The US health care system ranks last among 10 countries, according to the study

Among ten peer nations, Americans live the shortest lives and are the least healthy, despite the United States spending the most on health care, according to a recent Commonwealth Fund study.

The US health care system ranks last among ten comparably rich and industrialized nations on important metrics, such as life expectancy, preventable deaths, access to health care, and health equity. However, the US spends the most of any country examined in the study, twice the average per capita.

Significantly, Americans face the greatest barriers to obtaining affordable health care. This is partly because the US is the only country in the study that does not offer universal health coverage. Twenty-five million Americans are uninsured and tens of millions more are underinsured, meaning they have high deductibles, cost sharing, and limited options for affordable care. KFF News reports that more than 100 million Americans are burdened with medical debt. However, the vast majority of these people have health insurance and employment.

Also, doctors and patients in the US experience the greatest burden when it comes to payment and billing. The complexity and fragmentation of the US health care system, with its mix of public and private insurers and thousands of health plans, forces health care providers and patients to navigate a maze of coverage and cost-sharing requirements, paperwork and insurance disputes . Additionally, patients in the US are more likely to report not having a regular doctor or care setting compared to residents of other countries.

Other countries’ health care systems are not perfect by any means. The Commonwealth Fund report points to challenges in the UK, for example, in terms of long waits and resource constraints due to staff shortages and budget cuts. Also, health equity is a persistent problem in New Zealand, which ranks worse than the US on that metric. And countries such as Switzerland also have a relatively high administrative burden.

The Commonwealth Fund has published similar reports in the past. And his series of publications on international comparisons of health care system performance is not the first to show large discrepancies between the US and its peers. Comparing the quality of health care systems in relation to key health outcomes such as quality of care and life expectancy, Peterson-KFF demonstrates in a publication posted in October 2023 how badly the US fares against its peers. What is most striking is that despite spending significantly more money per capita on health care than any country with comparable gross domestic product per capita, the US has a significantly lower life expectancy. The gap has widened significantly since 2010, as the figure below shows.

The problem is not only mortality indices. On a wide range of measures of quality of care, the US performs relatively poorly. The US performs worse on some treatment outcomes, such as maternal mortality; patient safety measures, such as medication or treatment errors; and patients unable to receive appropriate care due to affordability issues.

Researchers published a landmark study more than a decade ago, “Shorter Lives, Poorer Health.” The results then showed, BEFORE stagnant growth and subsequent decline in life expectancy that began around 2010, that the US was lagging behind in population-wide health outcome gains while other countries steadily improved. While scores have worsened since then, American life expectancy is now lower than that of Cuba, Lebanon and the Czech Republic.

Comparing health system performance internationally is difficult as each country operates within a distinct political and socio-economic framework. Some of the observed disparities may be attributed to the aspects cited in the above studies related to the fragmented set of US sub-systems rather than a comprehensive health system. But socioeconomic and other factors, including the underlying health of the population, also play a role.

Every health system ostensibly aims to provide accessible, high-quality care that improves health outcomes subject to budget or resource constraints. Nations do this in different ways. It is clear from the Commonwealth Fund study that spending more on health care, as the US does, is not associated with better health outcomes.