How Bad Is U.S. Health Care? Among High-Income Nations, It's the Worst, Study says

Health Care
Republican leaders have struggled to replace the Affordable Care Act. U.S. health care remains among the worst ranked according to the Commonwealth Fund’s recent study. Jonathan Ernst/Reuters

As Republicans struggle to agree on a replacement for the Affordable Care Act, the Commonwealth Fund has rated the U.S. health care system as the worst among the 11 developed nations it analyzed as part of an evaluation conducted every three years. The think tank also rated the U.S. health care system as the worst-performing of the nations analyzed when the last evaluation was released in 2014.

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The Commonwealth Fund focused on care process, access, administrative efficiency, equity and health care outcomes, studying 72 indicators within those fields. The 11 countries analyzed were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. In addition to ranking last or close to last in access, administrative efficiency, equity and health care outcomes, the U.S. was found to spend the most money on health care.

The U.S. rated especially poor in equality of coverage. The report found that 44 percent of low-income Americans have trouble gaining access to coverage compared with 26 percent of high-income Americans. The numbers for the U.K. are 7 percent and 4 percent, respectively. Not unrelated, the U.K.'s National Health Service was deemed the best health care system, just as it was in 2014. "In contrast to the U.S., over the last decade the U.K. saw a larger decline in mortality amenable to health care than the other countries studied," the report reads.

Though the U.S. did rank fifth in care process, which includes prevention, safe care, coordination and patient engagement, its overall score was easily the worst of the 11 nations.

Health Care
The U.S. ranks last in health care among the 11 nations evaluated by the Commonwealth Fund. Commonwealth Fund

Particularly distressing when considering the last-place ranking is how much more America spends on health care relative to other nations.

Health Care
The U.S. leads in health care spending. Commonwealth Fund
Health Care
The U.S. health care system was the lowest performing. Commonwealth Fund

The U.S. is the only high-income nation to lack universal health care. As the report notes, this has effects that go beyond just access issues. Administrative efficiency, for example, lags because of the time wasted sorting out billing and insurance claims.

Though there is plenty of room for the U.S. to improve, the Commonwealth Fund concludes that for the country's health care system to compete with those of other high-income nations, a drastic change in course may be necessary.

"To gain more than incremental improvement,..the U.S. may need to pursue different approaches to organizing and financing the delivery system," the report reads. "These could include strengthening primary care, supporting organizations that excel at care coordination and moving away from fee-for-service payment to other types of purchasing that create incentives to better coordinate care. These steps should ensure early diagnosis and treatment, improve the affordability of care, and ultimately improve the health of all Americans."