Commonwealth Fund: U.S. Still Last in Health System Performance Among Seven Industrialized Nations

But Health Reform May Spark Changes, Say Report's Authors

July 09, 2010 05:20 pm News Staff

Once again, the United States has ranked last overall among six other industrialized countries in measures of health system performance despite much greater per capita expenditures on health care, but the newly enacted health care reform law may lead to improvements in the future, especially in Americans' access to care. So says a new report( from the nonprofit Commonwealth Fund.

According to a June 23 press release(, the United States health system ranked last or next to last on five performance measures when compared with health systems in Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom. The measures examined were quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.

"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 lead report author Karen Davis in the press release.

"With enactment of the (Patient Protection and) Affordable Care Act, however, we have entered a new era in American health care," she added. "We will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high-quality, efficient health care."

"Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update" updates a third edition of the same report that was published in 2007. The current report includes data from the seven countries and also incorporates the results of patient and physician surveys on care experiences and ratings on various dimensions of care.

According to the report, the Netherlands ranked first overall, followed by the United Kingdom and Australia. The United States ranked last overall on access, healthy lives, efficiency and equity and next-to-last on quality.

Specific findings of the report show that the United States

  • ranked last on all measures of cost-related access, with 54 percent of adults with chronic conditions reporting problems getting a recommended test, treatment or follow-up care because of cost;
  • ranked poorly on accessibility of appointments with primary care physicians;
  • ranked last in terms of infant mortality and potentially preventable deaths among those younger than age 75;
  • performed poorly on measures reflecting administrative costs, use of information technology, rehospitalization rates and duplicative medical tests;
  • ranked at the bottom on measures of equity, primarily because lower-income Americans with chronic conditions were more likely than those in the other six countries to report not going to the doctor when ill, not getting a test, not filling a prescription or not getting recommended follow-up care because of costs; and
  • ranked next-to-last on measures of quality, largely because of low scores on chronic care management, coordination of care and use of information technology.

According to the report, the key difference between the United States and the other countries included in the report is that the United States does not have universal health insurance coverage. The report's authors anticipate that recently enacted U.S. health reform legislation "will start to address these problems by extending coverage to those without and helping to close gaps in coverage -- leading to improved disease management, care coordination and better outcomes over time."