New Report Ranks US Healthcare Dead Last Among Wealthy Nations

The United States has the most expensive healthcare system in the world. And, according to a new report released by the Commonwealth Fund, it is also one of the worst performing systems when compared with other wealthy countries.

In fact, the U.S. ranked dead last among the 11 countries surveyed, as the infographic above shows. The United Kingdom took the top spot, followed by Switzerland.

Countries were judged based on quality, access, efficiency, equity, performance and healthy lives. The data were drawn from three international surveys of patients and primary care physicians conducted by the Commonwealth Fund from 2011-2013, and also used data from the World Health Organisation and the Organisation for Economic Cooperation and Development.

Some people have criticised the report’s methodology, which relied heavily on surveys instead of just hard data to create the ranking.

Another issue is that the Commonwealth Fund surveys only polled primary care physicians. The United States has a much higher proportion of specialists, around 70% of physicians, versus 30% generalists/primary care physicians. For the other countries included in the report, the ratio is reversed; they have significantly more primary care physicians compared to specialists. That means that much of the healthcare in the U.S. — that provided by specialists — was not evaluated, and it’s possible that our specialty care is superior.

Avik Roy, Senior Fellow at the Manhattan Institute, a conservative think tank, has suggested with regard to past reports that it is difficult to make apples-to-apples comparisons among the healthcare systems of wealthy countries.

The other countries in the report’s ranking offer citizens universal healthcare coverage, Roy notes. The United States, meanwhile, has three different coverage systems: private insurance, Medicare and Medicaid. And a significant — though shrinking — segment of the U.S. population does not have insurance at all. When an analysis looks at the country as a whole, all of these groups are measured together.

While some would say such a grouping is fair, Roy argues that it pulls the outcomes of the U.S. way down, even though our private insurance may outperform the universal healthcare offered in other countries.

In any case, the United States may continue to rank lower and outspend its peers, as long as its healthcare system is structurally so different, with inefficiencies baked in. Still, since the surveys were conducted before many of the most important provisions of the Affordable Care Act went into effect, it’s too soon to know whether the changes intended to improve our healthcare system are working.

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