U.S. ranks last in health performance among high-income countries

The United States spends far more on health care than 10 other high-income countries, yet the population’s health is poorer and the U.S. comes in last on health care system performance, according to recent research from The Commonwealth Fund. The report rated the United States last or next-to-last in four of the five health system categories assessed: equity, access, administrative efficiency, and health care outcomes. The United Kingdom ranked first in overall performance, according to the report, though it placed tenth in health care outcomes.

Performance indicators.

The report analyzes 72 indicators measuring performance in five categories, including care process, to compare health care system performance in the United States with the performance in ten other high-income countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. The report calls the performance of the United States health system “lackluster,” despite finding that the United States spends nearly twice as much as several other countries that ranked higher in performance. The United States is a “substantial outlier when it comes to achieving value,” the report concludes.

The report cites the lack of universal insurance coverage and barriers to primary care access as impediments to improving the U.S.’s poor performance in certain areas, such as infant mortality, life expectancy, and amenable mortality. The report noted that a high level of inequality exists in the system, and suggests that the United States could strengthen primary care, support organizations excelling at care coordination, and move away from the model of fee-for-service payment and toward other purchasing models.

Top performers.

The report notes that the top three countries in overall health system performance-the United Kingdom, Australia, and the Netherlands-all provide universal coverage and access, but operate very differently from one another. The U.K. uses a Beveridge model, with services paid for through general tax revenue rather than insurance premiums, and the government plays a significant role in organizing and operating the delivery of services. Australia operates a single-payer insurance program, its Medicare public insurance plan. The plan is financed through taxes, but the government has less involvement in the delivery services than in the U.K. In the Netherlands, by contrast, private health insurers fund services in a system somewhat similar to the health insurance exchanges established under the Patient Protection and Affordable Care Act.

SOURCE: www.commonwealthfund.org
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