The United States spends more on health care than any other high-income nation, yet Americans face higher rates of illness and premature death while struggling to afford essential medical services, according to a new report from The Commonwealth Fund. The independent research group’s report, released on Thursday, underscores that despite the high financial investment in health care, Americans have poorer health outcomes compared to their peers in other high-income countries.
In comparison with nine other wealthy nations, the U.S. ranked last overall, marked by lower life expectancy and higher rates of disease and death. This stark reality stands despite the fact that the country outspends all others on health care. Australia, the Netherlands, and the United Kingdom emerged as the top three performing countries in the report.
“This report reveals that our health system is continuing to lag far behind other nations when it comes to meeting our citizens’ basic health care needs. The US spends more on health care than any other country, and Americans are sicker, die younger and struggle to afford essential health care. We spend the most and get the least for our investment,” said Dr. Joseph Betancourt, president of The Commonwealth Fund, during a news briefing.
Betancourt, a primary care physician, emphasized the personal impact of these system failings. “As a primary care doctor, I see the human toll of these shortcomings in our system on a daily basis. I have patients who need medications they can’t afford. I spend time going back and forth with insurance companies who have denied care I know my patients need, and I see older patients who arrive sicker than they should because they’ve spent the majority of their lives uninsured,” he added.
According to Betancourt, the report provides a valuable “blueprint for health leaders and policymakers on how the US can achieve more equitable, affordable care for all Americans.”
Top Performers and Struggles of US Healthcare
The Commonwealth Fund’s analysis compared the health systems of ten countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States. These countries were evaluated across five key areas: access to care, the health care process, administrative efficiency, equity, and health outcomes, using data from the World Health Organization, OECD, Our World in Data, and other international surveys.
The highest-ranking nations in these five areas were Australia, the Netherlands, and the United Kingdom, with Australia taking the top spot. On the other hand, the U.S. ranked last in multiple domains, including access to care and health outcomes, reflecting significant issues in the system’s ability to provide timely and affordable health services.
The U.S. was highlighted as having the shortest life expectancy and the highest rates of avoidable deaths among the ten nations analyzed. The study also found that the U.S. recorded the most excess deaths related to the Covid-19 pandemic for individuals under the age of 75.
Equity was another area where the U.S. struggled, ranking ninth. This indicates that disparities based on income and background continue to be a major issue in accessing and receiving health care services. The country also ranked ninth in administrative efficiency, with numerous complaints about problems related to insurance approvals and billing processes.
“Administrative requirements can cost time and money for patients and doctors,” noted Reginald Williams II, vice president of international health policy at The Commonwealth Fund. He explained that many countries have simplified their health insurance systems through standardization and regulation. “For example, other countries apply standardized payments to all physicians for services, and do that on a regional basis, so that doctors know what they’ll be paid, and patients know what portion they’ll be responsible for,” he said. This makes their systems “much simpler.”
While the U.S. ranked poorly in several domains, the report did find that the country performed well in the care process domain, indicating that the quality of care delivered in some aspects is high. However, these gains were not enough to counterbalance the overall poor performance in other critical areas.
A Clear Outlier in Health System Performance
The U.S. stood as an outlier in the analysis, with researchers emphasizing that while all countries had areas where they could learn from one another, the gap between the U.S. and the other nations was particularly stark. The other nine countries shared universal health coverage systems, where copayments for services are minimal, which enhances both accessibility and affordability.
“A lot of the lagging performance of the United States’ health care system has to do with access to care and equity of care, both of which are heavily influenced by the availability and quality of insurance,” said Dr. David Blumenthal, former president of The Commonwealth Fund.
Blumenthal highlighted that, despite historic lows, approximately 20 million Americans remain uninsured, around 7-8% of the population. “It also lacks in terms of the ability of lower-income people to get access to basic services,” he said, reflecting the broader issue of access disparity.
Another key issue noted in the report was that despite similar health care spending levels in the other countries studied, the U.S. spends far more but delivers worse results. This inefficiency in spending, alongside the inequities in access, marks the U.S. as unique among its peers.
Improving US Health Care
The report calls for several reforms to improve the state of the U.S. health care system. These include expanding insurance coverage, reducing disparities in care, and simplifying the insurance system to minimize the administrative burden on both patients and providers.
Additionally, researchers argue that the U.S. must invest in addressing the social determinants of health, such as poverty, homelessness, and substance abuse, all of which contribute to poor health outcomes. “It’s important for the United States to invest in interventions outside of health care to address the social drivers of health: poverty, homelessness, hunger, discrimination, gun violence, substance use,” said Williams.
A stronger primary care system could also be key to improving health outcomes in the U.S. In the Netherlands, for instance, primary care physicians are required to offer after-hours coverage, ensuring that patients can access their doctor 24/7. Blumenthal noted that this system could significantly reduce the reliance on emergency rooms for after-hours care in the U.S., which is currently a major contributor to high health care costs and administrative complexity.
Impact of Political Choices on Healthcare
The future direction of U.S. health care is likely to be influenced by the upcoming presidential election, according to Blumenthal. “The American electorate makes choices about which direction to move in, and that is very much an issue in this election,” he said. Policies aimed at expanding insurance coverage could move the country closer to the standards seen in other high-income nations.
A similar report from The Commonwealth Fund last year revealed that the U.S. had the highest rates of avoidable deaths, maternal and infant mortality, while also spending the most on health care.
Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the reports, remarked last year, “We’re not getting the best value for our health care dollar.”
Benjamin outlined three areas for improvement: expanding universal access, increasing focus on primary care prevention, and investing in societal support systems. “They spend their money on providing upfront support for their citizens. We spend our money on sick care,” Benjamin said.