04 Oct 2006 Commonwealth Fund Scorecard Unfair to USA
David Hogberg says the Commonwealth Fund isn’t fair to the United States:
New Commonwealth Fund National Scorecard on U.S. Health System Performance Judges American Health System UnfairlyA new “National Scorecard on U.S. Health System Performance” released by the influential Commonwealth Fund uses misleading statistics to falsely make the U.S. health care system look as if it is performing more poorly than it genuinely is, charged Dr. David Hogberg, senior policy analyst at the National Center for Public Policy Research in Washington.
The Commonwealth Fund is a nonprofit research foundation established in 1918 focusing on government-oriented solutions to health care problems. It advocates in favor of universal coverage and greater spending on Medicaid while being highly critical of market-oriented solutions like health savings accounts. The Commonwealth Fund is a formidable presence in the health care debate, testifying often before Congress. It has 25 senior staff members and over $28 million in revenue in fiscal year 2005.
“The Commonwealth Fund’s Scorecard claims the U.S. health care system performs poorly compared to other nations,” said Hogberg, “but it is the Scorecard itself that is performing poorly. The measures it uses to condemn the American system — infant mortality, life expectancy at age 60, and mortality amenable to health care –tell us little about the effectiveness of a health care system.”
The Commonwealth Fund’s report is formally titled, “Why Not the Best? Results from a National Scorecard on U.S. Health System Performance.”
“Infant mortality is measured too inconsistently across nations to be a reliable indicator,” said Hogberg. “Nations use different definitions of ‘infant mortality.’ Some nations’ infant mortality statistics do not register many infants who die during the first twenty-four hours after birth. Switzerland, for example, doesn’t count as ‘living’ any infant born under 30 cm long, while the U.S. does. Italy has at least three different definitions for infant deaths in different regions of the nation. Many, but not all, nations tabulate births that occur while their citizens are living or traveling abroad as if their own health systems were tending to care, which they clearly are not. Overall, infant mortality is measured far too inconsistently to make cross-national comparisons useful.”
Life expectancy is also a poor measure to use when comparing the health systems of various nations, said Hogberg. “Any measure of life expectancy is going to be influenced by factors — GDP per capita, diet, lifestyle, income level, clean water, sanitation, etc. — that have nothing to do with a health care system.”
The measure of “mortality amenable to health care” comes from a 2003 article in the British Medical Journal. However, the authors of that study were far more sanguine than the Commonwealth Fund about the limits of that measure: “…amenable mortality has itself some limitations… A major limitation is that, for many conditions, death is the final event in a complex chain of processes that involve issues related to underlying social and economic factors, lifestyles, and preventive and curative health care… it is equally clear that large international differences in mortality are caused primarily by factors outside the health care sector.”
“When one looks at factors that a health care system can actually influence, like cancer or heart attack survival rates, the U.S. consistently tops other nations,” Hogberg said.
Hogberg noted that the Commonwealth Fund, along with the Organization for Economic Cooperation and Development, has a project on formulating quality cross-national measures of health care systems. “The measures that the Commonwealth Fund uses in its new National Scorecard on U.S. Health System Performance are not the ones they are using in their project on cross-national measures. Why didn’t the Commonwealth Fund use some of the measures in its quality indicators project to compare the U.S. health care system with other nations?”
For more details on why life expectancy and infant mortality are poor measure for comparing health systems, read David’s paper. “Don’t Fall Prey to Propaganda: Life Expectancy and Infant Mortality are Unreliable Measures for Comparing the U.S. Health Care System to Others,” here.