Fortunately, Linda Gorman of the Independence Institute has written a devastating critique of the Commonwealth study entitled, "Commonwealth Ranking: Are We Really 19th Out of 19?". She discusses numerous methodological problems with their report, including:
Choosing Nonmedical BenchmarksEach of those points is covered in greater detail.
Cherry-Picking the Benchmarks
Using Questionable Benchmarks
Equating Low Spending with Efficiency
Using Questionable Measurements
Confusing "Access" with "Third-Party Insurance"
Applying the Commonwealth Criteria of "Underinsured" to the Medicare Population
Ignoring Rationing by Waiting
She also discusses a number of measures in which the US has improved between 2006 and 2008, but which were not regarded as significant by the Commonwealth Fund, including:
1. Deaths per 100,000 population fell.For those who are interested in the details, I highly recommend reading the whole thing.
2. Infant mortality fell.
3. Higher percentages of adults and children received recommended preventive care.
4. Higher percentages of diabetics and hypertensive adults had better blood sugar and blood pressure control.
5. A higher percentage of hospital patients received recommended care.
6. A higher percentage of heart failure patients received written discharge instructions. (This is a process measure, whether it improves outcomes is unknown.)
7. A slightly lower percentage of patients reported medical, medication, or lab test errors.
8. A lower percentage of children were prescribed antibiotics for a sore throat without first getting a strep test.
9. A smaller percentage of short-stay nursing home residents developed pressure sores.
10. A higher percentage of patients reported that doctor-patient communication was adequate.
11. A higher percentage of adults reported that they had no cost barriers to health care access.
12. Actual to expected deaths for hospital mortality ratios fell from 101 to 82.
As John Goodman points out, "On his way to get health care at the Cleveland Clinic, Italian Prime Minister Silvio Burlesconi probably flew over a half dozen higher ranking countries, not to mention his own. What could he possibly have been thinking? Doesn't he read Commonwealth reports?"