Why should we compare internationally? The more dimensions the better

Looking at healthcare quality from an international perspective over time offers us a 3D picture of performance.

Blog post

Published: 03/07/2015

To improve in anything, we need inspiration. For some people it comes from the frustration of things not working as they should, for others from seeing the best. 

I am sure many people reading this blog will have briefly lived in a foreign country or went on holidays where you or one of your family members fell ill or broke an arm. You went to A&E, but may even have received quite complex care over a longer period. When you returned home to the UK, you were either delighted or extremely frustrated about the care you received.

You probably started thinking and comparing how things were different... better, worse...

Clearly, a one-off experience does not even begin to reveal the entire picture about quality of care but it has made you think, question and reflect. This is exactly what we hope our latest report will do for those who read it. 

Comparing the UK internationally – what can we learn? 

Our report looks at some indicators of the quality of care over time in the UK compared to a selection of similar OECD countries. We find that on almost all indicators UK has been improving over time. For some indicators – like flu immunisations - the UK is the best performing country. But on many indicators – from cancer survival rates to potentially preventable hospital admissions for asthma, it lags behind the other countries, and we need to understand why. 

Let’s unpick a little why this report is different.

A one-dimensional picture: a point in time

There are hundreds of national and international indicators out there, but most look at quality at one point in time or they measure health more broadly (e.g. life expectancy) rather than the quality of the healthcare system. The Commonwealth Fund or the Economist Intelligence Unit reports, to select two particularly high profile ones, are great examples of these. One point in time gives us a one dimensional picture.

A two-dimensional picture: longer term trends

The 300 indicators we look at as part of the QualityWatch programme aim to examine how quality of care has been changing, so we only analyse indicators that can be tracked over time. The focus is mainly on national analysis. In addition, regional analysis over time helps reveal if there are areas in the country which are significantly underperforming or over performing compared to the rest. These would be areas that others may want to visit or understand better. So to get the two-dimensional picture we need to look over time at the national or regional level.

A three dimensional picture: comparing internationally over time

Finally, let’s take the example of cancer survival – if we look at the UK’s performance alone, survival rates from common cancers like breast, cervical and colorectal cancer are improving over time but it is hard to know if the observed rates are high or low. Only by looking at other countries did we begin to see that performance could be even higher and we are not yet closing the gap with the best performing countries. Such simple comparison led to numerous initiatives (eg, ICBPCONCORD) trying to understand if the differences in survival are real (they seem to be), why they exist (we are not so keen on going to the doctor, doctors wait longer to test us etc.) and what could be done to improve (maybe we need be seen quicker by the right person and start treatment faster). So looking at other countries over time offers us an important third dimension. Our 3D view could be made even clearer if we had internationally comparable regional level data

However, there are still important areas where we know very little – quality of mental health services and safety in primary care, quality of services for children and young people, or how the healthcare system meets the needs and expectations of the citizens over time – just to name the few. So this report is just the beginning.  

Complex problems require sophisticated solutions

Only with these additional dimensions may we get closer to getting the full picture of the quality of healthcare. This can motivate action to drive progress and close the performance gaps between countries. Even then we should be mindful that there are no neat answers or catch all solutions to these problems. If care quality is complex and requires us to put on our 3D glasses, improving care quality is similarly complex. But if we can motivate better solutions through a more sophisticated look at the problem, then the picture we reveal will ultimately be better for patients - wherever they end up using healthcare.