The U.S. spends more on health care relative to the size of its economy than any other nation, but its health care system ranks dead last among a group of its peers, according to a new analysis from the Commonwealth Fund.
Researchers compared 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. They ranked their health care systems on 71 variables, clustered in five broad thematic areas: access to care, the care process, administrative efficiency, equity and health-care outcomes. In four of the five areas, the U.S. ranked last. In the one exception, the care process, the U.S. ranked second.
The top-performing countries overall were Norway, the Netherlands and Australia. But the top 10 nations were clustered together on many measures, leaving the U.S. in a class all its own, as the chart below indicates.
Where the U.S. falls short: The researchers said the top-performing systems have four characteristics that distinguish them from the U.S.:
1. universal coverage with no cost barriers;
2. excellent primary care that is available equally to all;
3. minimal administrative burdens that distract from care;
4. investment in social services, especially for children and working-age adults.
Cost and equity are particularly glaring problems for the U.S., where the wealthy are usually able to purchase excellent medical services but the non-wealthy face difficulties. “We’ve set up a system where we spend quite a bit of money on health care but we have significant financial barriers, which tend to dissuade people from getting care,” the study’s lead author, Eric Schneider, told The Washington Post.
The result is the least affordable health care system in the advanced world, which fails large portions of the population. “We have almost two health-care systems in America: one for people with means and insurance, and another one that falls short for people who are uninsured or don’t have adequate insurance coverage,” Schneider said.