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America's Health System Ranks Last (Again)


American healthcare may be the most expensive in the world, but it ranks last overall among 11 peer countries, according to a new report.

American healthcare may be the most expensive in the world, but among 11 peer countries the US health system ranks last overall, according to a new report.

The Commonwealth Fund report measured health system quality, efficiency, access to care, equity, and healthy lives in 11 industrialized countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

According to the report, the US stands out for having the highest costs and lowest performance. The UK ranked first overall and spent just $3,406 per person on healthcare in 2011 compared to the US, which spent $8,508 per person. The country with the second-highest health expenditures per capita was Norway, which only spent $5,669.

“It is disappointing, but not surprising, that despite our significant investment in healthcare, the US has continued to lag behind other countries,” lead author Karen Davis, said in a statement. “With enactment of the Affordable Care Act, however, we have entered a new era in American health care. The US performance on insurance coverage and access to care should begin to improve, particularly for low-income Americans. The Affordable Care Act is also expanding the availability and quality of primary care, which should help all Americans have better care and better health outcomes at lower cost.”

Access to primary care and inequities and inefficiencies in the US healthcare system substantially dragged down the country’s ranking, according to the Commonwealth Fund. For the rest of the categories, the US fell solidly in the middle of the pack, with its best ranking coming in third for effective care.

The US is no stranger to being at the back of the pack. When the report was produced in 2004, 2006, 2007, and 2010, America ranked last each time.

“Now that millions more Americans have good coverage, we have to invest in our healthcare delivery system to be sure all patients—and especially those with the greatest need and whose care is the most costly—can get the high-quality, well-coordinated health care they need,” said Commonwealth Fund President David Blumenthal, MD. “Those kinds of improvements will go a long way toward improving peoples’ health while making efficient use of our precious health care dollars.”

Here’s a look at how the US did in each individual category and why it ranked so low in some of them.

Healthy lives

The US ranked last in healthy lives because it had the worst infant mortality rate among the 11 countries, plus it ranked last on deaths that were potentially preventable with timely access to effective healthcare.

America ranked second to last on life expectancy. Citizens are only expected to live to age 40.

Access to care

Cost of care in America continues to be a major issue and the country ranks last on every measure of cost-related access. People in the US have the hardest time affording the healthcare they need.

More than a third (37%) of adults admitted to forgoing care—such as a recommended test, treatment, or follow-up care—because of the cost.

Healthcare quality

Although the US performs well at providing effective care landing at number 3, and it also ranked well (4) for patient-centered care, it does not perform well for providing safe care (7) or coordinated care (6), which dragged down the overall rank for quality of care.


Low marks on the time and dollars spent dealing with insurance administration, lack of communication among healthcare providers, and duplicative medical testing cause the US to rank last here.

According to the report, 40% of adults who visited an emergency room reported they could have been treated by a regular doctor if one had been available. In the UK just 16% of adults said the same.


Again, the US ranks last. In the past year, 39% of American adults with below-average incomes reported a medical problem but did not visit a doctor because of the costs. In comparison, less than 10% of similar adults reported the same in the UK, Sweden, Canada, and Norway.

According to the Commonwealth Fund, there were also large discrepancies between the length of time lower income adults had to wait for a specialist, emergency, and after-hours care compared to adults with higher income.

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