Access

“Access to care includes measures of health care’s affordability and timeliness. The Netherlands performs best on this performance domain among the 11 countries, ranking at or near the top in both subdomains. Norway and Germany also performed well on access to care (Exhibit 1), but all three are outranked on affordability by the U.K. (Exhibit 5).

“Overall, the U.S. is #11 — last — on access to care (Exhibit 1). The U.S. has the poorest performance on the affordability subdomain, scoring much lower than even the next-lowest country, Switzerland (Exhibit 5). Compared to residents of the U.S., residents of the Netherlands, the U.K., Norway, and Germany are much less likely to report that their insurance denied payment of a claim or paid less than expected. Residents of these countries are also less likely to report difficulty in paying medical bills (Appendix 4).”

Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). doi.org/10.26099/01dv-h208

Process

“The U.S. ranks #2 on this performance domain (Exhibit 1). Along with the U.K. and Sweden, the U.S. achieves higher performance on the preventive care subdomain, which includes rates of mammography screening and influenza vaccination as well as the percentage of adults who talked with their provider about nutrition, smoking, and alcohol use. New Zealand and the U.S. perform best on the safe care subdomain, with higher reported use of computerized alerts and routine review of medications. Still, in all countries, more than 10 percent of adults report experiencing medical or medication mistakes in their care.”

Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). doi.org/10.26099/01dv-h208

Administrative Efficiency

“The top performers on the administrative efficiency domain are Norway, Australia, New Zealand, and the U.K. (Exhibit 1). The U.S. ranks last.

“U.S. doctors are the most likely to have trouble getting their patients medication or treatment because of restrictions on insurance coverage. Compared to most of the other countries, larger percentages of adults in the U.S. say they spend a lot of time on paperwork related to medical bills. For nonemergency care, U.S. and Canadian adults are also more likely to visit the emergency department — a less efficient option than seeing a regular doctor.”

Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). doi.org/10.26099/01dv-h208

Equity

“Australia, Germany, and Switzerland rank highest on the equity domain, meaning these countries had the smallest income-related disparities in performance based on the included measures (Exhibit 6).

“Within these countries, experiences reported by people in lower- and higher-income groups on 11 indicators in the affordability, timeliness, preventive care, safe care, and engagement and patient preferences subdomains are less divergent than they are within other countries (Appendix 7).

“In contrast, the U.S. consistently demonstrated the largest disparities between income groups, except for those measures related to preventive services and safety of care. U.S. disparities are especially large when looking at financial barriers to accessing medical and dental care, medical bill burdens, difficulty obtaining after-hours care, and use of web portals to facilitate patient engagement. Compared to the other countries, the United States and Canada had larger income-related inequities in patient-reported experiences.”

Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). doi.org/10.26099/01dv-h208

Outcomes

“The U.S. ranks last overall on the health care outcomes domain (Exhibit 1). On nine of the 10 component measures, U.S. performance is lowest among the countries (Appendix 8), including having the highest infant mortality rate (5.7 deaths per 1,000 live births) and lowest life expectancy at age 60 (23.1 years). The U.S. ranks last on the mortality measures included in this report, with the exception of 30-day in-hospital mortality following stroke. The U.S. rate of preventable mortality (177 deaths per 100,000 population) is more than double the best-performing country, Switzerland (83 deaths per 100,000).

“The U.S. has exceptionally poor performance on two other health care outcome measures. Maternal mortality is one: the U.S. rate of 17.4 deaths per 100,000 live births is twice that of France, the country with the next-highest rate (7.6 deaths per 100,000 live births).

“The second is the 10-year trend in avoidable mortality. As depicted in Exhibit 8, all countries reduced their rate of avoidable mortality over 10 years, but the U.S., with the highest level in 2007, reduced it by the least amount — 5 percent reduction in deaths per 100,000 population by 2017 — compared to 25 percent in Switzerland (by 2017) and 24 percent in Norway (by 2016).”

Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). doi.org/10.26099/01dv-h208

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 sixteen other nations.

Page last updated August 7, 2022 by Doug McVay, Editor.