This collection of charts and a related brief explore a number of different metrics used to look at health outcomes, quality of care, and access to services. Inconsistent or unavailable data and imperfect metrics make it difficult to firmly judge system-wide health quality in the U.S., but a review of the data we do have suggests that the system is improving across each of these dimensions, though it continues to lag behind comparably wealthy and sizable countries in many respects.
Bench-marking U.S. quality measures against those of similarly large and wealthy countries is one way to assess how successful the U.S. has been at improving care for its population, and to learn from systems that often produce better outcomes. The OECD has compiled data on dozens of outcomes and process measures. Across a number of these measures, the U.S. lags behind similarly wealthy OECD countries (those that are similarly large and wealthy based on GDP and GDP per capita). In some cases, such as the rates of all-cause mortality, premature death, death amenable to healthcare, and disease burden, the U.S. is also not improving as quickly as other countries, which means the gap is growing.
Mortality rates have fallen steadily in the U.S. and in comparable countries
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. From 1980 to 2015, the overall mortality rate in the United States fell 29%, compared to a 54% decline in comparable countries.
The U.S. has poorer rates of Amenable Mortality, as measured by the Healthcare Access and Quality Index
Mortality amenable to healthcare is a measure of the rates of death considered preventable by timely and effective care. While the health care system might not be expected to prevent death in all instances, differences in amendable mortality indicate how effectively health care is delivered. The Healthcare Access and Quality (HAQ) Index is based on amenable mortality and uses age-standardized, risk-standardized mortality rates for 32 causes that timely and effective health care could potentially prevent. Based on data from the Global Burden of Disease Study, the HAQ Index is scaled from 0 to 100: lower scores indicate high mortality rates for causes amenable to health care, while higher scores indicate lower mortality rates and thus better quality of and access to health care. The U.S. ranks last among comparable countries on the HAQ index with a score of 88.7.
Potential Years of Life Lost have fallen steadily in the U.S. and in comparable countries
Premature deaths are measured in Years of Life Lost (YLL), which is an alternative to overall mortality rate. It is measured by adding together the total number of years that people who died before an specified age (e.g. 70) would have lived if they had lived to that age. For example, a person who dies at age 45 would have a YLL of 25. As a measure, it provides more weights to deaths at younger ages. The U.S. and comparable OECD countries have made progress in reducing YLL’s over the last 25 years (down 23% and 42% respectively), although the U.S. continues to trail comparable countries by a significant margin (12,282 v. 7,764 YLLs in 2017).
Disease burden is higher in the U.S. than in comparable countries
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. In 2017, the DALYs rate was 31% higher in the U.S. than the comparable country average.
Hospital admissions for preventable diseases are more frequent in the U.S. than in comparable countries
Hospital admissions for certain chronic diseases like circulatory conditions, asthma, and diabetes, can arise when prevention services are either not being adhered to or delivered. Hospital admission rates in the U.S. are higher than in comparable countries for congestive heart failure, asthma, and complications due to diabetes. However, the U.S. has lower rates of hospitalization for hypertension than comparably wealthy countries do on average. In total across these four disease categories, the United States has a 37% higher rate of hospital admissions than the average of other countries.
30-day mortality for heart attacks and ischemic stroke are lower in the U.S. than in comparable countries
Mortality within 30 days of being admitted to a hospital 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 ischemic strokes (caused by blood clots) is 4.2 deaths per 100 patients in the United States, compared to an average of 6.9 deaths per 100 patients in similar countries. The 30-day mortality rates after hospital discharge for heart attacks (acute myocardial infarction) and hemorrhagic stroke (caused by bleeding) are similar in the U.S. and comparable countries.
The U.S. has higher rates of medical, medication, and lab errors than comparable countries
According to a recent survey by the Commonwealth Fund, patients in the United States are more likely than those in comparable countries to experience a medical error at some point during their care. In this case, medical errors include being given the wrong medication or dose, or experiencing delays or errors in laboratory test results. In 2016, 19% of patients in the United States experienced a medical error compared to 12% of patients in similar countries.
