We’re number 11. We’re number 11.
Finishing in 11th place may not have been so bad if there had been more than 11 countries in the report.
But that’s where the United States ranked for most women’s health and health care indicators in The Commonwealth Fund’s new report entitled, “What Is the Status of Women’s Health and Health Care in the U.S. Compared to Ten Other Countries?”
The answer to this question posed in the title of the report is horribad, which is worse than horrible and worse than bad. How else would you describe a situation in which the U.S. consistently finished worse than basically everyone else in the report (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom) in most of the measures? The U.S. ranked at the bottom for the following measures:
- Percent of women ages 18–64 who had two or more chronic conditions. That’s 20% for the U.S., compared to 7% for first place Germany and 16% compared to the 10th place finisher Canada.
- Percent of women ages 18–64 who experienced emotional distress. That’s over a third (34%) for the U.S., compared to 7% for first place Germany and 11% for second place France.
- Maternal mortality ratio (maternal deaths/100,000 live births) among women ages 15–49. The U.S. registered 14% for this measure, significantly higher than the lowest ratio (4% for Sweden) and the second lowest ratio (5% for Norway).
- Percent of women ages 18–64 with at least one medical bill problem. A whopping 44% of women in the U.S. faced this problem versus 2% for the U.K., 8% for New Zealand, and 10% for Germany, the three countries with the lowest percentages.
- Percent of women ages 18–64 with at least one cost-related access problem. About 38% of women in the U.S. had to skip care because of cost compared to 5% for the U.K. and 7% for Germany.
- Percent of women ages 18–64 who reported having a regular doctor/regular place of care. The U.S. number (88%) may sound good until you realize that it is again last and significantly lower than the Netherlands at 100% and France, Norway, and France, all at 99%.
- Percent of women ages 18–64 who rated their quality of medical care as excellent or very good. This number was totally not excellent for the U.S. (24%), far below the U.K. (62%) and Switzerland (61%).
Looking for a top ten finish? Well, the U.S. finished second worst for the following two measures:
- Percent of women ages 18–64 with out-of-pocket costs of $2,000 or more. The U.S.’s 26% was just below the 28% for last place Switzerland, which also has really expensive fondue. Sweden, Netherlands, and the U.K. were lowest at 2%.
- Percent of women ages 18–64 who reported going to the emergency department in the past two years. That was 37% for the U.S. and 45% for Canada, which had the highest rate. Germany had the lowest rate at 12%.
A bright spot for the U.S. was related to breast cancer, finishing second to Sweden with 80% (versus 90% for Sweden) of women ages 50–69 being screened for breast cancer and finishing just behind Norway, Sweden, and Australia with the lowest rates of breast cancer–related deaths.
Yes, this report did have its limitations. The questions did not address all aspects of women’s health and health care. These numbers are not from all women in the 11 countries but from samples. Some of the data came from the 2016 Commonwealth Fund International Health Policy Survey of Adults, conducted between March and June 2016. Not everyone responded to survey requests (a low of 11% responded in Norway to a high of 47% in Switzerland) so the results are based on answers from 9,254 women between the ages of 18 and 64 years. Also, surprise, not everyone answers questionnaires accurately.
Additionally, all data have their limitations. The report used data from the Organisation for Economic Co-operation and Development (OECD), which works with statistical offices in each member country to compile health-related data such as health care spending, use, and mortality. A UNICEF database provided data on maternal mortality.
Nevertheless, it’s not as if the U.S. finished just a bit out of first place. Instead, this was like a Cleveland Browns’ 2017 season finish. Or a Browns’ 2016 season finish. Or their 2015 season. With the U.S. economy supposedly doing so well, there should be no financial excuse for America to fall behind these other North American, European, and Oceania higher income countries in something so important as health. It’s another sign that our health care system has many real problems when a significant percentage of our population can’t get appropriate health care.