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July 21, 2017

Researchers ranked 11 high-income countries on health care performance. The US came in last.

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    The United States' health system ranked last on performance when compared with 10 other high-income nations, according to research by the Commonwealth Fund.

    How to identify—and eliminate—care variation within your organization

    Study details

    For the study, researchers looked at a total of 72 indicators that measure access to care, administrative efficiency, care process, health care equity, and health outcomes in 11 comparatively wealthy countries:

    • Australia;
    • Canada;
    • France;
    • Germany;
    • The Netherlands;
    • New Zealand;
    • Norway;
    • Sweden;
    • Switzerland;
    • The United Kingdom; and
    • The United States.


    The researchers found that the United States spends more on health care than the other 10 nations, and that health care costs are rising more rapidly in the United States than in any of the other countries included in the study. According to the study, health care spending as a percentage of the country's gross domestic product (GDP) in the United States since 1980 has grown by 16.6 percent. In comparison, health care spending as a percentage of GDP since the 1980 has grown by:

    • 11.1 percent in France;
    • 10.9 percent in the Netherlands;
    • 10 percent in Canada;
    • 9.9 percent in the United Kingdom; and
    • 9 percent in Australia.

    Despite spending more on health care, the researchers found that the United States ranked last among the 11 countries in health care system performance. According to the study, the United States ranked last on measures of health care access, equity, and outcomes, and next to last on measure of administrative efficiency. The United States ranked fifth among the 11 countries on measures of care process, the researchers found.

    According to the study, the United States typically performed relatively well on measures related to:

    • 30-day hospital mortality after heart attack or stroke;
    • Breast and colorectal cancer survival;
    • Certain preventive care measures;
    • Chronic disease management;
    • End-of-life discussions;
    • Shared decision-making with primary care providers and specialists; and
    • Wellness counseling for healthy behaviors.

    However, the United States performed poorly on measures related to:

    • Administrative efficiency;
    • Coverage restrictions;
    • Disparities between lower- and higher-income adults;
    • Health care affordability;
    • Infant mortality;
    • Information flow between primary care, social service, and specialist providers;
    • Life expectancy at age 60; and
    • Timeliness of care.

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    Experts recommend ways to improve, cite concerns with GOP health reform efforts

    Commonwealth Fund experts recommended that, to fix the issues with the U.S. health system, policymakers should look to:

    • Bolster funding to improve nutrition and housing over specialty care;
    • Increase health insurance coverage rates and access to primary care; and
    • Simplify the insurance system to reduce administrative burdens on health care providers.

    The researchers wrote that the Affordable Care Act and other federal initiatives have helped to improve the U.S. health care system's performance. However, Eric Schneider, senior vice president for policy and research at the Commonwealth Fund, warned that Republican lawmakers' health reform proposals "would reverse" that progress, particularly when it comes to insurance coverage. "We suspect that alone would be taking us in a direction different from the solutions. The disparities we observe related to income would likely not get better under Medicaid cutbacks," he said.

    The experts said a decline in insurance coverage could lead to less access to primary care and ultimately less favorable health outcomes.

    In addition, Commonwealth Fund President David Blumenthal said expanding use of health savings accounts, as proposed in the Senate GOP's health reform bill, would make the U.S. insurance system more "comple[x]" (Anderson, Sacramento Bee, 7/14; Khazan, The Atlantic, 7/14; Commonwealth Fund interactive, accessed 7/17).

    How to identify—and eliminate—care variation within your organization


    Several factors drive care variation, including payer mix, provider risk-bearing levels, hospital and practice culture, and more.

    Read our report on how to find what's causing care variation in your organization—and how to change for the better.

    Download the Report

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