The U.S. health system ranks last in a new study on quality and accessible care among 11 high-income countries surveyed.
The study, conducted by the Commonwealth Fund, used data from international surveys of groups including the public and physicians along with the guidance of an independent advisory panel, choosing 71 measures relevant to healthcare system performance. They were categorized into five primary groups: access, care process, administrative efficiency, equity and healthcare outcomes.
It concluded that, among other things, receiving adequate healthcare in the U.S. depends on one’s income, despite the U.S. spending the most on care. The U.S. has ranked last in every edition of the report since 2004.
The U.S. was the only country without universal healthcare coverage, and half of lower-income adults reported being unable to afford needed healthcare, compared to only a quarter of higher-income adults. In the U.K., this disparity is only 12% to 7%, respectively. And in the U.S., 38% of adults said they skipped out on care in the past year due to costs, more than four times higher than in Norway and the Netherlands.
Even though the U.S. ranked second for care process, it was last in every other category and therefore last overall. The categories in which it ranked last include poor maternal and infant mortality, potentially preventable deaths, duplicative medical testing and time spent on paperwork. Nearly two-thirds of primary care doctors reported as a major problem the amount of time spent on fighting for patients’ treatment due to insurance restrictions. And 34% of adults reported insurance denying claims or paying less than expected, compared to 4% of adults in Germany and the U.K.
“What this report tells us is that our health care system is not working for Americans, particularly those with lower incomes, who are at a severe disadvantage compared to citizens of other countries. And they are paying the price with their health and their lives,” said David Blumenthal, Commonwealth Fund president, in a press release.
Among the countries that ranked the best were Norway, the Netherlands and Australia, in order from the highest ranking (1) to next highest (2) and (3).
The press release on the study noted that the funding of services such as child care, nutrition, transportation and paid sick leave—which other research has shown the U.S. lacks compared to other high-income countries—could improve population health. Expanding health insurance coverage, strengthening primary care and easing the complexity of the paperwork and administrative processes would also help the U.S. build a better system.
“A country that spends as much as we do should have the best health system in the world,” said Eric Schneider, M.D., the foundation's senior vice president of policy and research, in a statement. “We should adapt what works in other high-income countries to build a better health care system that provides affordable, high-quality health care for everyone.”