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 one area of care

Health Affairs

Volumn 23, Issue 3, 2004, Pages 89-99

  Hussey, Peter S ^a   Anderson, Gerard F ^a   Osborn, Robin ^b   Feek, Colin ^c   McLaughlin, Vivienne ^d   Millar, John ^e   Epstein, Arnold ^f  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^b Intl Program in Health Policy ^*  (United States)

^c New Zealand Ministry of Health   (New Zealand)

^d Australia Dept of Health and Ageing   (Australia)

^e PROVINCIAL HEALTH SERVICES AUTHORITY   (Canada)

^f HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACUTE HEART INFARCTION; ARTICLE; ASTHMA; AUSTRALIA; BREAST CARCINOMA; CANADA; CANCER CENTER; CANCER SCREENING; CANCER SURVIVAL; COMPARATIVE STUDY; FATALITY; FINANCIAL MANAGEMENT; HEALTH CARE DISTRIBUTION; HEALTH CARE QUALITY; HEALTH STATISTICS; INDUSTRIALIZATION; INTERNATIONAL COOPERATION; MORTALITY; NEW ZEALAND; OUTCOMES RESEARCH; SCORING SYSTEM; STROKE; SURVIVAL RATE; UNITED KINGDOM; UNITED STATES;

ADULT; AGED; AGED, 80 AND OVER; DEVELOPED COUNTRIES; HEALTH SERVICES RESEARCH; HUMANS; INTERNATIONALITY; MIDDLE AGED; NEOPLASMS; QUALITY OF HEALTH CARE; SURVIVAL RATE;

EID: 2442449374     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.3.89     Document Type: Article

References (45)