Post-op clots are less common in the U.S. than in some comparable countries
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 are most common after major surgeries, such as hip or knee replacement. The combined prevalence of post-operative clots for these procedures is 23% lower in the United States than comparable countries.
Post-op sepsis is less prevalent in the U.S. than in some comparable countries
Sepsis is a life-threatening condition that occurs when an infection within the body is either resistant to treatment or goes untreated. During and after surgery, the likelihood of a patient becoming septic can be greatly reduced by following proper safety and cleanliness precautions as outlined by the World Health Organization. The rate of post-operative sepsis following abdominal surgery is just above 2% in the United States, slightly lower than the average in similar countries that report data.
Post-op suture ruptures are more common in the U.S. than in comparable countries
Multiple factors can cause wound dehiscence, including faulty stitches or infection. Wound dehiscence and suture ruptures following major surgery are associated with longer hospital stays or readmission, more expensive healthcare costs, and increased morbidity. In 2015, post-operative wound dehiscence was 107% more common in the United States than in comparable countries that reported data.
Obstetric trauma during vaginal delivery is more common in the U.S. than some comparable countries, but only when instruments are involved
Obstetric trauma is more likely to occur in deliveries where instruments are utilized (i.e. forceps). Among comparable countries, the U.S. has the lowest rate of obstetric trauma during deliveries without an instrument (1.4 per 100 vaginal deliveries). However, the rate of obstetric trauma during deliveries with an instrument in the U.S. is 9.6 per 100 vaginal deliveries, higher than the comparable country average of 8.8 per 100.
Mortality rates for breast, colorectal, and cervical cancers in the U.S. are lower than in comparable countries
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 cancer. In 2015, the mortality rate for breast and cervical cancers in the U.S. was slightly lower than the comparable country average. For colorectal cancers, the U.S. has a mortality rate of 16.5 deaths per 100,000 population, compared to the average rate of 22.9 per 100,000 in similar countries.
The mortality rate for cancers has been falling in the U.S. and across comparable countries
The mortality rate for all cancers has fallen steadily in the U.S. and in comparable countries over the last 35 years. In the U.S., the age-adjusted mortality rate for cancers fell 21% from about 242 deaths per 100,000 population in 1980 to about 190 per 100,000 in 2015. The comparable country average fell 23% over the same period, from 262 deaths per 100,000 to 203.
Mortality rates for diseases of the circulatory system have fallen dramatically over the last 35 years
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 257 in 2015. Although the U.S. mortality rate for diseases of the circulatory system has improved by 59%, similar countries have seen an average improvement of 65% over the same time period.
The mortality rate for respiratory diseases is higher in the U.S. than in comparably wealthy countries
Mortality rates for respiratory diseases fell over the last 10 years in the U.S. and across comparable countries, however both experienced upticks from 2014-2015. From 1980 to 2015, the US mortality rate for respiratory diseases increased by 6%, while comparable countries experienced a 32% decline.
Mortality rates for endocrine, nutritional and metabolic diseases have fallen over the last 20 years
After rising significantly between 1985 and 1995, mortality rates for endocrine, nutritional, and metabolic diseases have fallen steadily, although they remain substantially higher in the United States than the average rate in comparable countries. Overall, the United States has experienced a 32% increase in mortality for these disease categories over the last 35 years. Similar countries have seen mortality rates for these diseases remain relatively stable, only decreasing around 5% since 1980.
Adults in most comparable countries have quicker access to a doctor or nurse when they need care
With the exception of Canada and Sweden, patients in the United States have a harder time making a same-day appointment when in need of care. In 2016, 51% of patients in the United States were able to make a same-day appointment with a provider, compared to 57% of patients in similar countries.
Use of the emergency department in place of regular doctor visits is more common in the U.S. than in most comparable countries
According to a recent survey by the Commonwealth Fund, patients in the U.S. visit the emergency department for conditions that could have been treated by a regular doctor or place of care nearly twice as often as in comparable countries. In similar countries, 9% of patients visited an ER for non-emergency care, compared to 16% of patients in the U.S.