Gauging the quality of health care systems is often difficult and restricted by the availability of data. One method for measuring quality is to look at mortality rates. Mortality rates can be influenced by a myriad of factors, one of which is the quality of the health care system for diseases where mortality is amenable to health care. The mortality rate (number of deaths per 100,000 people, adjusted for age differences across countries) has been falling in the U.S. and in comparable countries (those with total GDP and GDP per capita above OECD median levels).
Researchers have looked at mortality that results from medical conditions for which there are recognized health care interventions that would be expected to prevent death. While the health care system might not be expected to prevent death in all of these instances, differences in mortality for these conditions provides information about how effectively health care is being delivered. In 2006, the last year for which reasonably complete information is available, the U.S. had the highest mortality rate for deaths amenable to health care among the comparable OECD countries.
Potential Years of Life Lost (PYLL) is a measure of premature death. The U.S. and comparable OECD countries have made progress in reducing PYLL’s over the last thirty years, although the U.S. continues to trail the comparable country average by a significant margin (4,629 v. 2,982 PYLLs per 100,000 population in 2010).
Disability adjusted life years (DALYs) are a measure of disease burden and the rate per 100,000 shows the total number of years lost to disability and premature death. Though DALYs have declined in the U.S. and comparable countries since 2000, the U.S. continues to have higher age-adjusted rates than those of comparable countries.
Hospital admissions for certain chronic diseases like circulatory conditions, asthma, and diabetes, can arise when prevention services are either not being delivered or adhered to. Hospital admission rates in the U.S. are higher than in comparable countries for congestive heart failure (which is often caused by unmanaged high blood pressure), asthma, and complications due to diabetes. However, the U.S. has lower rates of hospitalization for uncontrolled diabetes than comparably wealthy countries do on average.
Lower extremity amputations due to diabetes are higher in the U.S. than in comparable countries, however the U.S. is making significant progress as the rate of such amputations has decreased by 54% between 2006 and 2010.
Mortality within 30 days of being admitted for a hospital stay is not entirely preventable, but can be reduced for certain diagnoses and services. Improvement in this area is often linked to improved quality of care. The 30-day mortality rates for heart attacks (acute myocardial infarction) and ischemic strokes (caused by blood clots) are lower in the United States than in comparable countries.
According to a recent international survey by the Commonwealth, the U.S. has higher rates of medical, medication, and lab errors than comparable countries. This includes medical mistakes, incorrect medications or dosages, lab test errors, or delays receiving abnormal test results.
Another way to measure the quality of the health care system is to ensure patients are receiving recommended care without additional harm. Post-operative pulmonary embolisms or deep vein thrombosis (DVT) are more prevalent in the U.S. than in comparable countries. Post-operative sepsis and wound dehiscence are similar in the U.S. and comparable countries.
The frequency with which surgical items are retained or fragments of surgical devices are un-retrieved from the patient is higher in the U.S. than in comparable countries. However, there has been a 13% decrease in the U.S. while there has been an 8% increase in comparable countries between 2006 and 2010.
Obstetric trauma during vaginal delivery happens more frequently in the U.S. than in comparable countries, but there has been some improvement in the U.S. between 2008 and 2010.
The five-year survival rates for breast cancer and colorectal cancer in the U.S. are slightly higher than in comparable countries, but the survival rate for cervical cancer is slightly lower. The gap in survival rates between the U.S. and comparable countries is beginning to close. While mortality rates are used to measure the outcomes for most diseases, the quality of cancer care is often assessed through five-year survival rates. The use of five-year survival rates versus mortality rates has been debated recently, though, as survival rates may be more heavily influenced by the time of diagnosis than the actual longevity of the patient. One study also found that while the U.S. outperforms comparable countries on survival rates for breast and colorectal cancer, this is not the case for all cancers, including lung cancer.
While there is debate over the best way to measure outcomes for cancer, the U.S. typically performs better in both mortality rates and five-year survival rates for breast and colorectal cancer. In 2010, the mortality rate for breast cancer in the U.S. was slightly better than the comparable country average. During the same period, there was about a 29% difference in the mortality rate for colorectal cancer in the U.S. (17.6%) and the comparable country average (22.7%).
The mortality rate for all cancers (neoplasms) has fallen in the U.S. and in comparable countries over the last 30 years. In the U.S., the age-adjusted cancer rate has fallen from about 242 deaths per 100,000 population in 1980 to about 203 per 100,000 in 2010.
The U.S. and other countries have made dramatic progress in lowering mortality from diseases of the circulatory system. In the U.S., the mortality rate has fallen from 629 deaths per 100,000 population in 1980 to 265 in 2010.
Mortality rates for respiratory diseases have fallen over the last 10 years in the U.S. and across comparable countries.
After rising significantly between 1985 and 1995, mortality rates for these disease have fallen steadily, although they remain substantially higher than the average rate in comparable countries.
According to a recent international survey by the Commonwealth, patients in the U.S. experience more cost-related barriers to accessing care than patients in comparable countries. Cost barriers prevent 37% of American adults in 2013 from filling prescriptions, visiting a doctor for a medical problem, and from receiving recommended care.
According to a recent international survey by the Commonwealth, with the exception of Canada, the U.S. has longer waits for an appointment when patients are sick and need care than comparable countries.
According to a recent international survey by the Commonwealth, patients in the U.S. visit the emergency department for conditions that could have been treated by a regular doctor or place of care more often than people in most comparable countries.