Key Points:
- The U.S. ranks lowest in health equity, with many low-income individuals unable to afford care and reporting unfair treatment.
- Americans have the shortest life expectancy and the highest rates of avoidable deaths among wealthy nations.
- U.S. patients are more likely to lack a regular doctor or a consistent place for care.
- The best-performing countries—Australia, the Netherlands, and the United Kingdom—spend less on health care as a percentage of their GDP.
- A new analysis shows the U.S. health system is the least effective among high-income countries in providing equitable access and good health outcomes.
The latest Commonwealth Fund report assessed the health systems of ten nations using 70 performance metrics across five categories: access, care process, administrative efficiency, equity, and health outcomes. Data sources included international organizations such as the World Health Organization and the OECD, along with global survey results.
In a press call, Commonwealth Fund President Dr. Joseph Betancourt emphasized that the U.S. health system is significantly lagging behind other countries in meeting basic health needs and described the current spending approach as “unsustainable.” He stated, “The U.S. spends more on health care than any other country, yet Americans are sicker, die younger, and struggle to afford essential health care.”
U.S. Rankings Compared to Other Countries: Among the analyzed nations, the U.S. was ranked last in overall health performance and scored poorly in four out of five categories. It ranked 10th for access to care and health outcomes, and 9th for equity and administrative efficiency. The report highlighted that U.S. patients are more likely to face financial burdens and rely on emergency departments for routine care.
In terms of equity, the U.S. exhibited the largest disparities between low-income and high-income patients. Many reported feeling that their health concerns were dismissed due to their racial or ethnic background.
This report also included measures related to COVID-19 outcomes, revealing that the U.S. had the highest per capita mortality from the virus among the countries studied.
The U.S. only excelled in one area—care process—where it ranked second, attributed to a focus on preventive services like screenings and vaccinations.
Top Performing Countries: Australia was ranked the best overall, leading in equity and health outcomes. The Netherlands came in second, excelling in access to care, while the United Kingdom ranked third for administrative efficiency.
The analysis revealed that countries with universal health care coverage generally performed better. In contrast, the U.S. lagged behind in most performance metrics.
High Spending, Low Returns: “No other country expects patients to pay as much out of pocket for essential health care as the U.S.,” Betancourt noted.
Areas for Improvement: Reginald Williams, vice president of international health policy and practice innovations at the Commonwealth Fund, stressed the need for significant investments to improve access to health care. This includes increasing insurance coverage, lowering out-of-pocket costs, and expanding the primary care workforce through better compensation and training.
“We need to create an equitable health system that meets the needs of all Americans,” Betancourt said. “It’s time to build a system that provides quality, affordable health care for everyone.”
In 2023, the U.S. spent over 16% of its GDP on health care, far more than other high-income nations. In contrast, Australia spent just 9.8%. While U.S. health care spending has doubled since 1980, affordability remains a major issue, with about 26 million Americans lacking coverage and many insured individuals facing rising costs.