USA in last place. I am not surprised.

NewScientist has a brief article on an international comparison of the health systems of 11 wealthy, industrialized nations. Each system was ranked on its performance within 5 different “domains”.

The domains were ease of access to healthcare, how equal access is to people of different incomes, administrative efficiency, how well the care process works for people who use it, and how good the health outcomes are.

So I know my friends in the States are dying to know, how did the US perform?

“We measured performance quality across five domains, and the USA fell short in all five,” says Eric Schneiderof the Commonwealth Fund think tank in Washington DC.

Of course you MAGA mavens out there are going to insist that this is all the fault of the ACA, but hold on to your hat, you’ll never believe this:


The US fell particularly short when it came to access to healthcare. The study found that in the US, 44 per cent of people on low incomes have difficulty accessing healthcare, and even 26 per cent of those on high incomes report access problems. The equivalent figures in the UK are only 7 and 4 per cent. …

The report says that, since President Obama’s Affordable Care Act (ACA) had been introduced, there has been some improvement, with access to healthcare coverage being extended to more than 20 million extra people in the US.

“The ACA has helped make major strides in coverage and access to care in the US, particularly for lower-income Americans,” says Benjamin Sommers of the Harvard T.H. Chan School of Public Health in Boston, Massachusetts.

“Current proposals being debated in Congress could undo most of that progress….”

Such a surprise. But just how bad was the US? Were we just consistently in 6th or 7th place while others had some strong showings to make up for weaker ones? In a word: no. From the original study (by a think tank named The Commonwealth Fund), we get this:

The U.S. ranks last in Access, Equity, and Health Care Outcomes, and next to last in Administrative Efficiency, as reported by patients and providers. Only in Care Process does the U.S. perform better, ranking fifth among the 11 countries. Other countries that rank near the bottom on overall performance include France (10th) and Canada (9th).

That’s right, we got 3 x 11th place out of 11, 1 x 10th place, and 1 x 5th place. And hell, I’m not even sure what they mean when they say “care process” works well. Are they including the unlimited forms you have to fill out? Or are they just measuring how long you have to wait for an appointment? Nope, that’s covered under “access”. Sorry. (See below for what this actually means*1).

For those who have to know, the UK’s NHS was the top performer, but Australia is really the place to be if you’re wealthy*2. It scored amazingly well on everything but equity of access, including 1st place in actual health outcomes. Since it scored acceptably on access generally (4th), it seems likely that there aren’t that many people without health care, but on equity they were 7th so which people end up without that access isn’t random. Conversely, the methodology established for the study led to UK’s being ranked first, but they were 10th in Health Outcomes. So almost everyone is getting to the doctor, and they don’t spend too much money, but they were dead last out of all the civilized countries in the study on actually making people healthy when they do go to the doctor.

Of note is that the UK has had more rapid improvement in health outcomes than any other country studied. So they each have something they can work on – Australia on equality of access and the UK on actually getting health from their health care – but I’d rather be in Australia’s situation than the UK’s: you know the health care is working for those who use it, you just have to get more people in the door. That sounds more doable to me.

*1: The definition of Care Process from the study:

Care Process encompasses four subdomains relevant to health care for the general population: preventive care, safe care, coordinated care, and engagement and patient preferences.

The preventive care measures include four survey items related to counseling by health professionals on healthy behaviors, two OECD measures of mammography screening and influenza vaccination, and three OECD measures of rates (age- and sex-standardized) of avoidable hospital admissions for three prevalent chronic conditions: diabetes, asthma, and congestive heart failure.

Safe care includes three survey items: two indicators of safe care based on patient reports of experiencing medical, medication, or laboratory mistakes, and failure to receive effective prescription medication management, as well as one measure indicating whether primary care doctors use electronic clinical decision supports in their practice to improve safety.

Coordinated care uses seven measures to summarize timely sharing of information among primary care clinicians, specialists, emergency departments, and hospitals. It includes three physician-reported measures of effective communication among primary care clinicians and home care and social service providers.

Engagement and patient preferences represents 10 measures that evaluate the degree to which doctors and other health professionals deliver patient-centered care, which includes effective and respectful clinician–patient communication and care planning that reflects the patient’s goals and preferences.


*2: High Equity is described in the report this way:

there are relatively small differences between lower- and higher-income adults on the 11 measures related to timeliness, financial barriers to care, and patient-centered care

Of course, wealth isn’t distributed randomly, so there is some indirect measure of disparate incomes based race, ethnicity, citizenship, sex & gender. I’d prefer if they measured those things more directly. I’d also prefer if they measured mental health more directly as well, but they didn’t.







  1. Jess says

    Getting more people in the door in Australia is complicated by the remoteness of some of our communities. Good luck getting to see a GP if you’re an Indigenous person from far north Queensland when English isn’t your first language and the cyclones wash out the road every year.

Leave a Reply

Your email address will not be published. Required fields are marked *