1. D.M. Berwick, "A User's Manual for the IOM's 'Quality Chasm' Report," Health Affairs 21, no. 3 (2002): 80-90; and E.C. Becher and M.R. Chassin, "Improving the Quality of Health Care: Who Will Lead?" Health Affairs 20, no. 5 (2001): 164-179.
2. D.M. Berwick, "A User's Manual for the IOM's 'Quality Chasm' Report," Health Affairs 21, no. 3 (2002): 80-90; and E.C. Becher and M.R. Chassin, "Improving the Quality of Health Care: Who Will Lead?" Health Affairs 20, no. 5 (2001): 164-179.
3. A recent example is the 2004 State of the Union address. White House, "The State of the Union," 20 January 2004, www.whitehouse.gov/news/ releases/2004/01/20040120-7.html (20 February 2004).
4. U.E. Reinhardt, P.S. Hussey, and G.F. Anderson, "Cross-National Comparisons of Health Systems using OECD Data, 1999," Health Affairs 21, no. 3 (2002): 169-181. Other international comparisons using general health status indicators as outcomes include J. Macinko, B. Starfield, and L. Shi, "The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970-1998," Health Services Research 38, no. 3 (2003): 831-865; V. Navarro and L. Shi, "The Political Context of Social Inequalities and Health," Social Science and Medicine 52, no. 3 (2001): 481-491; and World Health Organization, World Health Report 2000 (Geneva: WHO, 2000). Studies comparing the appropriateness of specific procedures in two countries include E.A. McGlynn et al., "Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery between Canada and New York State," Journal of the American Medical Association 272, no. 12 (1994): 934-940; and S. Bernstein et al., "The Appropriateness of the Use of Cardiovascular Procedures: British versus U.S. Perspectives," International Journal of Technology Assessment in Health Care 9, no. 1 (1993): 3-10. Finally, one study compared the applicability of primary care quality indicators between the United States and United Kingdom: M.N. Marshall et al., "Can Health Care Quality Indicators Be Transferred between Countries?" Quality and Safety in Health Care 12, no. 1 (2003): 8-12.
5. U.E. Reinhardt, P.S. Hussey, and G.F. Anderson, "Cross-National Comparisons of Health Systems using OECD Data, 1999," Health Affairs 21, no. 3 (2002): 169-181. Other international comparisons using general health status indicators as outcomes include J. Macinko, B. Starfield, and L. Shi, "The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970-1998," Health Services Research 38, no. 3 (2003): 831-865; V. Navarro and L. Shi, "The Political Context of Social Inequalities and Health," Social Science and Medicine 52, no. 3 (2001): 481-491; and World Health Organization, World Health Report 2000 (Geneva: WHO, 2000). Studies comparing the appropriateness of specific procedures in two countries include E.A. McGlynn et al., "Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery between Canada and New York State," Journal of the American Medical Association 272, no. 12 (1994): 934-940; and S. Bernstein et al., "The Appropriateness of the Use of Cardiovascular Procedures: British versus U.S. Perspectives," International Journal of Technology Assessment in Health Care 9, no. 1 (1993): 3-10. Finally, one study compared the applicability of primary care quality indicators between the United States and United Kingdom: M.N. Marshall et al., "Can Health Care Quality Indicators Be Transferred between Countries?" Quality and Safety in Health Care 12, no. 1 (2003): 8-12.
6. U.E. Reinhardt, P.S. Hussey, and G.F. Anderson, "Cross-National Comparisons of Health Systems using OECD Data, 1999," Health Affairs 21, no. 3 (2002): 169-181. Other international comparisons using general health status indicators as outcomes include J. Macinko, B. Starfield, and L. Shi, "The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970-1998," Health Services Research 38, no. 3 (2003): 831-865; V. Navarro and L. Shi, "The Political Context of Social Inequalities and Health," Social Science and Medicine 52, no. 3 (2001): 481-491; and World Health Organization, World Health Report 2000 (Geneva: WHO, 2000). Studies comparing the appropriateness of specific procedures in two countries include E.A. McGlynn et al., "Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery between Canada and New York State," Journal of the American Medical Association 272, no. 12 (1994): 934-940; and S. Bernstein et al., "The Appropriateness of the Use of Cardiovascular Procedures: British versus U.S. Perspectives," International Journal of Technology Assessment in Health Care 9, no. 1 (1993): 3-10. Finally, one study compared the applicability of primary care quality indicators between the United States and United Kingdom: M.N. Marshall et al., "Can Health Care Quality Indicators Be Transferred between Countries?" Quality and Safety in Health Care 12, no. 1 (2003): 8-12.
