US has worst health care system among wealthy nations, survey says

The United States health care system was deemed the worst overall compared to 10 similar nations, according to analysis from a leading health research nonprofit.

“Mirror, Mirror 2024: A Portrait of the Failing U.S. Healthy System,” published Thursday by The Commonwealth Fund, looked at 70 health care systems in 10 wealthy nations, including Australia, Canada, the United Kingdom and the U.S., and compared them to one another.  

The nonprofit has conducted and released an international health policy survey since 2004.  

In the survey, the U.S. system came in last place overall, in part because it earned 10th place in both accessibility and health care outcomes, as well as low rankings in administrative efficiency and equity.  

“Twenty years later this report reveals that our health care system continues to lag far behind other nations when it comes to meeting our citizens basic health care needs,” Joseph Betancourt, president of The Commonwealth Fund, said in a call with reporters.  

The Commonwealth Fund chose to focus on affordability and availability when it ranked health care systems on their accessibility.  

The Netherlands, the U.K. and Germany are ranked first, second and third, respectively, for health care access in the survey, with Switzerland and Australia earning the eighth and ninth place spots.  

In the Netherlands, visits to primary care, maternity care and child health care providers are fully covered by their insurance, and other health care services are covered in the country once patients pay an annual deductible, according to CZ, one of the country’s largest insurance providers.

The United Kingdom’s National Health Service offers Brits free public health care — including hospital, doctor and mental health care — and in Germany, co-payments are capped based on income, according to the country’s public health insurance company Krankenkassen. 

Germany and the Netherlands both have systems in which some physicians are required to work after-hours to ensure that people have round-the-clock access to care, according to the survey. 

Affordability is a major barrier to health care access in the U.S., the survey found.  

There are still at least roughly 26 million Americans who do not have health insurance who are expected to pay for all health care costs out of pocket, according to KFF.

Americans with health insurance still face significant financial hurdles when paying for health care.  

The out-of-pocket limit for marketplace health insurance plans under the Affordable Care Act was $9,450 for single adults and $18,900 for family plans in 2024, according to the survey.  

More than 40 percent of Americans spent at least $1,000 on health care out of pocket last year, according to a 2023 Commonwealth Fund survey.  

Americans are also far more likely to say they do not have a regular doctor or health care clinic to go to compared to people living in the other countries included in the analysis, the survey found.  

A recent Yahoo/YouGov poll found that 77 percent of Americans say they have a primary care physician, while 20 percent do not and 4 percent are not sure if they do.  

Americans also have limited options if they need to seek medical care after regular office hours, while many other countries have taken steps to ensure 24-hour access to providers, such as Germany and the Netherlands — the latter of which requires providers work 50 hours after normal business hours each year to keep their licenses, according to The Commonwealth Fund’s international health care systems profiles.  

The nonprofit looked at each country’s life expectancy at birth, rate of avoidable deaths and excess deaths due to the COVID-19 pandemic when determining its health outcome rankings.  

Australia, Switzerland and New Zealand earned the top three rankings using these three metrics.

Americans have the shortest life expectancy — at 77.5 years — of all 10 countries included in the survey and has the highest rate of preventable and treatable deaths.  

The U.S. also has the highest number of excess deaths linked to the COVID-19 pandemic for people under the age of 75. Drug overdoses and gun-related deaths are also far higher in the U.S. than they are in other wealthy nations — contributing to the country’s poor health outcomes, the survey notes.  

Drug overdose deaths have been declining in the U.S. in recent months, but more than 107,000 people died from overdoses in 2023, according to the Centers for Disease Control and Prevention.  

And nearly 43,000 people died from gun violence the same year, according to a report from the National Institute of Health Care Management.  

The U.S. has its health care problems, but none of the countries in the analysis are perfect, the survey notes.  

“Readers should use caution in drawing conclusions when comparing countries’ overall performance,” the survey reads. “Each country has areas of higher and lower performance, and all countries have something to learn from one another.” 

Updated on Sept. 20 at 9:09 a.m. EDT