Comparing National Health Systems - Health System Rankings

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

Sustainable Development Goals Health Index

Commonwealth Fund “Mirror Mirror”

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.

You can find an overview of the US healthcare system here. Overviews of several other national healthcare systems can be found here.

Information on more comprehensive comparisons of national healthcare systems and health outcomes can be found here.

Table 1: Cost of Care (by Country). This chart shows that the US has much higher healthcare costs on a per capita, out of pocket, and % of GDP basis. — **This chart shows that the US has much higher healthcare costs on a per capita and % of GDP basis.**

Health Systems Facts Table 2: National Comparisons of Life Expectancies. This demonstrates that the quality of care in the US is lower in terms of life expectancy. — **The quality of care in the US is lower compared with other nations in terms of life expectancy.**

Chart comparing the number of Doctors and Nurses per 10,000 Population in the US and several other nations. — **The US has fewer doctors and nurses per 100,000 population than several other OECD nations.**

Datatable comparing various aspects of the national healthcare systems of Austria, Canada, Costa Rica, Germany, Japan, South Korea, Sweden, the United Kingdom, and the United States

“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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6227911/

“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).”

“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“

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 Nov. 20, 2020 by Doug McVay, Editor.