The United States is worst among 11 high-income countries in delivery of and access to health care, according to an August 2021 study conducted by the Commonwealth Fund, despite spending the most, by far, of its gross domestic product (GDP) on health care than other countries surveyed. The survey used indicators across domains on access to care, care process, administrative efficiency, equity, and healthcare outcomes to compare healthcare system performance. Overall, the top-performing countries were Norway, the Netherlands, and Australia.

When it came to healthcare system performance, the United Kingdom, Germany, and New Zealand received the highest ratings. The United States ranked last, and the report showed the extent to which the country was an outlier in the study: its “performance fell well below the average of other countries and far below the two countries ranked directly above it: Switzerland and Canada.” The country ranked last on all domains except care processes, where it ranked second.

Meanwhile, healthcare spending growth in the United States “greatly exceeded growth in the other 10 nations.” The study considered spending as a share of GDP, and by 2019, the United States spent 16.8% of GDP on health care, whereas the remaining countries reported spending 9.1%11.7%.

The United States was another stark outlier in the correlation between spending and performance, the Commonwealth Fund reported. The other nations’ spending ranged from 8%–12%, with a health system performance ranging from 0.40 to –0.60, with the United States spending 16%–18% with a health system performance of –1.20 to –1.40.

The Commonwealth Fund reported that “striking contrast in performance between the United States and other high-income countries on avoidable mortality measures points to several intervention or policy targets,” ones that U.S. lawmakers should consider in future policies. Examples from the study’s top-performing countries include:

  • Provide for universal coverage and remote cost barriers so people can get care when they need it and in a manner that works for them.
  • Invest in primary care systems to ensure that high-value services are equitably available locally in all communities to all people, reducing the risk of discrimination and unequal treatment.
  • Reduce the administrative burdens on patients and clinicians that can discourage access to care, especially for marginalized groups.
  • Invest in social services to increase equitable access to nutrition, education, child care, community safety, housing, transportation, and worker benefits that lead to a healthier population and fewer avoidable demands on health care.

ONS’s position is that all people should have access to comprehensive and affordable health care and essential cancer care services, such as prevention and risk reduction, treatment, and screening, without discrimination. Thanks to oncology nurses, the country has access to some of the best advancements in cancer medicine and treatment, but the healthcare system still has opportunities for improvement. Join in advocating for the advancement of health care with the ONS Center for Advocacy and Health Policy.