U.S. Healthcare: Most Expensive and Worst Performing

In a new international ranking, the United Kingdom ranks first, while the U.S. performs poorly across almost all health metrics.
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Suzanne Plunkett/Reuters

The origin of the phrase "You get what you pay for" is sometimes attributed to the fashion mogul Aldo Gucci, who said, "The bitterness of low quality is remembered long after the sweetness of low price has faded." But when it comes to healthcare, Americans get neither quality nor affordability.

The United States healthcare system is the most expensive in the world, but when it comes to health outcomes, it performs worse than 11 other similar industrialized nations, according to a new report released today by the Commonwealth Fund.

The nonprofit examined the health systems of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom, and it found that the U.S. was last or near-last in measures of health access, efficiency, and equity.

Commonwealth Fund

According to the report, the United Kingdom, which has a single-payer healthcare system, ranks first. In second place is Switzerland, which like the U.S. has a compulsory health insurance system—though Swiss health insurers are not allowed to make a profit off their basic insurance plans.

It's important to note that one reason for America's lag, as the authors explain, is our historic absence of universal health coverage. But the data for the report was collected before the full implementation of Obamacare, which dramatically expanded health insurance, so it's possible that the U.S. may rise in future rankings.

And notably, both the U.K. and U.S. ranked low on the "Healthy lives" scale, which considers infant mortality, healthy life expectancy at age 60, and mortality from preventable conditions, such as high blood pressure.

The U.S. spends 17.7 percent of GDP on healthcare, much more than all of the other countries, while Australia spends the least—8.9 percent:

Commonwealth Fund

The metric the U.S. performed best on was "effective care." Particularly laudable were our preventative care efforts, which included things like physicians asking patients to eat healthy and exercise, and doctors' offices sending patients appointment reminders.

The U.S. fared poorly, meanwhile, when it came to managing administrative hassles for both doctors and patients, avoiding emergency room use, and reducing duplicative medical testing, all part of the score for "efficient care." 

"It is apparent that many primary care physicians struggle to receive relevant clinical information from specialists and hospitals, complicating efforts to provide seamless, coordinated care," the report authors note.

Americans also had the worst equity of care between high-income and low-income patients.

"The U.S. health care system is not the 'fairest of them all,'" the authors write, "At least from the viewpoint of those who use it to stay healthy, get better, or manage their chronic illnesses, or who are vulnerable because of low income and poor health."

The bitterness of that is likely to be around for a while, too.

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Olga Khazan is an associate editor at The Atlantic, where she covers health.

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