“Based on a broadly inclusive set of performance metrics, we find that U.S. health care system performance ranks last among 11 high-income countries. The country’s performance shortcomings cross several domains of care including Access, Administrative Efficiency, Equity, and Health Care Outcomes. Only within the domain of Care Process is U.S. performance close to the 11-country average. These results are troubling because the U.S. has the highest per capita health expenditures of any country and devotes a larger percentage of its GDP to health care than any other country.
“The U.S. health care system is unique in several respects. Most striking: it is the only high-income country lacking universal health insurance coverage. The U.S. has taken an important step to expand coverage through the Affordable Care Act. As a 2017 Commonwealth Fund report showed, the ACA has catalyzed widespread and historic gains in access to care across the U.S.4 More than 20 million Americans gained insurance coverage. Additional actions could extend insurance coverage to those who lack it. Furthermore, Americans with coverage often face far higher deductibles and out-of-pocket costs than citizens of other countries, whose systems offer more financial protection.5 Incomplete and fragmented insurance coverage may account for the relatively poor performance of the U.S. on health care outcomes, affordability, administrative efficiency, and equity.
“Several new U.S. federal initiatives—notably the Affordable Care Act—have promoted actions to improve U.S. health care system performance.6 In addition to extending insurance coverage to millions of Americans, recent legislation includes initiatives to spur innovation in health care delivery by changing payment incentives for providers. But health systems can be slow to change. Additional legislative and policy reforms may be needed to close the performance gap between the U.S. and other countries.
“The U.S. could learn important lessons from other highincome countries (see Lessons for the United States). For example, the U.S. performs poorly in administrative efficiency mainly because of doctors and patients reporting wasting time on billing and insurance claims. Other countries that rely on private health insurers, like the Netherlands, minimize some of these problems by standardizing basic benefit packages, which can both reduce administrative burden for providers and ensure that patients face predictable copayments.
“The U.K. stands out as a top performer in most categories except for health care outcomes, where it ranks with the U.S. near the bottom. In contrast to the U.S., over the past decade the U.K. saw a larger decline in mortality amenable to health care (i.e., a greater improvement in the measure) than the other countries studied. (The U.S. has had the smallest decline, or lowest level of improvement.) In the early 2000s, the U.K. made a major investment in its National Health Service, reforming primary care and cancer care in addition to increasing health care spending from 6.2 percent of GDP in 2000 to 9.9 percent of GDP in 2014 (Exhibit 1).7 The reforms and increased spending may have contributed to the rapid decline in mortality amenable to health care in the U.K.
“There is a striking contrast between the U.S’s poor performance on infant mortality, life expectancy, and amenable mortality and its relatively better performance on in-hospital mortality after heart attack or stroke. Researchers have noted that the only modest decline in the rate of amenable mortality in the U.S. may be attributable to better management, once diagnosed, of hypertension and cerebrovascular disease that lead to cardiovascular mortality.8 These findings highlight the combined impact of a lack of universal insurance coverage and barriers to accessing primary care, and suggest that the U.S. could make gains by investing more in preventing chronic disease. The high level of inequity in the U.S. health care system intensifies the problem. For the first time in decades, midlife mortality for less-educated Americans is rapidly increasing.9“
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.
Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.
Page last updated July 4, 2021 by Doug McVay, Editor.