7. U.E. Reinhardt, P.S. Hussey, and G.F. Anderson, "Cross-National Comparisons of Health Systems using OECD Data, 1999," Health Affairs 21, no. 3 (2002): 169-181. Other international comparisons using general health status indicators as outcomes include J. Macinko, B. Starfield, and L. Shi, "The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970-1998," Health Services Research 38, no. 3 (2003): 831-865; V. Navarro and L. Shi, "The Political Context of Social Inequalities and Health," Social Science and Medicine 52, no. 3 (2001): 481-491; and World Health Organization, World Health Report 2000 (Geneva: WHO, 2000). Studies comparing the appropriateness of specific procedures in two countries include E.A. McGlynn et al., "Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery between Canada and New York State," Journal of the American Medical Association 272, no. 12 (1994): 934-940; and S. Bernstein et al., "The Appropriateness of the Use of Cardiovascular Procedures: British versus U.S. Perspectives," International Journal of Technology Assessment in Health Care 9, no. 1 (1993): 3-10. Finally, one study compared the applicability of primary care quality indicators between the United States and United Kingdom: M.N. Marshall et al., "Can Health Care Quality Indicators Be Transferred between Countries?" Quality and Safety in Health Care 12, no. 1 (2003): 8-12.
8. U.E. Reinhardt, P.S. Hussey, and G.F. Anderson, "Cross-National Comparisons of Health Systems using OECD Data, 1999," Health Affairs 21, no. 3 (2002): 169-181. Other international comparisons using general health status indicators as outcomes include J. Macinko, B. Starfield, and L. Shi, "The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970-1998," Health Services Research 38, no. 3 (2003): 831-865; V. Navarro and L. Shi, "The Political Context of Social Inequalities and Health," Social Science and Medicine 52, no. 3 (2001): 481-491; and World Health Organization, World Health Report 2000 (Geneva: WHO, 2000). Studies comparing the appropriateness of specific procedures in two countries include E.A. McGlynn et al., "Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery between Canada and New York State," Journal of the American Medical Association 272, no. 12 (1994): 934-940; and S. Bernstein et al., "The Appropriateness of the Use of Cardiovascular Procedures: British versus U.S. Perspectives," International Journal of Technology Assessment in Health Care 9, no. 1 (1993): 3-10. Finally, one study compared the applicability of primary care quality indicators between the United States and United Kingdom: M.N. Marshall et al., "Can Health Care Quality Indicators Be Transferred between Countries?" Quality and Safety in Health Care 12, no. 1 (2003): 8-12.
9. U.E. Reinhardt, P.S. Hussey, and G.F. Anderson, "Cross-National Comparisons of Health Systems using OECD Data, 1999," Health Affairs 21, no. 3 (2002): 169-181. Other international comparisons using general health status indicators as outcomes include J. Macinko, B. Starfield, and L. Shi, "The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970-1998," Health Services Research 38, no. 3 (2003): 831-865; V. Navarro and L. Shi, "The Political Context of Social Inequalities and Health," Social Science and Medicine 52, no. 3 (2001): 481-491; and World Health Organization, World Health Report 2000 (Geneva: WHO, 2000). Studies comparing the appropriateness of specific procedures in two countries include E.A. McGlynn et al., "Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery between Canada and New York State," Journal of the American Medical Association 272, no. 12 (1994): 934-940; and S. Bernstein et al., "The Appropriateness of the Use of Cardiovascular Procedures: British versus U.S. Perspectives," International Journal of Technology Assessment in Health Care 9, no. 1 (1993): 3-10. Finally, one study compared the applicability of primary care quality indicators between the United States and United Kingdom: M.N. Marshall et al., "Can Health Care Quality Indicators Be Transferred between Countries?" Quality and Safety in Health Care 12, no. 1 (2003): 8-12.
10. U.E. Reinhardt, P.S. Hussey, and G.F. Anderson, "Cross-National Comparisons of Health Systems using OECD Data, 1999," Health Affairs 21, no. 3 (2002): 169-181. Other international comparisons using general health status indicators as outcomes include J. Macinko, B. Starfield, and L. Shi, "The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970-1998," Health Services Research 38, no. 3 (2003): 831-865; V. Navarro and L. Shi, "The Political Context of Social Inequalities and Health," Social Science and Medicine 52, no. 3 (2001): 481-491; and World Health Organization, World Health Report 2000 (Geneva: WHO, 2000). Studies comparing the appropriateness of specific procedures in two countries include E.A. McGlynn et al., "Comparison of the Appropriateness of Coronary Angiography and Coronary Artery Bypass Graft Surgery between Canada and New York State," Journal of the American Medical Association 272, no. 12 (1994): 934-940; and S. Bernstein et al., "The Appropriateness of the Use of Cardiovascular Procedures: British versus U.S. Perspectives," International Journal of Technology Assessment in Health Care 9, no. 1 (1993): 3-10. Finally, one study compared the applicability of primary care quality indicators between the United States and United Kingdom: M.N. Marshall et al., "Can Health Care Quality Indicators Be Transferred between Countries?" Quality and Safety in Health Care 12, no. 1 (2003): 8-12.
