National sections include detailed subsections on each nation’s health system rankings, population health coverage, health system expenditures, financing, costs to consumers, outcomes, and much more. World Health Systems Facts currently has sections on the US and sixteen other OECD nations – links below:
A number of attempts have been made to compare healthcare outcomes and rank the health systems of the world’s nations. Some of the most comprehensive comparisons of national healthcare systems include:
Healthcare Access and Quality Index 2019
Healthcare Access and Quality Index 2016
Institute for Health Metrics and Evaluation: Global Burden of Disease
Sustainable Development Goals Health Index
Commonwealth Fund’s “Mirror Mirror” 2021
World Health Organization’s World Health Report 2000
The charts below compare the performance of several national healthcare systems. The performance of the United States and several other nations are ranked in the areas of healthcare costs, expenditures, outcomes, resources, and coverage.
“Our analysis showed improvements in the overall and select age group HAQ Indices in almost every country and territory between 1990 and 2019. However, disparities in HAQ Index scores across locations persisted into 2019. Between 1990 and 2019, the gap with the high-SDI quintile in the young group declined or was steady for all SDI levels. In the two other age groups, only the middle-SDI-quintile countries closed the average gap with high-SDI-quintile countries, and the gap for the low-SDI-quintile countries grew. While we find evidence of convergence in the young HAQ Index, social and economic development remains a crucial predictor of levels and trends in health-care access and quality.
“Countries with higher social and economic development had better performance in the HAQ Index—nearly 50 points separates the lowest and highest SDI quintiles for the overall and age-group scores. Social and economic development supports countries in raising more funds for health, pooling resources for health insurance, improving the health-care workforce, and other factors that enhance the ability of health systems to improve health-care access and quality.46, 56, 57 Greater resources also enable purchasing of more expensive technology, equipment, and pharmaceuticals to prevent and treat disease.
“This study emphasised major improvements in the HAQ Index for the young age group between 1990 and 2019. Countries with lower scores in the past have made strides in closing disparities with highest performers on the HAQ Index. This observation aligns with the convergence theory advanced by the Lancet Commission on Investing in Health—that the burden of infectious diseases and maternal, neonatal, and child health in high-mortality LMICs could converge to the rates seen in best-performing middle-income countries.58 More substantial improvements in the young HAQ Index relative to the other age groups might be related to the billions of dollars in development assistance disbursed for these health areas over the past 30 years,59 and the creation and diffusion of relatively effective and cheap technologies, such as vaccines and oral rehydration salts that reduced mortality due to vaccine-preventable diseases and diarrhoea.60, 61, 62, 63, 64
“In contrast, our analysis shows less convergence in the post-working and working groups. This observation can be explained in part by comparatively lower funding for NCD care; in addition, conditional on the same set of diseases and conditions, averting mortality for older people requires more complex responses, a higher level of organisational capacity, higher costs, and different technology, treatment, and diagnostics.65, 66, 67, 68, 69 Differences could also be explained by how health systems evolve to meet their populations’ needs. High-SDI countries had a higher median age than the low-SDI countries with the lowest average HAQ Index scores in 2019.1 More broadly, some of these shortcomings might be due to the lack of robust primary health care. Health systems should address health needs across the life course, along the continuum of care, and focus on health more holistically rather than homing in on a single disease.70
“Given transitions in burden of disease and ageing, lags in improving health-care access and quality for the working and post-working age groups could have broader social and economic consequences. In the absence of formal health system capacity for elder care, women and children often bear the brunt of care-taking duties, with implications for gender equity and educational attainment.71, 72 If lack of access to high-quality health care depresses labour force participation or productivity among the working age group, countries going through the demographic transition might be unable to benefit from the demographic dividend,73 with implications for tax revenue, intra-family income transfers, and the broader ability of countries to confront increasing dependency ratios (ratio of the working age adult population to populations typically not working: aged 0–14 years and ≥65 years) forecasted for decades to come.1“
Source: GBD 2019 Healthcare Access and Quality Collaborators (2022). Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet. Global health, 10(12), e1715–e1743. https://doi.org/10.1016/S2214-109X(22)00429-6
“The global median health-related SDG [Sustainable Development Goals] index was 59·4 (IQR 35·4–67·3) in 2017, ranging from a low of 11·6 (95% UI 9·6–14·0) to a high of 84·9 (83·1–86·7; figure 1). The overall health-related SDG index masked substantial variation across indicators within countries. Many countries with low overall index scores performed reasonably well on some individual indicators and vice versa. For example, although Kenya scored only 31·7 (30·6–32·9) on the overall health-related SDG index for 2017, the country scored much better on met need for family planning (77·8, 74·6–80·9) and smoking prevalence (85·4, 82·6–88·0). By contrast, South Korea, which scored 72·2 (69·0–74·4) on the overall index, scored comparatively worse on suicide mortality (16·3, 11·5–21·1). Results for each indicator and country can be explored through the online data visualisation tool.
