NBC News
The US healthcare system is failing patients.
This was the conclusion of a compelling report which indicates that the country has the worst health system when compared to the 10 most developed nations in the world.
This is reflected, according to the report, in critical areas of health care such as death prevention, access – mainly due to high costs – and equity in the quality of treatment, regardless of the gender, income or geographic location of patients.
The report published this Thursday by The Commonwealth Fund, an independent research group, states that People in the United States are dying younger and suffer the most preventable deaths.
This is despite the fact that the country spends almost twice as much on the health system as the other nations evaluated, allocating 18% of the Gross Domestic Product.
Polls indicate that health care is one of voters’ priorities in the November presidential election. Vice President Kamala Harris has proposed strengthening the Affordable Care Act, known as Obamacare. Former President Donald Trump has offered few details about his vision on the issue; his running mate, JD Vance, has suggested deregulation.
The researchers who produced the report noted in their findings that Americans spend the most on health care, but get the least return on their investment.
“No other country in the world expects patients and their families to pay as much out-of-pocket for basic health care as the United States does,” Dr. Joseph Betancourt, president of The Commonwealth Fund, said in a call.
Ironically, the excessive prices people pay do not guarantee higher quality care.
“We are undersupplied with the things that people need most,” including doctors and hospital beds, said Dr. David Blumenthal, former president of The Commonwealth Fund. “It’s one of the reasons you have to wait so long in the U.S. for specialty care and why no one can find primary care physicians,” he said.
Preventable deaths
The findings emerge from tens of thousands of survey responses from primary care physicians and citizens in high-income countries collected over the past three years.
Researchers looked at how the United States compared to nine other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden and the United Kingdom. Each country was given a score in five categories: access to care, the process for receiving care, administrative efficiency, equity and health outcomes.
None of the countries were at the top or bottom of each category. The countries that performed the best overall were Australia, the Netherlands and the United Kingdom. Australia and the Netherlands also had the lowest health spending, according to the report.
The researchers said that The United States stood out for its “exceptionally weak” performance.
It ranked last or near last in almost every category except one — processes of care — where it ranked second, after New Zealand. This category measures preventive services such as mammograms and flu shots and patient relations.
The complex maze of hospital debt, health insurance disputes, and patient-paying requirements that patients and doctors are forced to navigate has left the United States second to last in administrative efficiency.
“We have so many different insurers, each selling a different product with different requirements for doctors and hospitals and other providers to be paid and for patients to be able to receive care,” Blumenthal said. “That leads to denials of care, to negotiations between doctors, hospitals and insurers.”
It also ranked second to last in terms of equity, with many low-income people reporting they could not afford the care they needed and many more reporting unfair treatment or discrimination.
Notably, the United States also had the lowest life expectancy and the highest number of preventable or treatable deaths, exacerbated by the pandemic.
In 2023, the average life expectancy in the United States was 77.5 years, just one year higher than in 2021, when the pandemic caused it to drop to 76.4 years, according to the most recent data from the Centers for Disease Control and Prevention (CDC).
“This is a new finding,” Blumenthal said. “We haven’t had a pandemic-related outcome in previous reports, and it shows that, unfortunately, our overall poor performance is true to our outcome in terms of COVID-19 mortality.”
Quality health care is out of reach for many
Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, said the findings are consistent with other research that consistently ranks the United States at the top of its peers on nearly every health indicator, including life expectancy, maternal and infant mortality, access to health care and equity.
Many of the most vulnerable people in the United States, including racial minorities and those with the lowest incomes, are uninsured or underinsured, Gostin said. Because of the high cost of services, many delay or avoid seeking medical care.
“The United States offers perhaps the most advanced medical treatments in the world, but only to those who can afford it,” Gostin said. “For too many people, quality health care is out of reach.”
It also differs from other countries in one critical area: universal health coverage, said Dr. Adam Gaffney, a critical care physician at Cambridge Health Alliance in Massachusetts.
“A universal health care system can make a difference,” Gaffney said, “not only because everyone is covered and can see a doctor when they need to, but because they have a long-standing health care provider who can give them advice and tips and treatments for preventing common conditions.”
The United States has ranked last in previous Commonwealth Fund reports, but researchers avoided comparing them because the questions and countries participating vary.
The recent study also listed solutions to health system problems, including lowering costs and expanding access to coverage.
“America’s shortcomings are clear from this international analysis, but there are opportunities for change,” said Reginald Williams II, vice president of The Commonwealth Fund’s International Health Policy and Practice Innovations program.
