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C O U N T R Y C O M P A R I S O N S How Does The Quality Of Care Compare In Five Countries? An international quality comparison shows that each country performs best and worst in at least o n e area of care. by Pete r S . Hussey^ Gerard F. An derso n, Robin O sborn, Colin Feek, VIvienne McLaughlin, John Millar, and Arnold Epstein ABSTRACT: International data on quality of medical care allow countries to compare the ir performance to that of other countries. The Commonwealth Fund International Working Group on Quality Indicators collected data on twenty-one indicators that reflect medical care in Au stralia, Canada, New Zealand, England, and the United States. The indicators in- clude five-year cancer relative survival rates, thirty-day case-fatality rates after acute myo- cardial infarction and stroke, breast cancer screening rates, and ast hma mo rtality rates. No country scores consistently th e best or worst overail. Each country has at least one area of care where it couid iearn from international experiences and one area where its experi- ences couid teach others. M OST INDUSTRIALIZED COUNTRIES share an interest in measuring, re- porting, and improving the quality o f medical care. Despite this interest, there have been limited internationally comparable data available on quality indicators, especiall y in areas involving medical care interventions. Collab- oration between countries to produce internationally comparable data permits benchmarking and allows policymakers and clinicians to identify specific areas where individual countries could improve. In the United States, sparked by Institute of Medicine (IOM) reports focusing attention on gaps in the quality of medical care, intere st in improving quality has expanded rapidly among policymakers, corporations, clinicians, the media, and the public. ^ Despite this concern abo ut the q uality of care, U.S. policymakers and chnicians often recite the mantra, "Americans have the best medical care in the world."^ The empirical basis for this statement is unclear. The limited empirical Peter Hussey i s a doctoral candidate at the Johns Hopkins Bloomherg School of Public Health i n Baltimore, Maryland. Gerard Anderson ([email protected]) i s a professor there. Robin Osborn i s assistant vice president o f th e Commonwealth Fund, i n N ew Yorfe City, a n d director of it s Intemational Program i n Health Policy. Colin Fcek i s deputy director-general Clinical Services Directorate, in the New Zealand Ministry of Health. Vivienne Mclaughlin i s assistant secretary o f t h e Health Priorities Branch, Australia Department of Health and Ageing. John Millar is executive director of Population Surveillance a n d Disease Control Planning, Provincial Health Services Authority. British Columbia. Arnold Epstein i s th e John H . Foster Professor a n d chair oj the Department o f Health Policy an d Management, Harvard School of Publie Health. i« Boston, Massachusetts. HEALTH AFFAIRS - Voiume 23. Number 3 89 DOI 10,1377/hliha(1. 2i.3.89 C2004Pr oj Eci HO PE-T k People-to-T'eopk Eedtth Foundation. Inc,

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