The American health care system, which spends more per person than any other industrialized nation but often reaps fewer rewards, should look toward European models for improvement, a panel of experts said at a Graduate School of Social Service forum on March 12.
Speaking at “Changing Health Care 2008: Lessons from Abroad,” panelists compared expenditures and outcomes in Germany, France, the Netherlands and elsewhere to those in the United States. The United States spends more than $6,400 per person annually—16 percent of its gross domestic product—on health care. By comparison, the next-highest nation is France at $3,400 per person.
“It really was the conventional wisdom that America has the best health care system in the world, but looking across the tables you see another story,” said Robin Osborn, vice president and director of The Commonwealth Fund’s International Program in Health Policy and Practice, which did a comparative survey of health systems abroad. “We spend more on hospital stays, more on doctors and more on drugs. We simply pay a lot more.”
Citing from the Fund’s study, Osborn noted that the United States falls behind in provider performance in many areas, including the number of medical/lab mistakes, implementation of electronic records, treatment of chronic illnesses, access to doctors and the fragmentation of medical care due to switching physicians or plans.
“No country is perfect, but we are not getting our value,” she said.
Katharina Janus, Ph.D., assistant professor in the Mailman School of Public Health at Columbia University, said that the German system, which spends $3,200 per person, prides itself on being based on the ethical principal of “solidarity,” offering the same services to everyone for approximately the same cost.
Germany has a social health insurance system and less than .5 percent of the population is uninsured, she said. Such a statutory health care system, she added, might be a way to improve coverage in the United States, where approximately 47 million Americans have no health insurance.
The large variation in health coverage among different socio-economic groups in the United States, experts noted, also was contributing to a systemic malfunction. Victor Rodwin, Ph.D., professor of health policy and management at the Wagner Graduate School of Public Service at New York University, cited his comparison of infant mortality rates between Manhattan and Paris.
Manhattan’s community districts fluctuated wildly, with infant mortality at 18.3 per thousand live births in Harlem and 4.8 in Greenwich Village. In Paris, averages across neighborhoods were much more level, making for an overall rate of 6.5. In the United States, he added, too much concentrated poverty and lack of education were other contributing factors.
“What good does it do to make a sick person well if you are going to send them back to a depressed neighborhood?” he asked.
The forum was co-sponsored by the Graduate School of Social Service’s Institute for Women and Girls, the Women’s City Club of New York, the New York Medical College School of Public Health, the Public Health Association of New York City and Rekindling Reform.