Despite leading the pack in healthcare expenditures among high-income countries, the United States lags behind in crucial health indicators, according to recent findings.
In comparison to nine other affluent nations, the United States placed last this year, showing lower life expectancy and higher mortality and illness rates despite investing the most in healthcare, as outlined in a report released by independent research organization The Commonwealth Fund on Thursday.
The top-performing countries in the report were Australia, the Netherlands, and the United Kingdom.
As stated by Dr. Joseph Betancourt, president of The Commonwealth Fund, in a news conference, "This report illustrates that our healthcare system continues to lag significantly behind other nations in meeting our citizens' fundamental healthcare needs. Despite the US spending more on healthcare than any other nation, Americans suffer from poorer health, die at younger ages, and struggle to afford essential healthcare services. We spend the most and obtain the least value for our investment."
During the conference, Betancourt, a primary care physician, shared his experiences of dealing with patients who cannot afford necessary medications, battling insurance companies for denied care, and treating older patients who have endured years of uninsured illness due to lack of coverage. He emphasized the potential lessons the US could learn from other nations in strengthening healthcare delivery and outcomes.
"This report provides a roadmap for healthcare leaders and policymakers on how the US can achieve more equitable, affordable care for all its citizens," Betancourt said.
Investigators at The Commonwealth Fund evaluated and analyzed the performance of ten countries' healthcare systems: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States. They looked closely at how these systems performed on 70 measures across five core areas in each country: access to care, the healthcare process, administrative efficiency, equity, and health outcomes. The assessments were conducted using data from the World Health Organization, the Organisation for Economic Cooperation and Development, Our World in Data, and surveys conducted by The Commonwealth Fund.
Based on their findings, the countries with the highest rankings in all five critical areas were:
- Australia
- The Netherlands
- The United Kingdom
- New Zealand
- France
In contrast, the countries with the lowest rankings in all five critical areas were:
- Sweden
- Canada
- Switzerland
- Germany
- The United States
In analyzing each country in each critical domain, the US ranked last in access to care, indicating the greatest difficulties facing Americans seeking and affording healthcare. The nation also ranked last in health outcomes, including acute illnesses, chronic diseases, and mortality.
Researchers noted that individuals in the US lived the shortest lives and faced the most avoidable deaths among the ten countries, with the US having the highest rates of excess COVID-19-related mortality for people younger than 75, as per the report.
The US ranked ninth in equity, indicating disparities in how individuals of varying income levels and backgrounds access and experience healthcare. The nation also ranked ninth in administrative efficiency, suggesting that doctors and patients in the US face more insurance approvals and billing-related complications.
"Administrative requirements can consume time and money for patients and doctors," Reginald Williams II, vice president of international health policy and practice innovations at The Commonwealth Fund, remarked during the conference.
"Many countries have simplified their health insurance and payment systems through legislation, regulation, and standardization, such as applying standardized payments to all physicians for services based on a regional basis, providing clear information about service fees and patient responsibilities," he added.
However, the US ranked highly in the care process, which indicates that the care it provides includes essential aspects or attributes associated with high-quality care.
The researchers noted that countries could learn valuable lessons from one another, although performances across all nations were relatively close, with the US being the only clear outlier. The remaining nine countries, which all featured universal coverage, had smaller copayments for health services, improving both access and affordability.
"A significant portion of the US healthcare system's poor performance has to do with access to and equity of care, which are heavily influenced by insurance availability," Dr. David Blumenthal, former president of The Commonwealth Fund, stated during the conference.
"The US lags behind in terms of uninsured individuals - approximately 20 million still without coverage - despite a modern record low, and access to basic services for lower-income populations is limited," he added.
The report also highlighted that healthcare spending was similar in other countries but higher in the US, which spends significantly more on healthcare yet suffers from poor performance.
To enhance the US's healthcare system, the report suggests expanding insurance coverage, reducing disparities in access and quality of care, and minimizing the administrative burden and complexities of insurance plans.
It also emphasized the importance of US investment in interventions outside the healthcare sphere, addressing the social determinants of health, including poverty, homelessness, hunger, discrimination, gun violence, and substance abuse.
Furthermore, the report advocates for a more robust primary care system in the US.
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"In the Netherlands, primary care physicians are required to offer services even during off-hours. As a resident in the Netherlands, you can easily access your primary care doctor or an alternative one, 24/7. Regrettably, this isn't the standard in the United States," Blumenthal pointed out.
"Americans frequently encounter issues in obtaining after-hours care, often resorting to emergency rooms for such needs," he added. "This is a straightforward measure that could decrease healthcare costs, alleviate access problems, and simplify healthcare management."
‘The American vote holds the key’
The upcoming US presidential election could significantly influence the nation's healthcare system, according to Blumenthal.
"The American electorate has the power to decide the direction we head, and this is a significant factor in this election," he stated. "If we aim to improve our healthcare system, elections that result in insurance coverage expansions based on current programs would move us closer to matching other international performance standards."
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The new report's rankings mirrored those in a paper published by The Commonwealth Fund the previous year, which revealed that the US had the highest rates of deaths from preventable or treatable conditions and the highest maternal and infant mortality rates, despite spending more on healthcare than any other high-income nation.
"We're not getting the best return on our healthcare investment," Dr. Georges Benjamin, executive director of the American Public Health Association, who was unconnected to either report, stated last year.
To address the deficiencies in the US healthcare system, Benjamin suggested three strategies.
"We're still the only nation without universal healthcare or access for all citizens," Benjamin said.
Second, "we lag behind other nations in primary care prevention, and our public health system remains divided," he added. "The third issue is that we underfund societal initiatives relative to other industrialized nations. They invest in frontline support for their citizens, while we focus on treating sickness."
Despite the high investment in healthcare, the United States continues to struggle with poor health outcomes. This is evident in its lower life expectancy and higher mortality rates compared to other affluent nations. (Follows from the first sentence)
The report suggests that expanding insurance coverage, reducing disparities in access and quality of care, and minimizing the administrative burden and complexities of insurance plans could enhance the US's healthcare system. (Follows from the last sentence)
