US comes in last in health care rankings of high-income countries

The nation has landed in the basement in all seven studies the Commonwealth Fund has conducted since 2004. The US is the only one of the 11 countries surveyed not to have universal health insurance coverage.

While the latest data does not reflect the impact of the coronavirus pandemic, it lays out the strengths and weaknesses of each country's health care system when Covid-19 hit the world in early 2020.

US health insurance does not provide enough protections, which compromises Americans' health and finances, said David Blumenthal, president of the Commonwealth Fund, which promotes better health care access and quality, particularly for the uninsured and disadvantaged. That forces people to skip care or become burdened with medical debt.

"In no other country does income inequality so profoundly limit access to care as it does here," Blumenthal said. "Far too many people cannot afford the care they need and far too many are uninsured, especially compared to other wealthy nations."

Half of lower-income US adults reported that they did not receive care because of the cost, compared to just over a quarter of higher-income Americans, the study found. In the United Kingdom, only 12% of people with lower incomes and 7% with higher incomes said they faced such financial barriers.

What's more, a high-income American was more likely to report financial hurdles than a low-income person in nearly all the other countries surveyed -- which include Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the UK.

Norway, the Netherlands, and Australia were the best performers in the study, which looked at access to care, health care outcomes, administrative efficiency, equity and care process, which includes preventative care, patient engagement and other metrics.

In addition to lower access to care, the US also ranked poorly on maternal mortality, infant mortality, life expectancy at age 60, and deaths that were potentially preventable with timely access to care, the survey found.

And the nation landed at the bottom when it came to administrative efficiency because of the time providers and patients have to spend dealing with paperwork, duplicative medical testing and insurance disputes.

The one area in which America excelled was care process, where it earned second place. The nation outperformed in terms of rates of mammography screening and influenza vaccination for older adults as well as the share of adults who talked with a health care provider about nutrition, smoking and alcohol use.

Adults in the US and Norway reported the highest usage of web-based portals for communicating medical concerns and refilling medications. And among those with chronic illness, American adults were among the most likely to discuss goals, priorities and treatment options with their providers, though less likely to receive as much support as they felt was needed.

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