U.S. Last in Health Care Among 7 Industrialized Countries

Although its citizens pay more for health care, the United States ranks last on several measures of health system performance compared with six other industrialized nations, according to a new report.

Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom all beat out the United States when it came to health care quality, efficiency, access, equity and the ability for citizens to lead long, healthy lives, says the report, from the Commonwealth Fund..

While there is room for improvement in every country, the United States stands out for not getting good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007 compared with the $3,837 spent per capita in the Netherlands, which ranked first overall.

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"It is disappointing, but not surprising that, despite our significant investment in health care, the U.S. continues to lag behind other countries," said Commonwealth Fund President and study author Karen Davis.

However, some researchers have noted that U.S. citizens pay more for heath care partly because they get sick more often than people in other industrialized countries and partly because they get more thorough treatment for some diseases.

The U.S.'s rank in terms of access to health care could be improved if the health care reform bill, known as the Affordable Care Act, does indeed extend health insurance coverage to 32 million currently uninsured Americans, as has been estimated, the authors say.

Earlier editions of the Commonwealth report, produced in 2004, 2006 and 2007, showed similar results. This year's version incorporates data from patient and physician surveys conducted in seven countries in 2007, 2008 and 2009.

Key findings include:

• On measures of quality the United States ranked No. 6 out of seven countries. On two of four measures of quality — effective care and patient-centered care — the United States ranks in the middle (No. 4). However, the nation ranks last on providing safe care.
• U.S. patients with chronic conditions are the most likely to report being given the wrong medication or the wrong dose of their medication, and experiencing delays in being notified about an abnormal test result.
• The United States ranked last in efficiency due to low marks regarding spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing.
• Nineteen percent of U.S. adults with chronic conditions reported they visited an emergency department for a condition that could have been treated by a regular doctor, had one been available, more than three times the rate of patients in Germany or the Netherlands.
• U.S. citizens have the hardest time affording the health care they need — with the United States ranking last on every measure of cost-related access problems. For example, 54 percent of adults with chronic conditions reported problems getting a recommended test, treatment or follow-up care because of cost. In the Netherlands, which ranked first on this measure, only 7 percent of adults with chronic conditions reported this problem.
• On measures of healthy lives, the United States ranks last when it comes to infant mortality and deaths before age 75 that were potentially preventable with timely access to effective health care, and second to last on healthy life expectancy at age 60.

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.

The 2007 Commonwealth Fund survey focused on the primary care experiences of nationally representative samples of adults ages 18 and older in the seven countries. The 2008 survey targeted a representative sample of "sicker adults," defined as those who rated their health status as fair or poor, had a serious illness in the past two years, had been hospitalized for something other than a normal delivery, or had undergone major surgery in the past two years. The 2009 survey looked at the experiences of primary care physicians.

The report also included information from the Organization for Economic Cooperation and Development Health Data 2009; and World Health Organization mortality and population statistics for 2002-03.

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