Report: U.S. Ranks Last Among 11 Countries for Health Care Quality

The U.S. health care system again ranked last among 11 western, industrialized nations, despite spending far more on health care per capita, according to a report from the Commonwealth Fund, the Washington Post's "To Your Health" reports (Bernstein, "To Your Health," Washington Post, 6/16).

For the study, the researchers surveyed the health care systems of 11 countries. They analyzed 80 separate measures in each of those countries that related to five overall performance areas:

  • Health;
  • Quality;
  • Efficiency;
  • Access; and
  • Equity.

The researchers found that:

  • The United Kingdom ranked first;
  • Switzerland and Sweden tied for second;
  • Australia ranked fourth;
  • Germany and the Netherlands tied for fifth;
  • Norway and New Zealand tied for seventh; 
  • France came in ninth;
  • Canada ranked 10th; and
  • The U.S. ranked 11th.

In addition to ranking last, the U.S. also spent the most of all the surveyed nations on health care. Overall the U.S. spent $8,508 per capita on health care, representing about 17.7% of the country's gross domestic product. In comparison, Canada spent $4,522 per capita and the U.K. spent $3,182 per capita (Mangan, Yahoo! News/CNBC, 6/16).

Details on U.S. Ranking

The report detailed areas of poor performance for the U.S. health care system, including:  

  • A shortage of primary care physicians;
  • Limited access to primary care, particularly in low-income populations;
  • The large number of low-income residents who skip necessary care, do not get a recommended tests or do not fill prescriptions because of cost;
  • High rates of infant mortality;
  • High rates of mortality from treatable conditions, such as high blood pressure; and
  • Lower healthy life expectancy, at age 60 ("To Your Health," Washington Post, 6/16).

Karen Davis, director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health and co-author of the study, noted that nearly 40% of U.S. residents said they did not visit a physician over the last year because they could not afford to do so, compared with less than one in 10 residents in the U.K., Canada, Norway and Sweden. Similarly, 40% of U.S. residents said they sought care in the emergency department for problems that could have been treated through a regular physician if one had been available, compared with just 16% of patients in the U.K.

The U.S. did rank well in some other metrics. For example, the U.S. ranked in the middle overall for health care quality metrics and ranked in third and fourth, respectively, for effective care and patient-centered care. However, the U.S. fell short in measures of safe or coordinated care and efficiency in the health care system.

Potential for Improvement

According to Yahoo! News/CNBC, the U.S. consistently has ranked poorly in all four prior versions of the report that have been released since 2004 (Yahoo! News/CNBC, 6/16).

The Commonwealth Fund collected the data for the 2014 report before the Affordable Care Act fully took effect. As a result, the law might eventually help the U.S. address equity and access issues by reducing the overall number of uninsured residents, "To Your Health" reports ("To Your Health," Washington Post, 6/16).

kerry pay
Incorrect, falsely written medical records doctors all write harm kill patients and doctors are not punished. Not enough competent primary because all (6) failed to recognized my "classic" symptoms or write them in my medical file and failed to request sleep test for over a decade as my body systems shut down from lack of sustained sleep cycles. Doctors in Contra Costa County of incompetent and were unable to write the symptoms I was complaining about. I, the patient requested the sleep test and then my self-referred sleep specialist at Respiratory Medical Group , Walnut Creek wrote false med records and violated my HIPPA rights falsifying my medical records and violated my HIPPA rights billing Medicare for false medical care forcing me to get second opinion learning Dr. Ka lin Cheung incorrect diagnosis & violated Medicare rules to re-evaluate retest when no improvement and this doctor failed to abide by Medicare law for very expensive Bi-pap. Doctors protect bad doctors why rating!
Tom Johnson
So, how do we move up from 11th to 1st? Is the Affordable Care Act a vehicle to facilitate that improvement? Are more government regulations and oversight needed? Should we embrace competition as the means to achieve improvement? After all, competition is the way in which other industries have achieved not only improvement but greatness. I'm guessing none of the above but the politicians will continue to embrace all of the above and we will see the same results, or worse, as time goes on. The English system or the Swiss system are infinitely better but not culturally adaptable to the U.S. mind set. I wish it weren't so. In the meantime, 17.5% of GDP will become 18% (it was 14% when I left the health care scene a decade ago) and the outcomes won't improve. What we need is bi-partisan leadership that is willing to face the facts and abandon the idea that competition in health care is the right path. It isn't and never will be.

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