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Commonwealth Fund Report: A Study in BS

The “news” media and some “progressive” blogs are parroting the latest health care propaganda from the Commonwealth Fund. Predictably, the new “study” finds all manner of problems with the American system:

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries.

Oddly absent from media reports and the Commonwealth Fund’s overview is any mention of the study’s methodology. To find that information, one must read the full PDF version. It turns out that this study is a distillation of two earlier surveys that report the subjective views of selected patients:

The 2004 survey focuses on patients’ self-reported experiences getting and using health care services … The 2005 survey examines sicker patients’ views of the health care system …

As anyone actually working in health care will tell you, the subjective views of patients regarding their care is often wildly at odds with the facts. This phenomenon is particularly pronounced after the patient receives her bill. I can’t tell you how many times my highly respected, not-for-profit hospital has gone from “hero to zero” upon the patient’s receipt of a bill for her co-pay.

So, if the survey’s finding that U.S. health care is inferior to that of the U.K. seems counterintuitive, listen to your instincts. Like many recent reports, it is subjective nonsense designed to convince the American public that our health care delivery system should be taken over by the federal government.

Comments 2

  1. Leisureguy wrote:

    Also evaluations by physicians. And “older”? 2004, 2005, and 2006—not so old after all. The surveys seem well designed, in addition (if you read the section on the methodology). Moreover, economic data are taken from the Organization for Economic Cooperation and Development databases (objective data). From the abstract:

    This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries’ health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next to last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health-care insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows U.S. lacking in adoption of information technology and use of nurses to improve care coordination for the chronically ill.

    So the “subjective data” probably includes asking physicians, for example, if they use an electronic medical records system (yes/no) and the like.

    Given that the same methods were used in all the countries, I still find the results pretty damning of the US health care system. But let the reader check out the study (the PDF file you link to) and its methodology and come to his/her own conclusions. To me, it seems like a serious study.

    Posted 15 May 2007 at 11:17 am
  2. Catron wrote:

    Also evaluations by physicians.

    The physician data are just as subjective. If you’ve been following the health care reform debate, you will know that the docs are all over the place on this issue and are thus no more authoritative than the patients.

    And “older”? 2004, 2005, and 2006—not so old after all.

    I think the term I use in my post is “earlier.”

    Economic data are taken from the Organization for Economic Cooperation and Development databases.

    OECD data are not infallible. That organization often compares apples and oranges. A good discussion of that problem can be found here (see page 15).

    Posted 15 May 2007 at 1:44 pm

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