U.S. Health System Trails Far Behind Other High-income Countries

The COVID-19 pandemic has shown that no nation has the perfect health system, but a report from the Commonwealth Fund finds the U.S. trails far behind other high-income countries on measures of health care affordability, administrative efficiency, equity, and outcomes.

By analyzing 11 high-income countries and measuring and comparing people’s experiences with their health care system, the report finds that the U.S. delivers too little of the type of care that’s most needed and delivers it too late, especially for people with complex chronic illness, mental health problems, or substance abuse disorders.

Some high-income nations get more for their health dollars than the U.S., as the report finds that the U.S. continues to outspend other nations on health care, devoting nearly twice as much of the GDP compared to the other high-income countries.

Compared to other high-income countries, the U.S. spends less on social programs such as early childhood education, parental leave, and income supports for single parents. 

The U.S. also spends less on supports for workers, such as unemployment protections and labor market incentives. Labor market policies in particular have been linked to so-called deaths of despair, including suicides and overdose deaths.

Outside the U.S., a larger proportion of clinicians are devoted to primary care and are geographically distributed to match population needs, and administrative costs are more substantial in the U.S. than in other high-income countries.

As the only high-income country that lacks universal health coverage, nearly 30 million people are still uninsured in the U.S. with some 40 million with health plans that leave them underinsured and paying out-of-pocket health care costs.

The U.S. was able to keep pace with or exceed other countries on things like influenza vaccination rates for older adults, lower rates of postoperative sepsis after abdominal surgery, and more use of patient-facing health information technology for provider communications and prescription filling.  

However, overall, the U.S. still lags behind other nations on measures of health care outcomes, access to care, equity, and administrative efficiency.