As the U.S. healthcare system faces continuous criticism over its high costs compared to other first world countries, two researchers have a contrarian take: Health and healthcare in the U.S. aren’t so bad.
In fact, the U.S. outperforms England and France when it comes to public health, the authors argue in article (PDF) published in the most recent issue of the Journal of Health Politics, Policy and Law.
The American healthcare debate often draws parallels to other Western countries, with many arguing there is plenty to learn from systems abroad. Last year, the Commonwealth Fund ranked the British system #1 out of 11 high-income countries. The U.S., meanwhile, ranked dead last.
In a widely shared interactive from the New York Times, a group of professors said the best healthcare system can be found in France (or Switzerland).
But decades of coordinated public health efforts in the U.S. have been tremendously effective, say the authors, who are affiliated with Columbia University's Mailman School of Public Health and the Centre de Sociologie des Organisations at Sciences Po Paris.
America's peers across the pond have made some efforts to prevent disease, but they have been neither coordinated nor effective, the pair writes.
The U.K. has focused most of its health-related attention on the National Health Service (NHS). Its health policies are “fragmented,” and there is no specific budget for prevention.
Meanwhile, France’s public health system has been “insufficiently” coordinated, remunerated and incentivized since the end of World War II, and its public health agency is “underfunded and understaffed.”
American public health agencies and advocates have been able to position their mission as a moral imperative, and they have solidified their victories through policies. Among them: smoking bans, motorcycle helmet laws, water fluoridation requirements, and mandatory vaccination programs.
Looking forward, the U.S.’s interest in prevention is stronger than ever, positioning it well to focus on population health. Recent efforts in value-based purchasing, coordinated care, and growth in data analytics could improve population health further, the authors add.
The U.S. is “not a public health laggard,” but it is “hardly a public health leader,” the article says, pointing to the opioid crisis as an example of a poor public health response.
While the authors acknowledge the initial costs (and long-term savings) of disease prevention, the cost of care was not their focus. Previous research has pointed out that per capita spending in the U.S. is nearly triple that of the U.K.
The article calls the U.S.’s success relative to England and France “a pyrrhic victory,” and the authors make it clear the U.S. is not a model for healthcare overall.
“Each of the nations discussed in this article would do well to dramatically increase its commitment and spending on public health and prevention,” it concludes.