s Cost-Quality Challenge

June 10, 2014
1:36 pm

The Healthcare Leadership Council has long maintained that the nation can’t make its way toward a high-quality, cost-effective, sustainable healthcare system simply through arbitrary cuts in healthcare expenditures and controlling prices through government fiat.  The importance of targeted research to better understand how to improve the efficacy of healthcare delivery and achieve a higher level of population health can’t be overstated.

That’s why we’re keeping a close eye on the comparative effective research being undertaken by the Patient-Centered Outcomes Research Institute.  An important tool in this observation is the annual survey of healthcare stakeholders conducted by the National Pharmaceutical Council (NPC) health policy research organization.  NPC has just released the results of its fourth annual survey of insurers, government leaders, employers and others who have a strong interest in the progress of comparative effectiveness research.  Some of the facets of the survey we found most interesting include:

•    A large majority – 84 percent – feel this research has had very little impact on healthcare decisionmaking over the past year, but are confident it will have a greater effect in the next three to five years.

•    Stakeholders see a public-private partnership in the way healthcare research is conducted.  According to the survey, they believe academia and the pharmaceutical industry will conduct most of the actual research in the years to come, but PCORI and the National Institutes of Health will be the leading players in funding and monitoring research.

•    More stakeholders are saying that research priorities are adequately addressing the real-world choices faced by patients and providers – 37 percent now, up from 22 percent last year.

We believe comparative effectiveness research can be a valuable tool, if it is used to provide the different sectors of the healthcare community with the kind of information that can improve clinical effectiveness for all patients and healthcare consumers.  The NPC survey provides an important measuring stick on this evolving linkage between data and healthcare practice.