1. Potera, Carol


Findings reveal worst overall U.S. ranking, including for access, equity, and outcomes.


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A review of health care systems in 11 countries by the Commonwealth Fund ranks the United States last and the United Kingdom first, even though the United States spends 16.6% of its gross domestic product on health care, compared with just 9.9% for the United Kingdom. The United States scored lowest overall and also for access, equity, and health care outcomes, and next to last for administrative efficiency, infant mortality, and life expectancy at age 60 years. Other countries evaluated were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, and Switzerland.

Figure. Health care ... - Click to enlarge in new window Health care system performance compared with spending. Image courtesy of the Commonwealth Fund.

The best score for the United States was fifth place for care process, including prevention, safety, and engagement. The United States excels or performs above average in physician-patient relationships, wellness counseling, shared decision making with providers, chronic disease management, end-of-life talks, mammography, and influenza immunizations for older adults. However, it lags on coordination of care measures, including avoidable hospital admissions and information exchange between primary care providers, specialists, and social service experts.


The United States is the only high-income country that lacks universal health insurance, and even people with coverage face higher deductibles and out-of-pocket costs than those in other countries. The United States could improve its ranking by investing more in preventing chronic diseases. Read the report at Potera