Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens

Abstract

This report is based on two surveys of patients: the first was conducted in 2004 among a nationally representative sample of adults in Australia, Canada, New Zealand, the United Kingdom, and the United States; the second was conducted in 2005 among a sample of adults with health problems in the same five nations and Germany. It ranks patients' ratings of various dimensions of their health care, according to the Institute of Medicine's framework for quality. The U.S. system ranked first on measures of effectiveness but ranked last on other dimensions of quality. It performed particularly poorly in terms of providing care equitably, safely, efficiently, or in a patient-centered manner. For all countries, responses indicate room for improvement. Yet, the other five countries spend considerably less on health care per person and as a percent of gross domestic product than the United States.