1	Why The United States Is So Different From Other Countries
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4	Is US Spending? Too High Too Low About Right How Would You Know?
5	Heresy For Americans: Learning From Other Countries
6	Health Care Spending per Capita in 2002
7	Health Care Spending per Capita in 2002
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9	Why Is The U.S. So Much More Expensive? Is Prices Stupid
10	U.S. Health Expenditures, 2002
11	Hospital Spending per Capita in 2002
12	Percentage of Total Health Care Spending on Hospital Care in 2002
13	Annual Hospital Inpatient Acute Care Days per Capita in 2002
14	Hospital Expenditures per Day in 2002
15	Similar Message For: Physicians Drugs
16	Relative Prices of Thirty Pharmaceuticals in Four Countries, 2003
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19	I do not mind paying more if I get more…
20	Are Clinical Outcomes Better in U.S.? Is Satisfaction Higher in U.S.?
21	Life Expectancy in 2002
22	Infant Mortality in 2002
23	These two indicators: - Life expectancy - Infant mortality May not be highly related to medical care spending
24	“We have the best health care in the world”
25	We examined 21 Indicators Where Medical Care Could Make A Difference
26	Cooperation of senior government officials from: U.S. U.K. New Zealand Australia Canada Published May/June issue of Health Affairs
27	Breast Cancer 5 Year Survival Rates
28	Cervical Cancer 5 Year Survival Rates
29	Kidney Transplant 5 Years Survival Rates
30	Mortality Rate per Million Asthmatics Age 5-39, 1990-1999
31	Summary For 21 Clinical Indicators No country consistently on top or on bottom on all indicators Each country best and each country worst on at least one indicator
32	Summary For U.S. No evidence to support claim: “We have the best health care in the world”
33	What About Satisfaction? Are we more satisfied with our health care system or own health care?
34	What’s Important? Institute of Medicine Crossing the Quality Chasm report uses six criteria to judge health care: • Patient safety • Patient-centeredness • Timeliness • Efficiency • Effectiveness • Equity
35	Patient Survey Design Commonwealth Fund surveys:2001 and 2002 Sampled “sicker” patients who would be using the health care system • Reported fair or poor health, or • Past two years hospitalized, major surgery or reported serious illness or injury requiring intensive medical care in past two years
36	Patient Safety U.S. ranked last overall • Wrong Rx past 2 years (12%) • Medical mistake in treatment (18%) U.K. ranked best overall • Wrong Rx past 2 years (10%) • Medical mistake in treatment (9%)
37	Patient Centeredness U.S. ranked next to last overall • Physician not listening to concerns (17%) • Physician not spending enough time (21%) New Zealand ranked best overall • Physician not listening to concerns (8%) • Physician not spending enough time (10%)
38	Timeliness U.S. ranked third overall • Long waits for hospital admission (13%) • Wait 5 or more days for appointment (18%) New Zealand ranked best overall • Long waits for hospital admission (24%) • Wait 5 or more days for appointment (1%)
39	Efficiency U.S. ranked last overall • Sent for duplicate tests by different MDs (22%) • Medical records or test results not in time (25%) Australia ranked best overall • Sent for duplicate tests by different MDs (13%) • Medical records or test results not in time (14%)
40	Effectiveness U.S. tied for last overall • Not getting test or follow-up due to cost (26%) • Not filling prescription due to cost (35%) U.K. ranked best overall • Not getting test or follow-up due to cost (5%) • Not filling prescription due to cost (10%)
41	Equity • U.S. ranked last for low income patients • Patients having problems paying bills (35%) • Unable to get care in community (28%) • U.K. ranked best overall • Patients having problems paying bills (4%) • Unable to get care in community (14%)
42	Physician Perspective Across Countries Ability to provide quality care gotten worse in past 5 years • U.S. ranks next to highest at 57% • Australia ranks lowest at 38% Very concerned quality will decline in future • U.S. ranks next to highest at 53% • U.K. ranks lowest at 39%
43	Conclusion Overall, substantial levels of dissatisfaction by patients and physicians with quality of U.S. health system
44	Conclusion U.S. Not getting value for dollar spent • substantially higher prices • no better quality • no higher satisfaction