America ranks dead last among 10 advanced economies for health outcomes according to a new report from the Commonwealth Fund that paints a grim portrait of a failing health system. The report reveals that despite paying more for healthcare than the other peer nations, Americans die the youngest, live the sickest lives, and have the most avoidable deaths.
“The U.S stands out for its exceptionally weak overall performance, especially in the context of spending more on health care than any other nation in the study. This edition’s findings suggest the U.S. needs to work on multiple fronts simultaneously to make significant progress.”
This is the eighth study since 2004 that the Commonwealth Fund has published, analyzing 70 health system performance measures focusing on 5 areas of healthcare system performance: access to healthcare, the care process, administrative efficiency, equity, and outcomes. The countries included in this report are Australia, Canada, France, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States of America.
Painting the portrait of a failing healthcare system
Much like other reports, the American healthcare system and resulting outcomes leave much to be desired:
“The U.S. continues to be in a class by itself in the underperformance of its health care sector.”
“The nine nations we examined are more alike than different with respect to their higher and lower performance in various domains. But there is one glaring exception — the U.S.”
“The ability to keep people healthy is a critical indicator of a nation’s capacity to achieve equitable growth. In fulfilling this fundamental obligation, the U.S. continues to fail.”
The American healthcare system is also failing children’s health whose outcomes are the key to the future. A paper published in JAMA Pediatrics suggests that American children and teens are dying at a higher rate than in 16 other peer high-income countries, and the infant mortality rate also exceeds peer nations.
Pointing to examples of other countries that have achieved success with child healthcare outcomes such as Switzerland and the Netherlands the report states: “In the Netherlands, visits to primary care, maternity care, and child health care providers are fully covered; other healthcare services are covered once patients pay their annual deductible,” adding that “Switzerland’s small size, along with the nation’s extensive transit options and, as of 2015, increased funding for women’s health, led to improved performance, including fewer childbirth injuries and a higher rate of postpartum checkups.”
Paying more for poor outcomes
Physician and scientist Dr. Robert Malone said, “Clearly, the US Healthcare system is failing to provide value for money, and is failing the citizens of the United States,” adding that “Generally speaking, US Citizens are glad to pay more for longer, healthier lives. But in fact, we are paying the most of the ranked countries for the worst overall outcomes.”
The report highlights that America is significantly falling behind its international peers in terms of healthcare performance outcomes despite having the highest spending, but it wasn’t always this way. In 1980 the healthcare expenditures were comparable to Germany and Sweden, however since then, “the U.S. has far outpaced other nations, spending more than 16 percent of its GDP on health care in 2022” — a figure “predicted to exceed 20 percent by 2035.”
The report’s authors suggest that this reflects an “enduring U.S. dilemma of spending vast amounts for generally poor results — the very definition of a low-value health system.”
Most barriers to access and affordability
The report concluded that Americans have the most barriers to overcome in order to both access and afford healthcare, calling the lack of affordability a pervasive problem and cited the fragmented insurance system as a critical factor in contributing to the poor outcomes. Stating that:
“While the ACA’s [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.
“Cost has also fueled growth of private plan deductibles, leaving about a quarter of the working-age population underinsured.”
“U.S. patients are more likely than their peers in most other countries to report they don’t have a regular doctor or place of care and face limited options for getting treatment after regular office hours.”
Shortest lifespans and most avoidable deaths
Even with the higher-than-average spending on healthcare and the high cost of healthcare services, America ranks last among all the countries in health outcomes, ranking last in 4 out of 5 outcomes measured in this study, including life expectancy, rates of preventable deaths, and rate of treatable deaths.
“Life expectancy is more than four years below the 10-country average, and the U.S. has the highest rates of preventable and treatable deaths for all ages,” the report noted. “The ongoing substance use crisis and the prevalence of gun violence in the U.S. contribute significantly to its poor outcomes.”
According to Malone, this report represents “the most compelling” indictment of the U.S. healthcare system and the U.S. “medical-industrial, pharmaceutical-industrial and federal public health service complex.”
America is not looking after the health and welfare of its people
The report stated that:
“Despite spending a lot on health care, the United States is not meeting one of the principal obligations of a nation: to protect the health and welfare of its residents.”
“The U.S., in failing this ultimate test of a successful nation, remains an outlier.”
To improve healthcare outcomes and improve failing grades:
There are “ample opportunities for cross-national learning,” and included several recommendations for areas where America can improve its healthcare performance.
The report suggests that America should “continue to reduce financial barriers to access to care by extending coverage to the remaining uninsured,” including “reducing the cost of care, which is driven primarily by high prices charged by providers.”
The report also recommends that America should minimize “the variation and complexity of insurance plans,” and “address the uncontrolled consolidation of health care resources in local markets, which helps drive prices higher and makes insurance less affordable for Americans.”
“Address the uncontrolled consolidation of health care systems and resources in local markets, which drives prices higher and makes insurance less affordable.”
Key Findings: “The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower.”
Conclusion: “The U.S. continues to be in a class by itself in the underperformance of its healthcare sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic healthcare needs, including universal coverage.”
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References/Sources/Materials provided by:
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2820614
https://blogs.cdc.gov/nchs/2023/11/01/7479/
