Research shows policy reforms may be needed to close the performance gap

The link between health and happiness is one of the best-documented in the study of well being. Simply put, one’s health overview—meaning access to care, affordability, and quality of outcomes—has a dramatic affect on one’s level of happiness. Specific health problems like heart disease, diabetes, and cancer clearly lower the well-being of individuals. At the national level, countries with higher levels of infant mortality and lower life expectancy are less happy than those where infant mortality is low, and life expectancy high (or increasing). One could extend the examples, but the pattern is clear: at both the individual and aggregate level, health promotes happiness.

But the connections are more complex than these simplistic summary would suggest. Other determinants of unhappiness—including poor working conditions, unemployment, poverty—are themselves strongly associated with poor health outcomes, especially in the absence of universal access to (quality) care. More generally, financial insecurity (especially fear of unemployment or underemployment) contribute to chronic stress and anxiety, among other psychological problems, that in turn are detrimental to physical well-being. All of these conditions are clearly determined in part by our economic and social policies, which we can—if we wish—change so as to maximize our health and happiness. It is in this context that an important new study of cross-national health patterns by the non-partisan Commonwealth Fund warrants attention.

This comprehensive and detailed study examined five aspects of healthcare systems, considering both observable outcomes and the institutional structure providing care. “Care Process” integrates 24 measures on the overall quality of patient interactions with the health care system (such use of preventive measures like mammography screening). “Access” utilizes six measures of affordability and nine measures of timeliness. “Administrative Efficiency” uses seven measures of the difficulty of the process by which patients navigate the health care system (including such measures as doctor evaluations of care be affected by administrators denying access to treatment). “Equity” uses 11 measures to ascertain the extent of different experiences by income groups. Most importantly, “Health Care Outcomes” assesses the bottom line of how well the system treats people using nine measures (such as the breast cancer and heart attack survival rates, as well as overall health measures).

The United States does not receive high marks. Overall, despite a level of spending that dwarfs the other countries in the study, the U.S. comes in dead last in three of the five, and arguably the most important three, of the five domains: health outcomes, equity, and access. We are tied for last on administrative efficiency and about average on care process. The U.S. is also last in their summary indicator aggregating all five dimensions.

The bottom line, and the paper’s most basic conclusion, is that “the performance of the U.S. health care system ranks last compared to other high-income countries.”

The study also finds that the “U.S. has the highest rate of mortality amenable to health care.” More people die unnecessarily in the U.S. due to inadequate care, or the pure absence of care, than any in any of country in the study. The issue is not merely problems in the American life style, Americans die more than Europeans because of poor quality health care or lack of access to care. It is that simple.

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