US Ranks Last Among 11 Developed Countries on Significant Health Measures

Lack of access to primary care, inequities and inefficiencies in the health system pushed the U.S. to last place among 11 industrialized countries on health system performance, according to a recent report from the Commonwealth Fund.

Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2014 Update compared health system quality, efficiency, access to care, equity and healthy lives in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the U.S.

According to the report, the U.S. stands out for having the highest costs and lowest performance — we spent $8,508 per person on health care in 2011, compared with $3,406 in the United Kingdom, which ranked first overall. The report’s authors noted that some provisions in the Affordable Care Act have already extended coverage to millions of people in the United States and can improve the country’s standing in some areas—particularly access to affordable and timely primary care.

“It is disappointing, but not surprising, that despite our significant investment in health care, the U.S. has continued to lag behind other countries,” said lead author Karen Davis, of the Roger C. Lipitz Center for Integrated Health Care at Johns Hopkins Bloomberg School of Public Health. “With enactment of the Affordable Care Act, however, we have entered a new era in American health care. The U.S. performance on insurance coverage and access to care should begin to improve, particularly for low-income Americans. The Affordable Care Act is also expanding the availability and quality of primary care, which should help all Americans have better care and better health outcomes at lower cost.”

The U.S. has ranked last in each prior year the report was produced: 2004, 2006, 2007, and 2010. This year, four additional countries were added — Switzerland and Sweden, which followed the U.K. at the top of the rankings, and Norway and France, which were in the middle of the pack. Australia, Germany, the Netherlands, New Zealand, and Norway also placed in the middle, while Canada was just above the U.S. at the bottom.

Key 2014 findings related to the U.S. include:

Healthy lives: The U.S. ranks last on infant mortality and on potentially preventable deaths with timely access to effective health care and second-to-last on healthy life expectancy at age 60. Nowhere is this more apparent than the current firestorm over the Veterans Administration Health System.

Access to care: People in the U.S .have the hardest time affording the health care they need. The U.S. ranks last on every measure of cost-related access. More than one-third (37%) of US adults reported forgoing a recommended test, treatment, or follow-up care because of cost.

Health care quality: The U.S. ranks in the middle. On two of four measures of quality—effective care and patient-centered care—the US ranks near the top (3rd and 4th of 11 countries, respectively), but it does not perform as well providing safe or coordinated care.

Efficiency: The U.S. ranks last, due to low marks on the time and dollars spent dealing with insurance administration, lack of communication among health care providers, and duplicative medical testing. Forty percent of US adults who had visited an emergency room reported they could have been treated by a regular doctor, had one been available. This is more than double the rate of patients in the U.K. (16%).

Equity: The U.S. ranks last. About four of 10 (39%) adults with below-average incomes in the U.S. reported a medical problem but did not visit a doctor in the past year because of costs, compared with less than one of 10 in the U.K., Sweden, Canada, and Norway. There were also large discrepancies between the length of time U.S. adults waited for specialist, emergency, and after-hours care compared with higher-income adults.

Commonwealth Fund President David Blumenthal, M.D. called on policymakers to invest in a healthcare delivery system that ensures high quality, well coordinated care for everyone, and especially for patients with the greatest needs. “Those kinds of improvements will go a long way toward improving peoples’ health while making efficient use of our precious health care dollars.”

Maybe it’s time to reconsider what “health reform” really means.

Lack of access to primary care, inequities