How does U.S. health care stack up globally? Not well, according to new data

Despite spending nearly twice what peer nations spend on health care, the United States ranks near the bottom on life expectancy, primary care physician supply and affordability — and at or near the top for preventable deaths and maternal mortality — according to a major new international report.

The Commonwealth Fund's “U.S. Health Care from a Global Perspective, 2026: Expanded Edition” compares the U.S. with 19 other member countries of the Organisation for Economic Co-operation and Development (OECD), a group of mostly high-income nations. The analysis draws on 2026 OECD health statistics compiled in January and February 2026 and covers four broad areas: insurance coverage and access to care, affordability, care delivery and equity of outcomes.

The findings are a stark rebuke of U.S. health system performance. It’s another confirmation that primary care physicians are in short supply and increasingly overwhelmed as they serve as the front door to a system that leaves tens of millions of Americans behind.

“The U.S. has long prided itself on having the best health care in the world, but the population benefits from this excellence unevenly, and it remains largely out of reach for many Americans. This causes us to lag, not lead, when we compare our health outcomes to other nations,” Commonwealth Fund President Joseph R. Betancourt, M.D., M.P.H.

“We spend more than any other nation on health care, so our poorer health outcomes aren’t due to a lack of resources — it is about how we choose to use them,” he said. “We know what high-performing health systems look like — other countries have them and are building them. It’s high time the U.S. did better."

Additional details were to be published with the full report on May 28.

Spending more, living less

In 2024, the U.S. devoted 18% of its gross domestic product (GDP) to health care — nearly twice the OECD average. Yet American life expectancy reached only 79 years, among the shortest in the OECD. Japan, Spain and Switzerland each outpace the U.S. by nearly five years. Only Mexico and Turkey fared worse. The United States also recorded the second-highest rate of avoidable deaths among the 20 countries studied, trailing only Mexico.

“International comparisons are one of our most powerful tools for understanding what's working and what isn't in U.S. health care,” lead author and Commonwealth Fund senior researcher Munira Z. Gunja said in a news release. “When we look at how other countries have expanded access to primary care and made health coverage more affordable, we see that better outcomes are within reach. This report makes clear that the U.S. has both the evidence and the opportunity to build a health system that works better for everyone."

Fewest primary care physicians per capita

For primary care physicians reading this report, one number stands out: the U.S. has just 0.3 primary care physicians per 1,000 people — less than one-third of the OECD average of 1.1.

The physician pipeline is equally thin. The U.S. produces 8.6 new physicians per 100,000 people each year, compared to an OECD average of 14.5 and Denmark's leading rate of 21.

The report attributes the shortage to high medical school tuition, limited residency training slots, chronic underinvestment in primary care, and physician burnout — a combination that has compressed the supply of physicians while demand continues to grow.

Millions uninsured — and numbers may rise

Approximately 27 million Americans — about 8 percent of the population — lack health insurance, making the U.S. one of the only OECD nations where a large share of residents remain uninsured. Rates are disproportionately high among Hispanic, Black, and American Indian and Alaska Native populations, as well as among low-income Americans and residents of states that have not expanded Medicaid eligibility.

The report warns that recent federal policy changes are projected to increase the number of uninsured Americans by an additional 17 million by 2034, potentially leading to more than 50,000 additional preventable deaths each year. By contrast, Mexico's newly established Universal Health Service is set to provide all residents with access to free care at any public health institute beginning in 2027.

The cost burden on patients

High out-of-pocket costs drive Americans to delay or skip care at rates that exceed every other country in the study. Americans spend more than $400 per person each year out of pocket on prescription drugs, compared with less than $100 in France. Those costs contribute to patients skipping prescriptions, delaying treatment, or forgoing care entirely.

Maternal mortality and racial disparities

The U.S. recorded the highest maternal death rate of any country in the study: nearly 19 deaths per 100,000 live births in 2023. Eleven of the 18 other nations studied reported fewer than five deaths per 100,000 live births, including Israel, Switzerland, and Sweden. For Black women in the U.S., the disparity is even more pronounced. Their maternal mortality rate — 50 deaths per 100,000 live births — exceeds the maternal mortality rate of every other country in the analysis.

The U.S. also ranked third-highest for suicide rates among the countries studied, with rural communities bearing a disproportionate share of that burden.

What the report recommends

Americans pay more for health care and get less in return, but that’s not inevitable, said Reginald D. Williams II, Commonwealth Fund Senior Vice President and leader of its international program.

“It’s the result of different choices,” he said. “Other countries have shown that alternatives work. What’s striking isn’t the absence of solutions; it’s our reluctance to implement them. The failure of the U.S. health system is not a failure of ideas. It’s a failure of will to act on them.”

The Commonwealth Fund authors call for a series of systemic changes to improve U.S. health system performance:

• Reduce health care costs. The report points to stronger price oversight and payment systems that reward quality and better patient outcomes as models used in other countries that could make care more affordable in the U.S.
• Expand access to affordable coverage. The authors describe comprehensive, affordable coverage for all residents as essential to improving health outcomes and reducing preventable deaths.
• Strengthen primary care. Greater investment in workforce development, retention, and technology-enabled, team-based care models could help improve population health, the report says.
• Address health inequities. Targeted investment in maternal health, rural mental health services, and equitable access to primary care could help narrow persistent gaps in outcomes.