Phusit Prakongsai International Health Policy Program (IHPP) Ministry of Public Health, Thailand

1. Mirror, Mirror on the Wall:How the Performance of the US Health Care System Compares Internationally Phusit Prakongsai International Health Policy Program (IHPP) Ministry of Public Health, Thailand 29 July 2010

2. Background • The US health system is the most expensive in the world. • Comparative analyses consistently show the US underperforms relative to other countries on most dimensions of performance. • The Commonwealth Fund Commission on a High Performance Health System employed the National Scorecard to measure and monitoring health care outcomes, quality, access, efficiency, and quality in the US in 2006 and 2008. • This 2010 report includes information on: • health care outcomes in the 2008 US health system scorecard, • Most recent three Commonwealth Fund surveys of patients and primary care physicians in 2007-2009.

3. Healthcare spending as % of GDPOECD countries, 2008

5. Growth in personal health care expenditures in the USfrom 1990 to 2007

6. Core dimensions of Commonwealth National ScorecardMeasuring and monitoring health system performance

7. 1. Quality care1.1 Effective care

8. 1. Quality care1.1 Effective care * Four recommended services include HbA1C checked in the past six months, feet examined, eye exam, and cholesterol checked in the past year.

9. 1. Quality care1.2 Safe care

10. 2. Access to care

11. 3. Efficiency measures

12. 4. Health equity

13. 5. Long, healthy, and productive lives measures

14. Overall ranking of health systems among seven countries

15. Summary key findings • Quality • The US was best on provision and receipt of preventive and patient-centered care, • However, its low scores on chronic care management, and safe and coordinated care which pull its overall quality score down, • Access • Without universal coverage, costs related access problems in the US were higher than other countries, • Efficiency • The US ranks last among the seven countries, while the UK and Australia ranking first and second, respectively. • Equity • The US ranks a clear last on nearly all measures of equity. • Long, healthy and productive lives • The US ranks last overall with poor scores on all three indicators of long, healthy, and productive lives.

16. Efficiency analysisPer capita THE at inter dollar with Life expectancy USA

17. Inputs & processes Outputs Outcomes Impact Intervention access & services readiness Intervention quality, safety and efficiency Coverage of interventions Prevalence risk behaviours & factors Improved health outcomes & equity Social and financial risk protection Responsiveness Infrastructure / ICT Health workforce Supply chain Information Financing Governance Population-based surveys Coverage, health status, equity, risk protection, responsiveness Administrative sources Financial tracking system; NHA Databases and records: HR, infrastructure, medicines etc. Policy data Facility assessments Clinical reporting systems Service readiness, quality, coverage, health status Vital registration Monitoring & Evaluation of health systems reform /strengthening A general framework for HSPA Indicator domains Data sources Analysis & synthesis Data quality assessment; Estimates and projections; In-depth studies; Use of research results; Assessment of progress and performance of health systems Communication & use Targeted and comprehensive reporting; Regular country review processes; Global reporting

18. Health Systems Assessment Approach of HS 20/20

19. Sub-national HSPAImmunization coverage <1 year by district in SA 2007-2008 Source: District Health Barometer 2007-08

20. Thank you for your attention 20