Study ranks US health system dead last among wealthy nations
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An analysis of the quality and accessibility of the healthcare systems of 10 Western democracies found that the U.S. ranked dead last overall.
The study comes from the Commonwealth Fund, a nonprofit that advocates for healthcare policy proposals, specifically those that improve accessibility for low-income communities. Their scathing paper, Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System, was published Thursday—and while the U.S. didn’t score last by every metric, the country did rank on the very bottom for accessibility and outcomes, and scored low in most other categories as well.
The study looked at the health systems of 10 countries, including Australia, the Netherlands, the United Kingdom, Canada, New Zealand, France, Sweden, Switzerland and Germany. For their analysis, the Commonwealth Fund opted to focus on factors that impact healthcare affordability and accessibility, weighing those the highest.
Specifically, the nonprofit examined data related to access, administrative efficiency, equity, outcomes and care—that final category being the only one where the U.S. earned a score above last or next-to-last, coming in second among its peer nations. Care process, for the purpose of this analysis, is defined as having the highest quality care options and technologies available. New Zealand earned the highest rating in that category.
In terms of access, the Netherlands, the U.K. and Germany ranked in the top three. For outcomes, Australia, Switzerland and New Zealand earned top marks.
“Despite their overall rankings, all the countries have strengths and weaknesses, ranking high on some dimensions and lower on others. No country is at the top or bottom on all areas of performance. Even the top-ranked country—Australia—does less well, for example, on measures of access to care and care process. And even the U.S., with the lowest-ranked health system, ranks second in the care process domain,” the study authors, led by David Blumenthal, former president of the Commonwealth Fund, wrote.
No perfect system
Of all the nations studied, only the U.S. lacks some kind of nationalized health insurance that covers everyone. However, all of the healthcare systems in the study have major variations.
For example, the U.K. has an entirely nationalized health service that offers its citizens free healthcare in totality, including hospital visits, doctors appointments, mental health, specialty services and more. Meanwhile, Germany does the same, but patients have co-pays that are linked to reported income.
France requires all its citizens to purchase private insurance at a subsidized rate, which then covers most healthcare needs based on a regulatory framework. The Netherlands has a socialized system that covers all primary care for patients and their families. All other services, including hospital stays, are subject to a deductible before the government pays the rest.
The other countries in the rankings have some variation of a single-payer system, with insurance provided by their respective governments.
In any case, the U.S. stacked up poorly due to the high number of uninsured Americans, who ultimately have limited or no access to healthcare, signaling a need for better policy.
“In the U.S., lack of affordability is a pervasive problem. With a fragmented insurance system, a near majority of Americans receive their health coverage through their employer. While the Affordable Care Act’s Medicaid expansions and subsidized private coverage have helped fill the gap, 26 million Americans are still uninsured, leaving them fully exposed to the cost drivers in the system,” the study authors wrote.
The full analysis is available here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.