The top-ranked countries overall are the United Kingdom, Australia, and the Netherlands. The U.S., France, and Canada score lower than the 11-country average across most of the five domains, but all three achieve above-average performance on at least one domain: France on Health Care Outcomes, Canada on Care Process and Administrative Efficiency, and the U.S. No country ranks first consistently across all domains or measures, suggesting that all countries have room to improve. This analysis reveals striking variations in performance across the domains. Other countries that rank near the bottom on overall performance include France (10th) and Canada (9th). perform better, ranking fifth among the 11 countries.
ranks last in Access, Equity, and Health Care Outcomes, and next to last in Administrative Efficiency, as reported by patients and providers. The United States ranks last in health care system performance among the 11 countries included in this study (Exhibit 2). Other comparative data are drawn from the most recent reports of the Organization for Economic Cooperation and Development (OECD), the European Observatory on Health Systems and Policies, and the World Health Organization (WHO). Since 1998, The Commonwealth Fund, in collaboration with international partners, has supported surveys of patients and primary care physicians in advanced countries, collecting information for a standardized set of metrics on health system performance. We based our analysis on 72 indicators that measure performance in five domains important to policymakers, providers, patients, and the public: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes.
with that of 10 other high-income countries and considers the different approaches to health care organization and delivery that can contribute to top performance. This report uses recent data to compare health care system performance in the U.S. In particular, poor access to primary care has contributed to inadequate prevention and management of chronic diseases, delayed diagnoses, incomplete adherence to treatments, wasteful overuse of drugs and technologies, and coordination and safety problems. Nuzum, “ The Affordable Care Act at 5 Years,” New England Journal of Medicine Online First, published online May 6, 2015. Donaldson (eds.), To Err Is Human: Building a Safer Health System (National Academies Press, 2000) and D. health care system falls short, failing to deliver indicated services reliably to all who could benefit.ģ L. Timely and accessible health care could mitigate many of these challenges, but the U.S. In addition, as the baby boom population ages, more people in the U.S.-and all over the world-are living with age-related disabilities and chronic disease, placing pressure on health care systems to respond. Deaton, “ Rising Morbidity and Mortality in Midlife Among White Non-Hispanic Americans in the 21st Century,” Proceedings of the National Academy of Sciences of the United States of America, Dec. Life expectancy, after improving for several decades, worsened in recent years for some populations, aggravated by the opioid crisis.Ģ A. Health in International Perspective: Shorter Lives, Poorer Health (National Academies Press, 2013). population has poorer health than other countries.ġ S. The United States spends far more on health care than other high-income countries, with spending levels that rose continuously over the past three decades (Exhibit 1). Data are for current spending only, and exclude spending on capital formation of health care providers. Notes: GDP refers to gross domestic product.
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