Study Ranks U.S. Healthcare Industry Dead Last Among Other High-Income Countries

September 01, 2021 by Alec Stone MA, MPA, ONS Director of Government Affairs and Advocacy

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:

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