Commonwealth Fund Report: US health care system worst of high-income nations

The United States health care system is utterly underperforming compared to other high-income countries, according to the latest issue brief from the Commonwealth Fund.

The Mirror, Mirror 2024 report is the Commonwealth Fund’s eighth report comparing health systems among selected countries. For the report, researchers used data from the Commonwealth Fund International Health Policy Surveys to analyze 70 health system performance measures in five areas, including access to care, care process, administrative efficiency, equity, and health outcomes.

This year’s report compared health systems of 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States.

The findings reveal a stark difference between the U.S. and the other countries.

“The U.S. continues to be in a class by itself in the underperformance of its health care sector,” wrote the researchers. “While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.”

Through their analysis, the research team found the top three countries based on health care system performance are Australia, the Netherlands, and the United Kingdom. Differences in overall performance between most countries are relatively small, noted the researchers. However, there was one “clear outlier” when it came to health system performance being dramatically lower—the United States.

Additional findings include:

The U.S. is also an outlier in health care spending, outpacing the other nations and spending more than 16 percent of its GDP on health care in 2022. Next in line is France, spending 11.9 percent.
Americans face the most barriers to health care access and affordability compared to other countries.
The U.S. is among the top performers for the care delivery process, which the researchers attributed to successful implementation of preventive services, such as mammograms and flu vaccinations, as well as an emphasis on patient safety.
Physicians and patients in the U.S. are most likely to face obstacles related to insurance rules, billing disputes, and reporting requirements.
The U.S. ranked last for equity in health care access and experience.
The U.S. also scored poorly on health outcomes, with Americans living the shortest lives and having the most avoidable deaths.

“The U.S. is failing one of its principal obligations as a nation: to protect the health and welfare of its people,” said Joseph R. Betancourt, M.D., Commonwealth Fund President in a statement. “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.”

The researchers made several policy recommendations to improve the U.S. health care system, including:

Extend health care coverage to the remaining uninsured and reform insurance coverage to meet minimal standards, including limits on patients’ out-of-pocket costs.
Improve compensation and training for primary care providers.
Advance health equity by addressing longstanding disparities in the health care that low-income individuals, Black, Latino, and Indigenous people, women, and people who live in rural areas receive.
Tackle the uncontrolled consolidation of health care systems and resources in local markets, which are driving prices higher and making insurance less affordable.
Invest in efforts to address the social determinants of health, including poverty, homelessness, hunger, gun violence, and substance use.