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COMMENTARY Regulated Competition Without Managed Care system delivers an overall superior performance. Much the Uwe E. Reinhardt, PhD same can be claimed by many other foreign health systems because, in cross-national comparisons, the higher US health EALTH SERVICES RESEARCHERS AROUND THE GLOBE spending has not translated into consistently superior qual- have known for decades that the United States, 4 5 ity of care or in greater satisfaction among patients, phy- with a comparatively young population, spends 6 7 sicians, and hospital executives. Furthermore, the United Hmuch more on health care than do other na- 1,2 States has consistently ranked relatively low on most tra- tions (TABLE). As US annual health spending continues ditional health status indicators, such as life expectancy and to exceed that in comparable nations by ever wider mar- infant mortality. These population-based health status in- gins, and as US health policymakers begin to run out of ideas dicators are driven by numerous socioeconomic variables for how to constrain that growth, interest in the perfor- besides health care and cannot be used as a reliable indica- mance of health systems abroad has increased in recent years. tor of health system performance in cross-national stud- One need not
JAMA – American Medical Association
Published: Sep 8, 2004
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