11. Members of the Commonwealth Fund's International Working Group on Quality Indicators were Gerard F. Anderson, Anne-Marie Audet, Arnold Epstein, Carolyn Clancy, Karen Scott Collins, Janet M. Corrigan, John E. Craig Jr., Colin M. Feek, Elma G. Heidemann, Jeremy Hurst, Peter S. Hussey Edward Kelley, Sheila T. Leatherman, Elizabeth A. McGlynn, Vivienne L. McLoughlin, Soeren Mattke, Gregg S. Meyer, John S. Millar, Robin Osborn, Stephen C. Schoenbaum, Robert Shaw, John Wyn Owen, and Nick York. The data in this paper for England are for England only and not for the entire United Kingdom.
12. K. Lohr, ed., Medicare: A Strategy for Quality Assurance, vol. 2 (Washington: National Academies Press, 1990).
13. For example, utilization rates of procedures such as coronary artery bypass graft were eliminated because it was not clear whether higher or lower use reflected better quality.
14. For example, the immunization rate for tuberculosis was not included because tuberculosis is a rare condition in these five countries and immunizations were already reflected by other indicators, including immunizations against polio and influenza and the incidence of vaccine-preventable diseases.
15. For example, we wanted to measure how many cancers were diagnosed at an early stage. Although each country has some information on stage of cancer at diagnosis, each uses a different classification system for cancer stage, which makes international comparisons impossible.
16. Survival rates are for cancers diagnosed in 1992 in Australia and Canada, 1994 in New Zealand and the United States (except breast cancer diagnosed in 1992), and 1991-93 in the United Kingdom. All rates were age-standardized to the OECD 1980 population. U.S. data are from Surveillance, Epidemiology, and End Results (SEER), which covers large portions of the country but is not nationally representative. Some differences between countries in statistical modeling and cancer registry operation could affect rates.
17. G. Gatta et al., "Toward a Comparison of Survival in American and European Cancer Patients," Cancer 89, no. 4 (2000): 893-900.
18. M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; G. Gatta et al., "Survival of European Women with Gynaecological Tumours during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2218-2225; and G. Gatta et al., "Survival of Colorectal Cancer Patients in Europe during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2176-2183. When cancer detection improves without an accompanying improvement in prognosis, lead-time bias can affect cancer survival rates without actually making a difference in patient survival; see H.G. Welch, L.M. Schwartz, and S. Woloshin, "Are Increasing Five-Year Survival Rates Evidence of Success against Cancer?" Journal of the American Medical Association 283, no. 22 (2000): 2975-2978.
19. M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; G. Gatta et al., "Survival of European Women with Gynaecological Tumours during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2218-2225; and G. Gatta et al., "Survival of Colorectal Cancer Patients in Europe during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2176-2183. When cancer detection improves without an accompanying improvement in prognosis, lead-time bias can affect cancer survival rates without actually making a difference in patient survival; see H.G. Welch, L.M. Schwartz, and S. Woloshin, "Are Increasing Five-Year Survival Rates Evidence of Success against Cancer?" Journal of the American Medical Association 283, no. 22 (2000): 2975-2978.
20. M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; G. Gatta et al., "Survival of European Women with Gynaecological Tumours during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2218-2225; and G. Gatta et al., "Survival of Colorectal Cancer Patients in Europe during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2176-2183. When cancer detection improves without an accompanying improvement in prognosis, lead-time bias can affect cancer survival rates without actually making a difference in patient survival; see H.G. Welch, L.M. Schwartz, and S. Woloshin, "Are Increasing Five-Year Survival Rates Evidence of Success against Cancer?" Journal of the American Medical Association 283, no. 22 (2000): 2975-2978.
