US health system ranks last among 10 countries

For the report, the Commonwealth Fund assessed the performance of 70 health systems in 10 countries in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. The 10 countries were Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States.

Data was collected from international surveys of older adults (age 65 and older), primary care physicians, and the general population (age 18 and older) in each country. The 2024 report uses survey data from 2021, 2022, and 2023.

Among the 10 countries included in the report, the United States ranked last overall, with Americans having the shortest life expectancy (77.5 years) and higher rates of death and disease despite having the highest healthcare spending. The three top-performing countries were Australia, the Netherlands, and the United Kingdom.

When analyzing each country by each key domain, the United States ranked last in access to care and health outcomes. It also ranked ninth when it came to administrative efficiency and equity. However, the United States ranked second when it came to care process.

"Strong U.S. performance in the care process domain is the result of the successful provision of preventive services, such as mammograms and flu vaccinations, and an emphasis on patient safety," the Commonwealth Fund wrote.

According to the researchers, "all countries have something to learn from one another." However, they noted that there were relatively small differences in overall performance among the countries except for the United States, which was "the only clear outlier."

"The U.S. continues to be in a class by itself in the underperformance of its health care sector," the Commonwealth Fund wrote.

Commentary

According to Joseph Betancourt, president of the Commonwealth Fund, the report "reveals that our health system is continuing to lag far behind other nations when it comes to meeting our citizens' basic health care needs."

"The US spends more on health care than any other country, and Americans are sicker, die younger and struggle to afford essential health care. We spend the most and get the least for our investment," he added.

Separately, David Blumenthal, former president of the Commonwealth Fund, said that "[a] lot of the lagging performance of the United States' health care system has to do with access to care and equity of care, both of which are heavily influenced by the availability and quality of insurance."

"The United States lags both in having 20-plus million Americans still uninsured – 7% to 8% of the population – though an historic low, still very high by international standards," Blumenthal said. "It also lacks in terms of the ability of lower-income people to get access to basic services."

Reginald Williams II, VP of international health policy and practice innovations at the Commonwealth Fund, noted that "[m]any countries have simplified their health insurance and payment systems, usually through legislation, regulation and standardization."

"For example, other countries apply standardized payments to all physicians for services, and do that on a regional basis, so that doctors know what they'll be paid, and patients know what portion they'll be responsible for," Williams said. "They make it much simpler."

According to Blumenthal, the upcoming U.S. presidential election could have a significant impact on the future of the U.S. healthcare system.

"The American electorate makes choices about which direction to move in, and that is very much an issue in this election," Blumenthal said. "If we are continuing to lay the foundation for improvement of our health care system, elections that result in expansions of insurance coverage, based on the existing programs, would take us in the direction that makes us closer in performance to other international comparisons."

Overall, the report "underscores the many lessons we could learn from others on how to strengthen our health care delivery and outcomes," Betancourt said. "It provides a blueprint for health leaders and policymakers on how the US can achieve more equitable, affordable care for all Americans." (O'Connell-Domenech, The Hill, 9/19; Goldman, Axios, 9/19; Howard, CNN, 9/19; Blumenthal et al., Commonwealth Fund, 9/19)

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