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US healthcare ‘one of least cost-effective’


The USA has one of the least cost-effective healthcare systems in the Western world, according to a study published in the Journal of the Royal Society of Medicine.

Compared to the healthcare systems of 17 other Western countries, the USA finished at the bottom, alongside Switzerland and Portugal, while the UK and Ireland were top.

The biggest factors taken into account during the study period of 1979 to 2005 were reduced mortality rates (considered the key goal of any healthcare organisation) and gross domestic product health expenditure (GDPHE).

Ireland (48%), Australia (47%) and the UK (46%) recorded the greatest reduction in mortality rates, with Portugal (18%) and the USA (28%) recording the least.

Once GDPHE was taken into account, Ireland (1:1,817), the UK (1:1,490) and New Zealand (1:1,451) boasted the best cost-effectiveness ratios, while Switzerland (1:347), Portugal (1:434) and the USA (1:515) revealed the worst.

Professors Colin Pritchard from Bournemouth University, UK, and Mark Wallace from Latymer School, London, UK, led the study, which was devised to test the theory that the USA had a superior healthcare system to the UK’s National Health Service (NHS).

The authors themselves acknowledged inherent flaws in the use of both economic and mortality data, given the confluence of factors affecting both.

Similarly, they noted that the results were rather dependent upon whether or not initial mortality rates were high.

“In countries like Switzerland, with high average GDPHE and below the mean mortality rate, such countries can only have relatively marginal improvements,” wrote the authors.
“Whereas, the USA, with high average GDPHE but relatively high initial mortality rate, had greater opportunity for improvement, but their mortality rate worsened and is now significantly above the Western mean.”

The study provides an important step in the international application of cost-effectiveness in evaluating the performance of healthcare systems, especially at a time when most Western governments are looking for means and justifications for cost containment, the authors concluded.

It is hoped that the results will help reinforce the perception that cost-effectiveness parameters are needed, both in terms of assessing how healthcare systems are performing, and also as a tool of healthcare rationing by itself.

Journal of the Royal Society of Medicine

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