21. M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; G. Gatta et al., "Survival of European Women with Gynaecological Tumours during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2218-2225; and G. Gatta et al., "Survival of Colorectal Cancer Patients in Europe during the Period 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2176-2183. When cancer detection improves without an accompanying improvement in prognosis, lead-time bias can affect cancer survival rates without actually making a difference in patient survival; see H.G. Welch, L.M. Schwartz, and S. Woloshin, "Are Increasing Five-Year Survival Rates Evidence of Success against Cancer?" Journal of the American Medical Association 283, no. 22 (2000): 2975-2978.
22. Kidney transplant survival rates are for transplants performed in 1995 in Australia and Canada, 1994-96 in the United Kingdom, and 1995-96 in New Zealand and the United States. Liver transplant survival rates are for transplants performed in 1985-96 in Australia/New Zealand, 1995 in Canada, and 1995-96 in the United States. Liver transplant rates for Australia and New Zealand were combined. Survival rates are observed, not relative survival.
23. Case-fatality rates are from 2000 (Canada) and 2000-01 (Australia and New Zealand). Australia uses International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes; Canada and New Zealand use ICD-9. The rate for ages 20-84 was age-standardized using the sum or the study population from the three countries as the standard population.
24. S.M. Davies et al., Refinement of the HCUP Quality Indicators, Pub. no. 01-0035 (Rockville, Md.: Agency for Healthcare Research and Quality, May 2001).
25. Suicide rates for the total population were age-standardized to the OECD 1980 population. Data are from 2000 in Australia and England/Wales, 1998 in Canada and the United States, and 2000-01 in New Zealand. Suicide rates are influenced by many factors in addition to medical care but are also influenced by mental health care. This, in addition to the dearth of mental health quality indicators, led to its inclusion by the working group as well as in other quality measurement activities including the U.S. National Quality Report. AHRQ, National Healthcare Quality Report (Rockville, Md.: AHRQ, December 2003).
26. The rate for the United Kingdom is for ages 14-19, not 15-19, and the rate for the United States is for ages 20-24, not 20-29.
27. Data are from 2000 except in Canada (1999). Some differences in notification requirements and practices may affect rates.
28. The ages of 5-39 were chosen after consultation with clinical experts in each of the five countries.
29. Asthma-related mortality was a rare event in the four countries that reported these data. Since this could lead to sizable year-to-year fluctuations, a moving average of the rate over the period 1980-2000 is shown in Exhibit 4. J.R. Charlton et al., "Geographical Variation in Mortality from Conditions Amenable to Medical Intervention in England and Wales," Lancet 1, no. 8236, Part 1 (1983): 691-696; W.W. Holland and the EC Working Group on Health Services and "Avoidable Death," eds., European Community Atlas of Avoidable Death, 1985-1989, 3d ed. (Oxford: Oxford University Press, 1997); D.G. Manuel and Y. Mao, "Avoidable Mortality in the United States and Canada, 1980-1996," American Journal of Public Health 92, no. 9 (2002): 1481-1484; and Australian Institute for Health and Welfare, "National Health Priority Areas," www.aihw.gov.au/nhpa/asthma/indicators.html (20 February 2004).
30. Asthma-related mortality was a rare event in the four countries that reported these data. Since this could lead to sizable year-to-year fluctuations, a moving average of the rate over the period 1980-2000 is shown in Exhibit 4. J.R. Charlton et al., "Geographical Variation in Mortality from Conditions Amenable to Medical Intervention in England and Wales," Lancet 1, no. 8236, Part 1 (1983): 691-696; W.W. Holland and the EC Working Group on Health Services and "Avoidable Death," eds., European Community Atlas of Avoidable Death, 1985-1989, 3d ed. (Oxford: Oxford University Press, 1997); D.G. Manuel and Y. Mao, "Avoidable Mortality in the United States and Canada, 1980-1996," American Journal of Public Health 92, no. 9 (2002): 1481-1484; and Australian Institute for Health and Welfare, "National Health Priority Areas," www.aihw.gov.au/nhpa/asthma/indicators.html (20 February 2004).
