California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Report: U.S. Ranks Last Among 11 Countries for Health Care Quality

The U.S. health care system again ranked last among 11 western, industrialized nations, despite spending far more on health care per capita, according to a report from the Commonwealth Fund, the Washington Post's "To Your Health" reports (Bernstein, "To Your Health," Washington Post, 6/16).

For the study, the researchers surveyed the health care systems of 11 countries. They analyzed 80 separate measures in each of those countries that related to five overall performance areas:

  • Health;
  • Quality;
  • Efficiency;
  • Access; and
  • Equity.

The researchers found that:

  • The United Kingdom ranked first;
  • Switzerland and Sweden tied for second;
  • Australia ranked fourth;
  • Germany and the Netherlands tied for fifth;
  • Norway and New Zealand tied for seventh; 
  • France came in ninth;
  • Canada ranked 10th; and
  • The U.S. ranked 11th.

In addition to ranking last, the U.S. also spent the most of all the surveyed nations on health care. Overall the U.S. spent $8,508 per capita on health care, representing about 17.7% of the country's gross domestic product. In comparison, Canada spent $4,522 per capita and the U.K. spent $3,182 per capita (Mangan, Yahoo! News/CNBC, 6/16).

Details on U.S. Ranking

The report detailed areas of poor performance for the U.S. health care system, including:  

  • A shortage of primary care physicians;
  • Limited access to primary care, particularly in low-income populations;
  • The large number of low-income residents who skip necessary care, do not get a recommended tests or do not fill prescriptions because of cost;
  • High rates of infant mortality;
  • High rates of mortality from treatable conditions, such as high blood pressure; and
  • Lower healthy life expectancy, at age 60 ("To Your Health," Washington Post, 6/16).

Karen Davis, director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health and co-author of the study, noted that nearly 40% of U.S. residents said they did not visit a physician over the last year because they could not afford to do so, compared with less than one in 10 residents in the U.K., Canada, Norway and Sweden. Similarly, 40% of U.S. residents said they sought care in the emergency department for problems that could have been treated through a regular physician if one had been available, compared with just 16% of patients in the U.K.

The U.S. did rank well in some other metrics. For example, the U.S. ranked in the middle overall for health care quality metrics and ranked in third and fourth, respectively, for effective care and patient-centered care. However, the U.S. fell short in measures of safe or coordinated care and efficiency in the health care system.

Potential for Improvement

According to Yahoo! News/CNBC, the U.S. consistently has ranked poorly in all four prior versions of the report that have been released since 2004 (Yahoo! News/CNBC, 6/16).

The Commonwealth Fund collected the data for the 2014 report before the Affordable Care Act fully took effect. As a result, the law might eventually help the U.S. address equity and access issues by reducing the overall number of uninsured residents, "To Your Health" reports ("To Your Health," Washington Post, 6/16).

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