US Is Drastically Behind Other Wealthy Nations On Healthcare, Despite Spending The Most

The United States continues to drag behind other industrialized nations when it comes to healthcare, according to new research from the Commonwealth Fund.

America ranked last overall among 10 high-income countries in health system performance — despite spending nearly twice as much on healthcare, according to the research foundation, which has compared the U.S. healthcare system with those of other nations for the past twenty years.

“Our health system is continuing to lag far behind other nations when it comes to meeting our citizens’ basic healthcare needs … We spend the most and get the least for our investment,” Commonwealth Fund President Joseph Betancourt said during a Wednesday press briefing.

The foundation’s analysis adds onto a mountain of research highlighting how the U.S. spends far more on healthcare than other wealthy countries, despite similar healthcare utilization. Much of the difference has been attributed to higher prices in the U.S., rooted in causes ranging from high hospital consolidation tamping down on competition, to inefficiency and administrative waste, to a lack of universal health insurance coverage.

Meanwhile, America’s higher healthcare spending is not mirrored by better health outcomes. The nation ranks the worst among comparable countries in many metrics, including life expectancy and maternal mortality.

“While other nations have successfully met their health needs, the United States health system continues to lag significantly,” said David Blumenthal, former president of the Commonwealth Fund.

‘In a class by itself’

For its analysis of health system performance, the Commonwealth Fund analyzed wealthy nations in five areas: access to care, administrative efficiency, equity, health outcomes and care process.

The top three countries overall were Australia, the Netherlands and the United Kingdom. However, differences in overall performance between most countries were “relatively small,” according to the report.

The U.S. was the only outlier, with “dramatically lower” health system performance.

America “really is in a class by itself,” Blumenthal said. “This is not, in the United States, a high-value health system.”

When it comes to care access, Americans are more likely to report financial barriers to care than citizens in other countries, the Commonwealth Fund found. The report cites the nation’s fragmented insurance system that has left millions of Americans uninsured.

Meanwhile, rising prices have fueled increases in out-of-pocket costs for covered consumers, which could incentivize patients to skip care. And, U.S. patients are more likely than their peers in other countries to report they don’t have a regular doctor or care site, the Commonwealth Fund found.

The U.S. healthcare system is also bloated with inefficiencies, according to the report. Doctors and patients in America were significantly more likely to report issues related to insurance approvals and billing than those in other countries.

It’s also highly inequitable, with the largest disparity in performance between low-income and high-income individuals, according to the Commonwealth Fund.

Meanwhile, Americans live the shortest lives and have the most avoidable deaths. Life expectancy is more than four years below the average of all ten countries, due in part to the ongoing substance abuse epidemic and pervasive gun violence, the report found. The U.S. also had higher rates of excess deaths due to the coronavirus pandemic compared to other nations.

In the report’s lone bright spot, the U.S. ranked second out of the 10 nations when it comes to care process: functions of the healthcare system that are essential to high-quality care, like prevention, safety and patient engagement.

The country’s strong performance in care process is likely the result of intensive policy interest in ensuring people get preventive care stemming from value-based care models in Medicare and run by other insurers, researchers said.

‘The American electorate makes choices’

America’s poor health system performance is even more shocking when taken into account with the nation’s spending on healthcare, according to the Commonwealth Fund. In 1980, U.S. spending on healthcare as a percentage of its GDP was at the high end among the ten nations the research group studied, but was comparable to spending in Sweden and Germany.

Since then, the U.S. has “far outpaced” other nations, spending over 16% of its GDP on healthcare in 2022, according to the report. That figure is expected to reach around 20% over the next decade, according to government estimates.

Meanwhile, the other nations included in the report spent between 8% and 12% of their GDP on healthcare as of last year. The two countries with the highest overall performance — Australia and the Netherlands — also had the lowest healthcare spending as a percentage of their GDP.

The poor performance of the U.S. health system is due to a smorgasbord of shortcomings, including administrative inefficiency, massive consolidation, underfunding and decentralization of the national public health system and a lack of investment in primary care, the Commonwealth Fund said.

Perhaps the largest driving force is that the U.S. is the only wealthy nation analyzed without a form of universal health insurance coverage, according to the report. A lack of adequate insurance can contribute to financial burden and poorer health outcomes.

Currently, 26 million Americans are uninsured — a historic low for the country, but high by international standards, according to Blumenthal. And, among Americans with insurance, nearly one-quarter are underinsured, undermining the quality and effectiveness of coverage.

“Universal coverage is fundamental,” Blumenthal said. “A lot of the lagging performance of the United States healthcare system has to do with access to care and equity of care, both of which are heavily influenced by the availability and quality of insurance.”

The U.S. should look to the success of other nations for ways to improve its healthcare system, but it’s unlikely there are easy near-term fixes to its issues, Commonwealth Fund researchers said. The Affordable Care Act, for example, which helped millions of Americans access affordable health insurance coverage, was passed in 2010 after decades of gradual expansion of public health services.

This year’s presidential election could play a significant role in the future direction of the U.S. healthcare system, Blumenthal said.

The Democrat nominee Vice President Kamala Harris has pledged to expand upon the ACA, while Republican nominee former President Donald Trump has pushed to repeal the law in the past and expressed support for cutting Medicare and Medicaid.

“I don’t expect that we will in one fell swoop rewrite the social contract, but the American electorate makes choices about which direction to move in, and that is very much an issue in this election,” Blumenthal said. “If we continue to lay the foundation for improvement of our healthcare system, elections that result in expansions of insurance coverage based on the existing programs would take us in the direction that makes us closer in performance to other international comparisons.”