US Health Care System Ranks Last Overall Among Other High-Income Countries

The US health care system ranked last overall among 10 other high-income countries on key issues such as equity, access to care, and outcome measures, according to a new report, Mirror, Mirror 2024: A Portrait of the Failing US Health System, by The Commonwealth Fund.¹

The US ranked 10th overall in health system performance, significantly lagging behind Australia, the Netherlands, and the United Kingdom, which were the top performers. | Image credit: MargJohnsonVA - stock.adobe.com

“The US is failing one of its principal obligations as a nation: to protect the health and welfare of its people,” said Joseph Betancourt, MD, president of The Commonwealth Fund, in a statement.² “The status quo—continually spending the most and getting the least for our health care dollars—is not sustainable. It isn’t about lack of resources—it’s clearly about how they are being spent. Too many Americans are living shorter, sicker lives because of this failure. We need to build a health system that is affordable and that works for everyone. It’s past time that we step up to this challenge.”

In this report, an analysis of 70 health system performance measures was conducted across 5 areas: access to care, care process, administrative efficiency, equity, and health outcomes. The report covered 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the US.¹

The study relied on unique data collected from international surveys that The Commonwealth Fund conducts in collaboration with participating countries. The study also included data from cross-national organizations, as well as national data registries and research literature.

US Health Care System Rankings

The US ranked 10th overall in health system performance, significantly lagging behind Australia, the Netherlands, and the United Kingdom, which were the top performers.

Access to care was the US’ weakest area, with the country placing last due to issues like high out-of-pocket costs and its 26 million uninsured individuals. In contrast, countries like the Netherlands and Germany excelled due to universal coverage and affordable care.

In the care process category, the US ranked second, due to its focus on preventive care and patient safety, including initiatives like Medicare's pay-for-performance programs. However, administrative efficiency was another area of weakness, with the US ranking ninth, largely due to the complexity of its insurance system, which burdens both providers and patients with denials and appeals.

When asked in a media briefing about how value-based care models could help address some of the burdens in the US health care system, Reginald D. Williams II, vice president of The Commonwealth Fund, told The American Journal of Managed Care^®, “It may increase value by increasing quality, but it may not improve administrative efficiency. I think that's where the opportunity is, to think about the use of how technology can potentially support the care of the administrative efficiency around payments.”

Equity was also poor, with the US placing ninth due to significant disparities in care access and reports of racial and ethnic discrimination.

Lastly, in health outcomes, the US ranked 10th, with the highest rates of preventable deaths and a lower-than-average life expectancy, further exacerbated by the opioid crisis and gun violence.

Ways to Improve

To improve its health care system, the researchers believe the US can learn from other nations by reducing financial barriers and expanding coverage while ensuring insurance protects against high out-of-pocket costs. Simplifying the complex insurance system and investing in primary care—by improving compensation and training for providers—are also key areas for improvement.

Additionally, addressing consolidation in health care markets and regulating mergers can help reduce costs and improve access. Furthermore, the researchers believe that strengthening the public health infrastructure is essential for combating chronic diseases and responding to future emergencies. Finally, the researchers state that addressing social determinants like gun violence, drug overdoses, and racism, along with expanding social safety nets, will be critical for achieving equity and improving health care.

“This report underscores the many lessons we could learn from others on how to strengthen our health care delivery and outcomes," said Betancourt, during the media briefing. “It provides a blueprint for health leaders and policymakers on how the US can achieve more equitable, affordable care for all Americans.”

References

1. Blumenthal D, Gumas E, Shah A, et al. Mirror, Mirror 2024: A Portrait of the Failing US Health System. The Commonwealth Fund; September 19, 2024. Accessed September 18, 2024. https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024

2. US health system fails many Americans; ranks lowest on health equity, access, and outcomes. News release. The Commonwealth Fund. September 19, 2024. Accessed September 18, 2024.