Our Healthcare System Is Only as Good as Estonia’s, Study Says

If any kind of consensus has emerged from our now nearly decade-long debate over health care in the United States, it's that the status quo is unacceptable. Even President Donald Trump, typically an "America First" kind of guy, admitted that our system is "failing," telling Australian Prime Minister Malcolm Turnbull, "you have better healthcare than we do." Of course, his attempted fixes have thus far been extremely dubious.

But just how bad is the US system, compared to other nations? According to the first-ever global study of quality of healthcare, published in The Lancet, it's…not great. As in, an overall score tied with Estonia and Montenegro and we spend way more than they do on healthcare.

Researchers looked at 195 countries, comparing access and quality of services from 1990 to 2015. To do so, they devised a Healthcare Access and Quality (HAQ) Index. It's based on death rates from 32 causes that could be avoided by timely and effective medical care. That's what's known as "amenable mortality"—these are deaths that, in an ideal system, shouldn't happen.

The paper breaks down each country's performance on those 32 diseases on a scale from 1 to 100, as well as assigning an overall score. The highest-scoring countries in 2015 tended to be in western Europe, with the lowest scores coming from sub-Saharan Africa and Oceania. The United States earned an 81, placing it in the second-best group, outpaced by western European countries like Switzerland (92) and Spain (90), as well as Japan (89), Canada (88), and, yes, Australia (90). The United Kingdom similarly underperformed with a score of 85.

The US scored 100 in managing common vaccine-preventable diseases like diphtheria, tetanus, and measles, despite our vocal contingent of anti-vaxxers. Yet in nine categories, the US scored in the 60s, including neonatal disorders (69), non-melanoma skin cancer (68), diabetes (67), Hodgkin's lymphoma (67), hypertensive heart disease (64), ischemic heart disease (62), chronic kidney disease (62), lower respiratory infections (60), and the adverse effects of medical treatment itself (68).

"America's ranking is an embarrassment, especially considering the US spends more than $9,000 per person on health care annually, more than any other country," Christopher Murray, senior author of the study, said in a statement. "Anyone with a stake in the current healthcare debate, including elected officials at the federal, state, and local levels, should take a look at where the US is falling short." The US spends $9,237 per person on healthcare every year while Estonia and Montenegro, countries we tied with at 81, spend $1,830 and $1,025 respectively.

The low grades helped drag down the US's overall score, but another important measure shows how our system fails. The researchers created what they called the HAQ Index frontier, which assesses the gap between how our healthcare should be doing (based on socio-demographic development) versus how it actually fares. "This gap highlights the untapped potential for improving healthcare based on a country's current resources," according to the authors. For the US, that number is 10.2, down from 14.8 in 1990. Improvement! But Australia's gap is only 1.1 and in Canada, it's 4.0.

As Murray says, the overall results are embarrassing. If we're being honest, though, that's not news—even Trump has admitted as much, even if he didn't have these new numbers to make his case. The question remains what, as a country, we're willing to do about it.

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