“Scores for NCD [Non-Communicable Disease] mortality were worst in Afghanistan and in many countries in Oceania; the best scores were primarily among higher-SDI countries, with the exception of Peru (figure 1). Most countries with the best alcohol use scores were in north Africa and the Middle East, whereas countries with the worst values were generally concentrated in Europe. The worst smoking prevalence scores were found among a heterogeneous set of locations (eg, Greenland, Kiribati, and Montenegro), and the best were primarily found in sub-Saharan Africa. Suicide mortality scores were generally best in countries in the Middle East and worst in a variety of countries (eg, Greenland, Lesotho, and Lithuania).
“The worst scores for health worker density were primarily in sub-Saharan African countries; by contrast, Cuba, Qatar, and many European countries recorded among the best scores for this indicator. Several Latin American countries had the worst scores for sexual violence by non-intimate partners, whereas several countries in central Asia, eastern Europe, and south Asia had the best scores for this indicator.
“During 2008–17, 165 countries conducted at least one population and housing census. 30 countries had existing or had implemented population registries during this time, and eight of these countries had conducted at least one census since 2008 (appendix 2). Eight countries did not have this important source of demographic information over the full time period.”
Source: GBD 2017 SDG Collaborators. “Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.” Lancet (London, England) vol. 392,10159 (2018): 2091-2138. doi:10.1016/S0140-6736(18)32281-5.
“Performance on the health-related SDG index in 2017 varied globally (figure 2) and at the subnational level (figure 3). Countries in the tenth decile of performance—those with the best index values—were primarily in western Europe, although Canada, Japan, and Singapore were also in this decile. Afghanistan was in the first decile of performance, which otherwise predominantly included countries in sub-Saharan Africa.
“Among the countries with subnational SDG index scores (figure 3), India (which ranked in the third decile nationally) had the largest range in 2017, with a 34·9-point difference between states with the highest and lowest scores. China also had considerable subnational differences, performing in the sixth decile nationally but recording a 19·3-point difference in scores across provinces, followed by the USA (ninth decile nationally and a 14·8-point difference across states) and Mexico (seventh decile nationally and a 15·3-point difference across states). Scores were most homogeneous in Japan (tenth decile nationally and a 3·0-point difference across subnational locations), the UK (tenth decile nationally and a 3·6-point difference across regions in England), and Brazil (eighth decile nationally and an 8·0-point difference across states).”
Source: GBD 2017 SDG Collaborators. “Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.” Lancet (London, England) vol. 392,10159 (2018): 2091-2138. doi:10.1016/S0140-6736(18)32281-5.
“It is well known that national averages mask subnational disparities within countries, and the results of the health-related SDG index at the subnational level showed substantial differences in performance within countries, particularly in India and China. Differences between localities were lowest in Japan and the UK. Across countries, the states with the lowest SDG index scores in the USA (Mississippi, Arkansas, West Virginia, and Nevada) had lower scores than did 17 states in Mexico and 12 states in Brazil, while ten states in the USA had lower scores than Shanghai.
“Disparities on the health-related SDGs at the subnational level were particularly pronounced among low-SDI and middle-SDI countries, indicating that greater investments in targeting the most vulnerable or disadvantaged people in a country are probably required to improve the health of the entire population. Generally, we found that higher-SDI countries had less variation in their performance among first administrative levels; however, differences at more focal levels (eg, counties in the USA and municipalities in Brazil) and by age and sex might still present considerable challenges to reaching the SDG aims of leaving no one behind. Identifying such gaps is a necessary first step to focus the attention of local decision makers when targeting resources and programmes. Few reports of countries seeking to address SDGs at the local level exist, although many countries have published voluntary reports of SDG progress with national-level data.71–77“
Source: GBD 2017 SDG Collaborators. “Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.” Lancet (London, England) vol. 392,10159 (2018): 2091-2138. doi:10.1016/S0140-6736(18)32281-5.
“According to the 2016 Commonwealth Fund International Health Policy Survey conducted in 11 OECD countries (Box 2.1), most people in 2016 were able get an answer to their medical concern from their regular doctor’s office on the day when they contacted the office, although in some countries it was easier to get such a quick answer (Figure 2.1). The share of people reporting that they “sometimes, rarely or never get an answer from their regular doctor’s office on the same day” was low in Switzerland (12%), Germany (13%) and the Netherlands (13%), but higher in Canada (33%) and the United States (28%). In most countries, this share did not change significantly between 2013 and 2016, although the survey results show progress in Australia and Switzerland, and suggest some deterioration in Sweden.”
Source: OECD (2020), Waiting Times for Health Services: Next in Line, OECD Health Policy Studies, OECD Publishing, Paris, doi.org/10.1787/242e3c8c-en.
The Real Reporting Foundation and World Health Systems Facts was a proud supporter of the “Lessons for U.S. Health Reform: Ideas from Health Care around the World” conference held May 7, 2021 at the University of California-Berkeley. All presentations are available on Youtube.
World Health Systems Facts and the Real Reporting Foundation were also supporters of a conference entitled “International Health Systems In Perspective: Lessons for US Health Reform” that was held Oct 22-23 at UC-Berkeley. All presentations are available on Youtube.
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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 nations.
Page last updated July 16, 2023 by Doug McVay, Editor.
