A recent analysis by The Commonwealth Fund has revealed what many Americans may already suspect: the United States health care system ranks last among wealthy nations. Despite spending more on health care than any other country, the US continues to underperform in critical areas like accessibility, efficiency, equity, and health outcomes.
A Troubling Report Card
In the "Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System" report, researchers compared health care systems across 10 high-income countries—Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States. The US came in last place overall, ranking 10th in accessibility and health outcomes, and poorly in administrative efficiency and equity.
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According to a September article in AJMC, Joseph Betancourt, MD, president of The Commonwealth Fund, summed it up saying: "The US is failing one of its principal obligations as a nation: to protect the health and welfare of its people… Continually spending the most and getting the least for our health care dollars is not sustainable."
What's Holding the US Back?
One of the biggest issues is access to care. With 26 million uninsured Americans and sky-high out-of-pocket costs, health care remains out of reach for many. In contrast, countries like the Netherlands and Germany offer universal coverage and affordable care, making access far more equitable.
The shortcomings of the US health care system are further evident in its unparalleled spending. According to the Peter G. Peterson Foundation, in 2022, the United States spent an estimated $12,742 per person on health care—the highest per capita spending among wealthy nations. For comparison, Switzerland, the second-highest spender, allocated $9,044 per person, while the average for other Organization for Economic Development Cooperative and Development countries, excluding the US, was just $6,850.
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Administrative inefficiency is another key weakness. The US ranked ninth in the category due to its complex insurance system, which forces patients and providers to navigate endless denials, appeals, and paperwork.
In terms of equity, the US fared poorly as well, with widespread disparities in care based on race, ethnicity, and income. Issues like racial discrimination and uneven access to resources disproportionately impact vulnerable communities, worsening health outcomes for millions.
Finally, the US performed the worst in health outcomes. The country has the highest rate of preventable deaths, along with a lower-than-average life expectancy, driven by factors like the opioid crisis, gun violence, and chronic diseases.
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What Can Be Done?
The report emphasizes that the US health care system could learn a lot from other nations. Here's what researchers suggest:
- Reduce financial barriers: Expand insurance coverage and ensure it protects against high out-of-pocket costs.
- Simplify the system: Streamline administrative processes to reduce inefficiencies for both patients and providers.
- Strengthen primary care: Invest in training and compensation for primary care providers to improve access and outcomes.
- Address inequities: Combat racial and socioeconomic disparities by expanding social safety nets and addressing social determinants of health, like housing and food security.
- Tackle market consolidation: Regulate health care mergers to reduce costs and improve access.
As Betancourt put it, "This report underscores the many lessons we could learn from others on how to strengthen our health care delivery and outcomes."
The Bottom Line
The US health care system's high spending has not translated into better health outcomes or broader access. It's clear that reform is overdue, with opportunities to build a system that is more equitable, efficient, and effective for all Americans. By learning from other nations, the US could finally turn its spending into meaningful improvements for its citizens.
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