No country ranked first or last in any category. The top three countries overall were Australia, the Netherlands and the UK, with Australia and the Netherlands also having the lowest health spending, according to the report.
The researchers said the US’s performance stood out as “exceptionally weak,” ranking at or near the bottom in every category except process of care, where it came in second only to New Zealand, which measures preventive services like mammograms and flu shots, as well as patient interactions.
The complex maze of hospital bills, insurance disputes and copayments that patients and doctors must navigate ranks the United States second from the bottom in government efficiency.
“There are so many insurance companies out there, all selling different products with different requirements to help doctors, hospitals and other providers get paid and patients get care,” Blumenthal said. “That’s leading to denials of service. It’s leading to negotiations between doctors, hospitals and insurance companies.”
The United States also ranked second to last for equity, with many low-income people reporting not being able to get the health care they need and high numbers reporting unfair treatment and discrimination.
In particular, the United States has the shortest life expectancy and the highest rate of preventable and treatable excess mortality, which has been exacerbated by the pandemic.
According to the latest data from the Centers for Disease Control and Prevention (CDC), life expectancy in the United States last year was 77.5 years, up just over a year from 2021, when the pandemic caused life expectancy to fall to 76.4 years.
“This is a novel finding,” Blumenthal said, “and one that has not been pandemic-related in previous reports, but unfortunately it shows that our overall poor performance also applies to our performance on COVID-19 mortality.”
Advanced medical 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 studies that have found the United States consistently ranks near the bottom compared to other countries in nearly every major health indicator, including life expectancy, infant and maternal mortality, and access to and equity in health care.
Gostin noted that many of America’s most vulnerable people, including racial minorities and low-income people, are uninsured or underinsured, and the high cost of health care causes many to delay or avoid treatment.
“The United States has perhaps the most advanced health care in the world, but it’s only available to those who can afford it,” Gostin said. “For too many people, quality care is out of reach.”
Dr. Adam Gaffney, an intensive care physician at Cambridge Health Alliance in Massachusetts, pointed to universal health care as a key thing that sets the U.S. apart from other countries.
“Universal health care can make a difference,” Gaffney says, “because not only would everyone have insurance and be able to see a doctor when they need it, but long-standing health care providers would be available to offer counseling, advice, and treatment and prevention of common conditions.”
Previous Commonwealth Fund reports have ranked the United States last, but researchers tried to avoid making direct comparisons from report to report because questions and participating countries change.
Thursday’s report also listed solutions to the nation’s health care problems, including lowering health care costs and expanding insurance coverage.
“This international analysis makes clear the shortcomings of the United States, but the opportunities for change are equally clear,” said Reginald Williams II, vice director of the Commonwealth Fund’s Global Health Policy and Practice Innovation Program.
