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1. Health Care for Women: How the U.S. Compares Internationally

Author:
Munira Z. Gunja, Relebohile Masitha, and Laurie Zephyrin
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Recently released federal data once again show the United States with by far the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic.1 Racial disparities are also extreme: Black women in the U.S. are nearly three times more likely to die from pregnancy-related complications than white women are. But maternal deaths and complications may be an indicator of the nation’s wider failures with respect to women’s health and health care. Compared to women in other high-income countries, American women have long had worse access to the health care they need. While the U.S. spends more on health care than other countries do, surveys regularly find that Americans avoid seeking care because of costs at the highest rates, even as the U.S. continues to lead in the prevalence of chronic disease.2 At the same time, limited access to primary care and inadequate coordination of health services are likely factors in the nation’s poor performance when it comes to the prevention, diagnosis, and management of diseases.3 In this brief, we compare selected measures of health care access and outcomes for women in high-income countries. We drew upon data from four sources: the Commonwealth Fund’s 2023 International Health Policy Survey of Australia, Canada, France, Germany, the Netherlands, New Zealand, Switzerland, the United Kingdom, and the United States, which allowed us to analyze responses by race and ethnicity;4 the Centers for Disease Control and Prevention National Vital Statistics System; the Organisation for Economic Co-operation and Development (OECD); and the Institute for Health Metrics and Evaluation Global Burden of Disease. The latter two data sets permitted us to show results on selected measures for five additional countries — Chile, Japan, Korea, Norway, and Sweden. (See “How We Conducted This Survey” for more details.)
Topic:
Women, Public Health, Healthcare System, and Life Expectancy
Political Geography:
United Kingdom, Canada, France, Germany, Australia, and United States of America

2. Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

Author:
David Blumenthal, Evan D. Gumas, Arnav Shah, Munira Z. Gunja, and Reginald D. Williams II
Publication Date:
09-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement. Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower. Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.
Topic:
Development, Public Health, Efficiency, and Healthcare System
Political Geography:
North America and United States of America

3. Boosting Childhood Vaccination Rates Post-Pandemic: Lessons from Five Countries

Author:
Irene Papanicolas, Robert A. Berenson, and Laura Skopec
Publication Date:
10-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Issue: Childhood vaccination rates fell worldwide during the COVID-19 pandemic. However, reductions in childhood vaccination were not universal, which may be related to differences in vaccine eligibility, vaccine hesitancy, and vaccine administration programs across countries. Goals: Explore how childhood vaccination rates changed during the COVID-19 pandemic in five high-income countries with varying approaches to vaccine policy. Methods: Surveys of in-country experts and analysis of secondary data sources in Australia, Germany, Singapore, the United Kingdom, and the United States. Key Findings and Conclusion: While vaccination rates fell worldwide during the COVID-19 pandemic, the high-income countries in our study maintained high childhood vaccination rates for polio and measles-mumps-rubella (MMR) near or above the herd immunity threshold (80% for polio and 95% for measles). Australia and Singapore, which have the strictest vaccine requirements, boasted the highest polio vaccination rates in both 2018 and 2021. No countries require the human papillomavirus (HPV) vaccination nationwide, but Australia, Singapore, and the U.K. have school-based HPV vaccination programs and high vaccination rates. Strong vaccine requirements, combined with school-based immunization or catch-up programs, may help boost childhood vaccination rates where they lagged during the pandemic.
Topic:
Children, Vaccine, COVID-19, and Healthcare System
Political Geography:
United Kingdom, Germany, Australia, Singapore, and United States of America

4. Finger on the Pulse: The State of Primary Care in the U.S. and Nine Other Countries

Author:
Evan D. Gumas, Corinne Lewis, Celli Horstman, and Munira Z. Gunja
Publication Date:
03-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
For many people, primary care is their first point of contact with the health system, and decades of evidence shows it is critical for population health, health equity, and the overall efficiency of health care systems.1 Primary care is also uniquely positioned to screen for social needs and provide integrated behavioral health services.2 Ensuring people have access to high-quality, comprehensive primary care is vital to good health outcomes and positive experiences with the health system at large. Despite the importance of primary care, health systems around the world are facing challenges at the patient and provider level. Many countries struggle to ensure access to care, or first contact; continuity of care; comprehensiveness of care; and coordination of care. These four core components of high-quality primary care are essential to better overall health outcomes.3 Factors like workforce shortages, physician burnout, and dwindling access for patients, driven in part by underinvestment and growing administrative burdens, pose significant barriers to care.4 To better understand how patient care can be improved in a changing primary care landscape, this brief compares the state of primary care in the United States with nine other high-income nations. It updates an earlier Commonwealth Fund study comparing primary care performance in the U.S. with nine peer countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom. Our data come from the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians and the 2023 International Health Policy Survey of adults age 18 and older. The 2022 and 2023 surveys asked different questions of the participating physicians and responding adults, so this edition includes new measures on access to telehealth, preparedness to treat behavioral health conditions, and care coordination. For more details on our methods, see “How We Conducted This Study.”
Topic:
Equity, Primary Care, and Healthcare System
Political Geography:
United Kingdom, Canada, France, Germany, Australia, Switzerland, North America, Sweden, Netherlands, New Zealand, and United States of America

5. Hospital Global Budgeting: Lessons from Maryland and Selected Nations

Author:
Bob Atlas
Publication Date:
06-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Issue: Maryland has utilized hospital global budgeting for a decade, but the approach is rarely used elsewhere in this country. The Centers for Medicare and Medicaid Services now hopes to test global budgeting in more states to help scale up this form of cost containment. Goals: Examine the ways Maryland, Canada, the Netherlands, New Zealand, and Norway employ hospital global budgeting and the lessons they offer to those hoping to see wider adoption in the United States. Methods: Analysis of the various health systems and expert interviews. Key Findings and Conclusion: Maryland and the four selected countries vary significantly in their approaches to hospital global budgeting. With its previous experience using price controls and current global budgeting approach, Maryland has succeeded in holding hospital spending growth steady for nearly a decade. While Norway combines fixed and variable payments to support global budgeting, the Netherlands and Canada’s province of Ontario are moving away from global budgeting in favor of other approaches. Meanwhile, New Zealand has added multiyear rolling forecasts and budgets to support its own model. Future approaches in the U.S. could prove more effective by factoring in the complexities, conflicting incentives, and potential unintended consequences of global budgeting.
Topic:
Public Health, Healthcare System, and Budgeting
Political Geography:
Canada, Maryland, Netherlands, New Zealand, and United States of America