Wide variation in morbidity and mortality are still observed across countries with similar levels of socioeconomic and educational attainment. This variation is due to differences in health system performance. Variations in the “design, content and management of health systems translate into differences in a range of socially valued outcomes such as health, responsiveness and  fairness” (Murray). Therefore, policy makers are required to identify key indicators to assess every country’s healthcare system, in the hope of improving it. Consistent with the World Health Organization’s framework, the three most suitable criteria that should be included in this universal assessment are clinical outcomes, insurance coverage for vulnerable populations, and rationing.  

More often than not, countries have agreed to use mortality rates as the universal health outcome. From 1980 to 2015, the overall mortality rate in the United States and other comparable countries have declined significantly. However, compared to the average 54% decrease of death in other developed countries, the United States had only managed to reduce 29% of its mortality rate. In addition, the United States also ranks last among comparable OECD countries for amenable mortality rate. Defined as “a measure of the rates of death considered preventable by timely and effective care” (Kurani), amenable mortality rate is often used to indicate how effectively health care is provided. The data shows that the United States continues to trail behind other OECD countries by a significant margin in both clinical outcomes and effective care. 

Besides health outcomes, insurance coverage for vulnerable populations is also important in assessing the health system because it is associated with healthcare equity, one of the World Health Organization’s main goals. Discrepancies in healthcare are not only affecting the group facing inequity, but also limit general gains in quality of care for the broader population which result in economic loss. In the United States, inequities within the health system remain a problem. According to the Commonwealth Fund, “people with socioeconomic disadvantages have greater difficulty obtaining healthcare, receiving lower-quality care and have poorer health outcomes” (Tikkanen).  This is worse for those who live in rural and frontier communities. Counterintuitively, the United States, which is an OECD country, rank last in terms of healthcare equity when compared to other eleven developed nations. This is so because health disparities in America is exacerbated by its preferential distribution of health goods, driven by the country’s historical discrimination of gender, race/ethnicity and socioeconomic status.          

Along the same line, the last criteria also deals with questions of fairness. Rationing is included as one of the universal indicators because it is unavoidable in every country. Described as “the allocation of scarce resources, which in healthcare necessarily entails withholding potentially beneficial treatments from some individuals” (Scheunemann) rationing is inevitable because needs are boundless, while resources are not. Rationing in the United States is not as prevalent as it is in European countries. While European countries ration due to national budget constraints and limited supply, “the United States’ lack of access to comprehensive insurance and affordable care represent a de facto form of rationing that leads people to delay getting care or going without it entirely” (Tikkanen). The United States has the highest rate of patients skipping needed care due to cost compared to Germany, the Netherlands, Switzerland and  Sweden. Approximately 1 out of 3 Americans are underinsured due to the health deductibles that are disproportionately higher than their incomes. 

The United States continues to fall behind other OECD countries. It has slower progression in all three universal indicators of health systems: clinical outcomes, coverage for vulnerable population, and rationing. This becomes a problem when the United States currently ranks highest in healthcare spending among the developed nations of the world. It is imperative for the United States to analyze why its high deductibles, unpredictable copayments and health care prices are not reflected in its quality of care. We live in a world where financial resources alone are often not enough to solve complex problems embedded within a system — and health is not immune to the consequences of this truth.

References:

Kurani, Nisha. “How Does the Quality of the U.S. Healthcare System Compared to Other Countries?” Peterson-KFF Health System Tracker, 20 Aug. 2020, www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-hospital-admission -rate -for-asthma-heart-failure-hypertension-and-diabetes-2015. 

Murray, Christopher JL, and Julio Frenk. “A WHO Framework for Health System Performance Assessment.” Health Policy , World Health Organization, 2006, www.who.int/healthinfo/paper06.pdf. 

Scheunemann, Leslie P, and Douglas B White. “The Ethics and Reality of Rationing in Medicine.” Chest, American College of Chest Physicians, Dec. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3415127/. 

Tikkanen, Roosa, and Robin Osborn. Does the United States Ration Health Care? Commonwealth Fund, 11 July 2019, www.commonwealthfund.org/blog/2019/does-united-states-ration-health-care.