US healthcare ranks last compared to 9 other countries, including Australia. UK and Netherlands lead, report says

No country ranks at the top or bottom of each category. The countries ranked in the top three overall are Australia, the Netherlands and the United Kingdom. Australia and the Netherlands also have the lowest health spending, the report said.

The researchers said the United States stood out for its “exceptionally weak” performance.

The country ranked last or near last in every category except one: process of care, in which it ranked second behind New Zealand. Process of care measures things like preventive services, including mammograms and flu shots, and engagement with patients.

The complex maze of hospital bills, insurance disputes and out-of-pocket spending requirements that patients and doctors are forced to navigate puts the United States in second-to-last place in administrative efficiency.

“We have so many different insurers, each of them selling a different product with different requirements for doctors or hospitals and other providers to get paid and for patients to get coverage for care,” Blumenthal said. “That leads to a denial of service. That leads to negotiations between doctors, hospitals and insurance companies.”

The United States also ranks second to last in fairness, with many low-income people saying they cannot afford the care they need and more people reporting unfair treatment or discrimination.

The United States, in particular, has had the lowest life expectancy and the highest rates of preventable and treatable deaths, a situation made worse by the pandemic.

Last year, the average life expectancy in the United States was 77.5 years, just over a year longer than in 2021, when the pandemic pushed life expectancy down to 76.4 years, according to the most recent data from the Centers for Disease Control and Prevention.

“This is a new finding,” Blumenthal said. “We’ve never had a pandemic-related finding in a previous report, and it shows that, unfortunately, our overall poor results have been confirmed in our COVID mortality results.”

Advanced medical care is out of reach for many

Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, said the findings are consistent with other research consistently ranking the United States near the bottom of peer countries on nearly every major health indicator, including life expectancy, infant and maternal mortality, access to health care and equity.

According to Gostin, most of the most vulnerable Americans, including racial minorities and low-income people, are uninsured or underinsured. Given the high cost of medical services, many people delay or avoid care.

“The United States may offer the most advanced medical treatments in the world, but only to those who can afford them,” Gostin said. “For far too many people, quality medical care is out of reach.”

Dr. Adam Gaffney, a critical care physician at Cambridge Health Alliance in Massachusetts, noted that the United States stands out from other countries in one key area: universal health coverage.

“A universal health care system can make a difference,” Gaffney said, “not only because everyone is covered and can see a doctor when they need it, but also because they have a long-standing health care provider who can provide advice, counseling, treatment and prevention for common illnesses.”

The United States ranks last in previous Commonwealth Fund reports, but researchers have tried to avoid direct comparisons between reports because they change the questions and the countries that participate.

Thursday’s report also lists solutions to the country’s health care problems, including reducing the cost of care and expanding access to coverage.

“The shortcomings of the United States are clear from this international analysis, but so are the opportunities for change,” said Reginald Williams II, vice president of the Commonwealth Fund’s International Health Policy and Practice Innovations program.