Even for Wealthy, US Healthcare Fails to Match Care in Many Other Countries

By Linda Carroll

December 29, 2020

(Reuters Health) - When it comes to health care, even privileged white Americans fare worse than the average citizens of 12 other developed countries, a new study suggests.

Researchers compared health outcomes of white Americans in the top 5% of rich counties to those of average patients from 12 other nations. In many areas, such as infant mortality, maternal mortality and heart attack survival, U.S. patients fared worse, the researchers reported in JAMA Internal Medicine.

Breast cancer survival was the only area in which wealthy white American patients fared better than average patients from all of the comparison countries.

"The most privileged white Americans do not get the world's best health care across a variety of areas," said study leader Dr. Ezekiel Emanuel, co-director of the Health Care Transformation Institute and vice provost for Global Initiatives at the University of Pennsylvania. "In a few they do, but mostly they don't."

Many Americans, especially the wealthy ones, think they are getting the best care possible, Dr. Emanuel said. "But having the head of the hospital come to meet you in your nice private room doesn't equate with quality care," he added.

Dr. Emanuel hopes the new study will be a wakeup call for both patients and clinicians.

The 12 other countries in the study were Australia, Austria, Canada, Denmark, Finland, France, Germany, Japan, the Netherlands, Norway, Sweden and Switzerland.

In many respects, average citizens of at least some of those countries fared better than the most privileged Americans. For example, infant mortality in the top 1% of highest-income U.S. counties is 3.54 per 1,000 live births. In Finland, by comparison, the infant mortality rate is 1.7 per 1,000 live births.

The infant mortality rate among those living in the top 5% of highest-income counties was 4.01 per 1,000 births, a rate higher than that of all 12 comparison countries. The average rate in America 5.9 deaths per 1,000 live births.

Maternal mortality among white women living in the 1% highest income counties in the U.S. is 10.05 per 100,000 births (it's 26.40 per 100,000 overall in the U.S.). Of the 12 countries examined by the researchers, Canada and France had the highest maternal mortality at 6.0 deaths per 100,000 births and 5.10 deaths per 100,000 births, respectively.

Wealthy patients suffering heart attacks in the U.S. also fared worse than average patients in Norway and Denmark. The 30-day mortality rate of Americans living in the richest 1% of counties was 12.7% as compared to a rate of 10.2% in average Norwegians and 10.7% in average Danes.

The only bright spots for privileged white Americans were breast and colon cancer. The five year survival rate for U.S. women with breast cancer living in the richest 5% of counties was 92.6%, which was similar to average rate in 11 of the comparison countries and exceeding just one.

Five year survival rates for colon cancer in the 5% highest income counties was 67.2%, which was higher than that of average Americans (64.9%) and average citizens of six of the comparison countries, comparable to the rate for average citizens in four countries and lower than the rate for average citizens of two countries.

Dr. Emanuel sees two possible explanations for the better breast cancer results. First, he credits women putting collective pressure on the health care system and demanding better outcomes. Second, the high rates of mammography, which can detect very small tumors, may be improving the survival rates in the U.S.

The big problem with health care in the U.S. is fragmentation, Dr. Emanuel said. And while having a single payer system might improve that, there are other ways of attaining the same goal, he said.

The new paper highlights the misconception Americans have that "healthcare in this country is the best in the world," said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

"The paper shows that even privileged white U.S. citizens do not have consistently better outcomes than the average residents of a comparison group of developed countries," Dr. Wu said. "In fact when it comes to outcomes for infant and maternal mortality, as well as the 30-day death rate after a heart attack, privileged white citizens generally fare worse."

"This paper reinforces the message that it's the system of health care that matters," Dr. Wu said. "And it supports an argument for universal health care or national health insurance."

SOURCE: https://bit.ly/34PNEma JAMA Internal Medicine, online December 28, 2020.