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U.S. Health System a Pitiful Last Among Wealthy Nations

August 9, 2021

Mirror, Mirror 2021: Reflecting Poorly
Health Care in the U.S. Compared to Other High-Income Countries
The Commonwealth Fund
August 4, 2021
By Eric C. Schneider et al.

Issue: No two countries are alike when it comes to organizing and delivering health care for their people, creating an opportunity to learn about alternative approaches.

Goal: To compare the performance of health care systems of 11 high-income countries.

Methods: Analysis of 71 performance measures across five domains — access to care, care process, administrative efficiency, equity, and health care outcomes — drawn from Commonwealth Fund international surveys conducted in each country and administrative data from the Organisation for Economic Co-operation and Development and the World Health Organization.

Key Findings: The top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.

Conclusion: Four features distinguish top performing countries from the United States: 1) they provide for universal coverage and remove cost barriers; 2) they invest in primary care systems to ensure that high-value services are equitably available in all communities to all people; 3) they reduce administrative burdens that divert time, efforts, and spending from health improvement efforts; and 4) they invest in social services, especially for children and working-age adults.


Comment by: Isabel Ostrer

The Commonwealth Fund compared health systems in 11 high-income countries to identify what policies and practices are associated with better performance. The countries were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

The overall health care system ranking is striking: the U.S. ranks last in every domain except care process. (This includes preventive care, e.g., rates of mammography and influenza vaccination.)

In access to care, which includes affordability and timeliness, we’re last because individuals here are most likely to experience insurance denials, high out of pocket costs, difficulty paying medical bills, and delays in seeing a provider.

To add insult to injury, health care spending in the U.S is uniquely high. In 2019, the U.S. spent 16.8% of its GDP on health care. The next highest spender, Germany, clocked in at 11.7% .

What do we get for all this spending? The U.S. is dead last in health care outcomes. We have the highest infant mortality rate, the highest rate of maternal mortality, and the highest rate of preventable mortality.

So what can we learn from our peer countries? For starters, they all have universal health coverage and no cost barriers. The U.S. has 30 million uninsured … and 40 million underinsured.

The evidence speaks loudly. Sinking more money into a multi-payer health care system serves only to inflate U.S. health care costs without improving access or outcomes. A truly patient-centered system is one that provides universal coverage and shields patients from unnecessary cost-sharing.


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