31. Asthma-related mortality was a rare event in the four countries that reported these data. Since this could lead to sizable year-to-year fluctuations, a moving average of the rate over the period 1980-2000 is shown in Exhibit 4. J.R. Charlton et al., "Geographical Variation in Mortality from Conditions Amenable to Medical Intervention in England and Wales," Lancet 1, no. 8236, Part 1 (1983): 691-696; W.W. Holland and the EC Working Group on Health Services and "Avoidable Death," eds., European Community Atlas of Avoidable Death, 1985-1989, 3d ed. (Oxford: Oxford University Press, 1997); D.G. Manuel and Y. Mao, "Avoidable Mortality in the United States and Canada, 1980-1996," American Journal of Public Health 92, no. 9 (2002): 1481-1484; and Australian Institute for Health and Welfare, "National Health Priority Areas," www.aihw.gov.au/nhpa/asthma/indicators.html (20 February 2004).
32. Asthma-related mortality was a rare event in the four countries that reported these data. Since this could lead to sizable year-to-year fluctuations, a moving average of the rate over the period 1980-2000 is shown in Exhibit 4. J.R. Charlton et al., "Geographical Variation in Mortality from Conditions Amenable to Medical Intervention in England and Wales," Lancet 1, no. 8236, Part 1 (1983): 691-696; W.W. Holland and the EC Working Group on Health Services and "Avoidable Death," eds., European Community Atlas of Avoidable Death, 1985-1989, 3d ed. (Oxford: Oxford University Press, 1997); D.G. Manuel and Y. Mao, "Avoidable Mortality in the United States and Canada, 1980-1996," American Journal of Public Health 92, no. 9 (2002): 1481-1484; and Australian Institute for Health and Welfare, "National Health Priority Areas," www.aihw.gov.au/nhpa/asthma/indicators.html (20 February 2004).
33. N. Pearce et al., "End of the New Zealand Asthma Mortality Epidemic," Lancet 345, no. 8955 (1995): 41-44; and S. Suissa and P. Ernst, "Optical illusions from Visual Data Analysis: Example of the New Zealand Asthma Mortality Epidemic," Journal of Clinical Epidemiology 51, no. 7 (1997): 1079-1088.
34. N. Pearce et al., "End of the New Zealand Asthma Mortality Epidemic," Lancet 345, no. 8955 (1995): 41-44; and S. Suissa and P. Ernst, "Optical illusions from Visual Data Analysis: Example of the New Zealand Asthma Mortality Epidemic," Journal of Clinical Epidemiology 51, no. 7 (1997): 1079-1088.
35. The smoking rate for Canada is for age twenty and older, and the rate for the United Kingdom is for age sixteen and older, not eighteen and older. Data are from 2001 in Australia and New Zealand, 2000-01 in Canada, 2000 in England, and 1999 in the United States.
36. M. Raw, A. McNeill, and R. West, "Smoking Cessation: Evidence Based Recommendations for the Healthcare System," British Medical Journal 318, no. 7177 (1999): 182-185.
37. Data from Australia, Canada, and the United States are from a population survey; data from England and New Zealand are from an organized screening program. Australia, England, and New Zealand measure the screening rate within the past three years; Canada and the United States measure within the past two years. Australia and Canada use ages 50-69; England and New Zealand, ages 50-64; and the United States, age 40 and older. Data are from 2001 in Australia and England, 2000-01 in Canada, 2002 in New Zealand, and 1999 in the United States.
38. The cervical screening rate during the past three years is measured except in England, where 3.5 years is used, since reminders are sent to the eligible population after three years. Data from Australia, Canada, and the United States are from a population survey; data from England and New Zealand are from an organized screening program. Rates are for ages 18-69 in Australia, Canada, and the United States and ages 20-69 in England and New Zealand. Data are for 2001 in Australia and England, 2000-01 in Canada, 2002 in New Zealand, and 1999 in the United States.
39. E.L. Franco, E. Duarte-Franco, and T.E. Rohan, "Evidence-Based Policy Recommendations on Cancer Screening and Prevention," Cancer Detection and Prevention 26, no. 5 (2002): 350-361.
40. Data from Australia, Canada, and the United States are from a population survey; data from England and New Zealand are from an organized screening program. Data are from 2000 in Australia, 2000-01 in Canada, 2001-02 in England, 2001 in New Zealand, and 1999 in the United States.
41. Data are from 2001 in Australia and New Zealand, 2002 in Canada, 2000-01 in England, and 2000 in the United States. The U.S. rate is measured for the period 19-35 months, not 24 months.
42. The incidence of polio was 0.00 per 100,000 in all five countries in 2000 (1999 in Canada), according to unpublished data collected by the Working Group.
43. P. Moise and S. Jacobzone, "OECD Study of Cross-National Differences in the Treatment, Costs, and Outcomes of Ischaemic Heart Disease," OECD Health Working Paper no. 3 (Paris: Organization for Economic Cooperation and Development, 2003).
44. R.J. Blendon et al., "Inequities in Health Care: A Five-Country Survey," Health Affairs 21, no. 3 (2002): 182-191.
45. Reinhardt et al., "Cross-National Comparisons of Health Systems."