Despite spending more on health care than any other country in the world, the U.S. health care system lags far behind many other high-income nations recently analyzed.
A new report from the Commonwealth Fund found that among 11 countries in the Organization for Economic Cooperation and Development (OECD), the U.S. ranks last.
“We ranked last when it comes to care, affordability, administrative inefficiency, equity, and health care outcomes,” David Blumenthal, president of the Commonwealth Fund, said on a press call. “In no other country does income inequality so profoundly limit access to care as it does here.”
The countries ranking ahead of the U.S. were Norway, the Netherlands, Australia, the United Kingdom, Germany, New Zealand, Sweden, France, Switzerland, and Canada. (These countries, chosen due to existing partnerships with the Commonwealth Fund, have been featured in this annual report since 2004.)
“Other countries have much better primary care than we do in the United States,” Blumenthal said. “They invest more in primary care and social services than we do, and they have health systems that are more equitable.”
The main categories used to determine the rankings were access to care, care process, administrative efficiency, equity, and health care outcomes. The U.S. ranked last in every category except for care process.
Spending the most on health care does not mean having the best health care
The American health care system is no stranger to criticism.
Health care spending in the U.S. has grown rapidly since 1980, significantly quicker than in other nations. In 2019, national health expenditures increased to $3.8 trillion, which accounted for 17.7% of gross domestic product (GDP).
“One might think that such a high level of spending would enable the U.S. to achieve the best-performing health care system,” Eric Snyder, senior vice president for policy and research at the Commonwealth Fund, said. “Our results suggest that isn’t true.”
Care process was the only category in which the U.S. excelled, which Snyder attributed to provisions in the Affordable Care Act (ACA). These include services like counseling for diet, tobacco, and alcohol; preventative services including vaccinations and mammograms for older adults; documentation of patients’ preferences for care; and the availability of technology for patients to use to communicate with their providers.
“Overall, of our $4 trillion in U.S. health expenditures, we spend less than 3% on public health, 5% on preventative services, and 6-7% on primary care,” Dr. Anand Parekh, chief medical advisor at the Bipartisan Policy Center, told Yahoo Finance. “If we really want to improve population health, we must invest in these three areas.”
One particular area in which the U.S. struggles compared to other countries is how doctors have trouble getting medication or treatment for their patients due to restrictions in insurance coverage.
“Compared to most of the other countries, larger percentages of adults in the U.S. say they spend a lot of time on paperwork related to medical bills,” the report stated.
Another unfortunate category where the U.S. ranks last is health care outcomes. Among the 11 countries, the U.S. has the highest infant mortality rate, maternal mortality rate, lowest life expectancy, and highest rate of avoidable mortality.
‘Where we spend our resources reflects our priorities’
Dr. Parekh agreed that the lack of universal health care and the costliness of the current system are primary factors for America’s relative failings.
“We’ve known for some time that the combination of high costs of care, lack of access to timely and high-value care, uneven quality of care, and disparities in health care are holding us back in achieving a high-functioning health care system,” he told Yahoo Finance. “The combination of high prices of medical services as well as the continued existence of fee-for-service payment yields high health care costs.”
This was only exacerbated by the coronavirus pandemic, Parekh argued, after record job losses showed how dependent the country is on employer-sponsored health coverage. According to Health and Human Services (HHS), 30 million U.S. residents lacked health insurance in the first half of 2020.
According to the report, there are four “clear opportunities” for solutions: Providing universal coverage and removing cost barriers (given that many Americans — particularly low-income people — cannot afford needed care at times); investing in primary care systems to ensure services are equitably available across all communities; reducing the administrative burdens on patients and providers; and investing in social services to increase equitable access to things like nutrition, education, and housing, which the report argued would lessen the demands placed on the health care system.
“The lack of universal primary care and a well-financed primary care system in the country has made it more difficult to prevent and manage chronic conditions during the pandemic as well as counter vaccine hesitancy and increase vaccine uptake,” he said. “Ultimately, where we spend our resources reflect our priorities, and our priorities reflect our values. The question for us is: How healthy of a country do we want to be?”