US has worst healthcare system among wealthy nations, survey says

The United States healthcare system was deemed the worst overall in a new analysis of 10 similar nations by a leading health research nonprofit.  

"Mirror, Mirror 2024: A Portrait of the Failing U.S. Healthy System," published by The Commonwealth Fund Thursday, looked at 70 healthcare 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 spots 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 healthcare system continues to lag far behind other nations when it comes to meeting our citizens basic health care needs,” said Joseph Bentacourt, president of The Commonwealth Fund, in a call with reporters.  

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

The Netherlands, the United Kingdom 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 one of the country’s largest insurance providers CZ.

The United Kingdom’s National Health Service offers Brits free public health care — including hospital, doctor and mental health care — while 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., per the survey.  

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

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

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.  

Over 40 percent of Americans spent $1,000 or more on health care out of pocket last year, according to a 2023 survey from The Commonwealth Fund.  

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

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.  

For example, in Germany doctors are required to provide after-hours care at their practices and in the Netherlands general practitioners have to work 50 hours after normal business hours a 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 — out 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 out of all 10 countries. 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 years, 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 healthcare 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.”