Health care hits, misses.......as of May 2004

THE HEALTH systems of developed countries all have their own strengths and weaknesses and none outshines the others in every respect.

That sounds like Pollyanna. It's also the conclusion of a survey of health care quality in five nations - the U.S., Britain, Canada, Australia and New Zealand - sponsored by the Commonwealth Fund, a U.S. foundation that supports health and social research.

The study, conducted by doctors at Johns Hopkins University, found Canada has the highest five-year survival rates for childhood leukemia (81 per cent) and kidney and liver transplants (94 per cent and 87 per cent, respectively).

These ranged from 11 to 16 percentage points higher than the next best performer, something clearly to be proud of.

On the downside, Canada had the highest fatality rate (11.1 per cent) within 30 days of a serious heart attack. Australia had the best record among the three countries with comparable data (New Zealand was the other), with 7.3 per cent.

The U.S. led on breast cancer survival rates and did the poorest on kidney transplant survival. New Zealand excelled in colorectal cancer survival, Australia in breast cancer screening and Britain in suicide prevention and polio vaccination.

A companion study by Harvard's School of Public Health asked hospital administrators what they would choose if they had funding for just one capital improvement.

In all five countries, the first choice was electronic medical records or information technology. An interesting difference, however, was the degree to which this was a priority.

In the U.S., 62 per cent put IT first, 13 per cent favoured emergency room (ER) investment and only three per cent would choose basic hospital facilities, diagnostic equipment or other medical technology.

IT was tops for managers in the other countries, too, ranging from 47 per cent in Canada to 35 per cent in Australia.

But ER, basic facilities and medical technology were higher priorities in these countries. Among the Canadians, 18 per cent opted for ERs, 16 per cent for medical technology.

Again, these numbers point to the strengths and weaknesses of different systems.

U.S. hospitals are technology rich, but have a high info-burden in dealing with thousands of insurers. Public systems, as Canadians know, are having a tough time funding the latest medical technology.

Managers in all five countries were critical of ER quality and long waits were common in the U.K., Canada and U.S.

"Half of Canadian respondents rated the quality of their emergency departments as fair or poor," says the survey, "as did 17 to 30 per cent of administrators in other countries."

In general, wait times divided the U.S. from the rest. One per cent of U.S. managers said waits of six months or more for elective surgeries occurred often. In the other countries 26 to 57 per cent said waits this long were common. This stark difference may not simply reflect the ample facilities of U.S. hospitals. The study notes U.S. waits may not reflect those with no health insurance, who never join the queue.

But resources do not guarantee satisfaction. The survey found that, despite being positive about their facilities and short waits, U.S. managers were more negative overall. Half were dissatisfied with their health system, compared with 12 per cent or fewer in the other countries. U.S. managers worried about competition and the cost of caring for uninsured patients.

So while there is no perfect system, you can always learn from best practices found somewhere else. America spends a lot more per capita on health than anyone else, yet its system has hits and misses, like everyone's. Without an open mind to innovation, an open wallet alone is not a ticket to superior health care.