“The United States ranks last in health care system performance among the 11 countries included in this study (Exhibit 2). The U.S. ranks last in Access, Equity, and Health Care Outcomes, and next to last in Administrative Efficiency, as reported by patients and providers. Only in Care Process does the U.S. perform better, ranking fifth among the 11 countries. Other countries that rank near the bottom on overall performance include France (10th) and Canada (9th).

“This analysis reveals striking variations in performance across the domains. No country ranks first consistently across all domains or measures, suggesting that all countries have room to improve. The U.S., France, and Canada score lower than the 11-country average across most of the five domains, but all three achieve above-average performance on at least one domain: France on Health Care Outcomes, Canada on Care Process and Administrative Efficiency, and the U.S. on Care Process (Appendix 1).

“Top Performers
“The top-ranked countries overall are the United Kingdom, Australia, and the Netherlands. In general, the U.K. achieves superior performance compared to other countries in all areas except Health Care Outcomes, where it ranks 10th despite experiencing the fastest reduction in deaths amenable to health care in the past decade. Australia ranks highest on Administrative Efficiency and Health Care Outcomes, is among the top-ranked countries on Care Process and Access, but ranks low on Equity. The Netherlands is among the top performers on Care Process, Access, and Equity; its performance on Administrative Efficiency stands out as an area for improvement.

“New Zealand performs well on measures of Care Process and Administrative Efficiency, but below the 11-country average on other indicators. Norway and Sweden did better on Health Care Outcomes compared to the other countries, despite having relatively low rankings on Care Process. Switzerland performs well on measures of Equity and Health Care Outcomes, while Germany achieves a high rank only on measures of Access.”

Source: Schneider, E. C., Sarnak, D. O., Squires, D., & Shah, A. (2017). Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better US Health Care.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.

Page last updated May 1, 2025 by Doug McVay, Editor.