Commonwealth Fund: US has lower life expectancy but spends most on health compared to other countries

The U.S. has both the lowest life expectancy compared to other wealthy nations and the highest rate for avoidable deaths, a new study finds. 

The study, released Tuesday by the Commonwealth Fund, also found that the U.S. has the highest infant and maternal mortality rates as well as deaths by assault. The findings come as the Biden administration is hoping to improve maternal mortality. 

“To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population,” said Munira Gunja, senior researcher for Commonwealth Fund’s International Program in Health Policy and Practice Innovations and the study's lead author, in a statement. 

Researchers relied on data from the Organization for Economic Cooperation and Development, which tracks health system measures across 38 countries. They also used findings from a 2020 Commonwealth Fund International Health Policy Survey.

The analysis found that in 2021, the U.S. spent 17.8% of its gross domestic product on healthcare, which is “nearly twice as much as the average” for 38 high-income countries. The country with the second-highest spending rate was Germany at 12.8% followed by France with 12.4%. The analysis includes spending by government programs as well as employer-sponsored programs and out-of-pocket health costs. 

There is one key difference between the U.S. and other countries: a single-payer health system. 

“All the countries in this analysis, except the U.S., guarantee government, or public, health coverage to all their residents,” the analysis said. “In 2021, 8.6% of the U.S. population was uninsured. The U.S. is the only high-income country where a substantial portion of the population lacks any form of health insurance.”

But researchers found that despite the higher spending, the life expectancy for U.S. citizens was 77 years in 2020, which was three years lower than the average among high-income countries.

“In the U.S., life expectancy masks racial and ethnic disparities,” the analysis said. “Average life expectancy in 2019 for non-Hispanic Black Americans (74.8 years) and non-Hispanic American Indians or Alaska Natives (71.8 years) is four and seven years lower, respectively, than it is for non-Hispanic whites (78.8 years).”

However, the life expectancy for Hispanic Americans (81.9 years) is higher in New Zealand than it is for whites. Hispanic Americans also have similar life expectancy in the Netherlands and Canada. 

Racial disparities aren’t the only thing driving the gap in life expectancy.

The U.S. had the highest infant mortality rate in 2020 with 5.4 deaths per 1,000 live births, the highest of all countries in the analysis.

“Women in the U.S. have long had the highest rate of maternal mortality related to complications of pregnancy and childbirth,” the analysis said. “In 2020, there were nearly 24 maternal deaths for every 100,000 live births in the U.S., more than three times the rate in most of the other high-income countries we studied.”

The U.S. is also a significant outlier in physical assault deaths, including those stemming from gun violence. The average among high-income countries was 2.7 deaths per 100,000 people, but in the U.S. it was 7.4 per 100,000. 

The Biden administration is hoping to address some of the gaps in maternal mortality, including offering a “birthing friendly” hospital designation on its Hospital Compare website to help consumers. The American Rescue Plan Act also allowed states to expand postpartum Medicaid coverage for a year compared to 90 days after birth. 

Federal agencies are looking to incorporate health equity requirements into regulations, measuring providers and payers based on how well they address social determinants of health. The new ACO REACH value-based payment model, for example, mandates participants must create an equity plan on how the provider will identify and mitigate social determinants of health.