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The United States spends more on health care than any other high-income country, yet a new report suggests that “Americans are getting sicker, dying younger, and struggling to afford basic health care costs.”
Compared to nine other high-income countries, the United States spends the most on health care, yet has a short life expectancy and high mortality and morbidity rates, ranking last in this year’s overall rankings. ReportThe Commonwealth Fund, an independent research group, announced the findings on Thursday.
The top three countries in the report were Australia, the Netherlands and the UK.
“This report makes clear that our health care system continues to lag far behind other countries in meeting the basic health care needs of our people. America spends more on health care than any other country, yet Americans are getting sicker, dying younger, and struggling to afford basic medical costs. We spend the most, yet get the least return on our investment,” Commonwealth Fund President Joseph Betancourt said at a press conference.
“As a family physician, I see the human toll of our failing health care system every day. Patients cannot afford their medications. I deal with insurance companies who deny patients the treatment they need. I see elderly patients who have been uninsured most of their lives coming into the hospital with more severe illness than they should have,” Betancourt added.
“This report highlights many lessons we can learn from other countries about how to strengthen health care delivery and outcomes,” he said. “The report provides a blueprint for health care leaders and policymakers on how the United States can achieve more equitable and affordable health care for all Americans.”
Researchers from the Commonwealth Fund compared and analysed the performance of health systems in 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the UK and the US.
The researchers looked closely at how these countries’ health systems are performing across 70 measures across five key areas: access to care, health processes, administrative efficiency, equity and health outcomes. The assessment was based on data from international surveys conducted by the World Health Organization, the Organization for Economic Cooperation and Development, Our World in Data and the Commonwealth Fund.
The countries with the highest overall rankings across the five key areas were:
1. Australia
2. Netherlands
3. United Kingdom
4. New Zealand
5. France
The countries with the lowest overall rankings across the five key areas are:
6. Sweden
7. Canada
8. Switzerland
9. Germany
10. United States
When the researchers analyzed each country by key areas, they found that the United States ranked last in access to health care, indicating that Americans face the greatest barriers to accessing and paying for health care. The United States also ranked last in health outcomes, including acute illness, chronic disease, and death.
The researchers noted that Americans have the shortest life expectancy of the 10 countries, have experienced the most preventable deaths, and have the highest excess COVID-19-related mortality rates among people under the age of 75.
The United States ranked 9th in equity, indicating that there are still disparities in how people of different incomes and backgrounds access and experience health care. The United States also ranked 9th in administrative efficiency, indicating that American doctors and patients are more likely to report problems with insurance approvals and billing.
“Administrative requirements can impose time and cost burdens on patients and physicians,” Reginald Williams II, vice president of global health policy and practice innovation at the Commonwealth Fund, said at the briefing.
“Many countries have simplified their health insurance and payment systems through legislation, regulation and standardization. For example, other countries apply a standardized payment for services to all physicians and enforce it on a regional basis, so physicians know what they’re going to be paid and patients know how much they’re going to pay out of pocket,” he said. “They’ve made their systems much simpler.”
The only area in which the United States ranked highly was the process of care, indicating that the health care provided by the United States includes aspects and characteristics considered essential to high-quality care.
The researchers noted that “all countries have something to learn from each other,” but the differences in overall performance were relatively small between all countries except for the United States, “the only clear outlier.”
The other nine countries may have different health systems, but they all have universal health coverage and lower out-of-pocket costs for health services, improving both access to and ability to afford care, the researchers wrote.
“Much of the weakness in the U.S. health care system has to do with access to care and equity in care, both of which are heavily influenced by the availability and quality of insurance,” Dr. David Blumenthal, former president of the Commonwealth Fund, said at the briefing.
“The United States lags behind in that more than 20 million Americans are still uninsured, representing 7% to 8% of the population, a historic low but still very high by international standards,” he said. “It also lacks the ability for low-income people to access basic services.”
Moreover, the researchers found that while health care spending is similar in other countries, this is not the case in the United States, which spends significantly more on health care than other countries and yet has the worst overall performance.
The top two countries in the overall ranking, Australia and the Netherlands, had the lowest health care spending.
To improve health care outcomes, the researchers wrote, the United States could expand insurance coverage, reduce health care disparities, and reduce the administrative burden and complexity of health plans.
Williams also said it was important for the U.S. to “invest in non-healthcare interventions to address the social determinants of health, such as poverty, homelessness, hunger, discrimination, gun violence and drug use.”
The report also called for strengthening the U.S. primary care system.
For example, “family doctors in the Netherlands are required to be available after hours. People in the Netherlands can see their family doctor or their doctor at any time, 24 hours a day, which of course is not the case in the United States,” Blumenthal said.
“Americans are most likely to report difficulty obtaining after-hours care and, as a result, have to use emergency rooms for after-hours care,” he said. “This is a very simple intervention that will reduce the cost of care, reduce access issues, and reduce the administrative complexity of care.”
Blumenthal said the upcoming U.S. presidential election could play a big role in the future of the country’s health care system.
“American voters have a choice of which direction to go, and that’s the big issue in this election,” he said. “If we continue to build on the foundations of improving our health care system, an election that leads to expanded coverage under our existing system would put us on a path that would move us closer in performance to other international comparisons.”
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The new report’s rankings are consistent with those of a Commonwealth Fund paper published last year, which found that the United States still spends more on health care than any other high-income country, despite having the highest rates of deaths from preventable or treatable causes and maternal and infant mortality.
“We’re not getting value for our health care dollars.” American Public Health AssociationHe was not involved in either report but said last year:
Benjamin said there are three steps the country can take to address the shortcomings of the U.S. health care system.
“We are the only country that still does not have universal health care or access to health care for all of our citizens,” Benjamin said.
Second, “we don’t do as much primary care prevention as other countries, and we still have a broken public health system,” he said. “Third, we underinvest in social issues compared to other developed countries. Developed countries spend their money on providing upfront support to their people. We spend our money on treating disease.”
