U.S. is last in global health-care rankings

Published: July 17, 2014 5:00 a.m. ET

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Despite having the most expensive health care system in the world, the U.S. ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives, according to a report by The Commonwealth Fund, a private foundation that supports independent research on health care issues. The U.S. under performs relative to other countries on most dimensions of performance.


This is how the 11 countries ranked overall:

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11. United States

Cost per capita: $8,508

The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage, the report states. Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes. The Affordable Care Act is increasing the number of Americans with coverage and improving access to care, though the data in this report are from years before the full implementation of the law. Thus, it is not surprising that the U.S. underperforms on measures of access and equity between populations with above- average and below-average incomes.

At left, a child is vaccinated for measles in Miami. The Centers for Disease Control and Prevention recently announced that in the U.S. they are seeing the most measles cases in 20 years as they warned clinicians, parents and others to watch for and get vaccinated against the potentially deadly virus.

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10. Canada

Cost per capita: $4,522

Trailing the U.S. for poor performance is Canada, where patients are found to have little to no financial burden of health care, but experience wait times for specialized services, leaving Canada ranked last on timeliness of care.

At left, Thomas Shipley prunes dry marijuana buds at a medical marijuana farm in Smith's Falls, Ontario, April 22.

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9. France

Cost per capita: $4,118

Communication measures in the study included whether patients reported if they got timely answers to their questions, understandable explanations, and clear instructions about what to watch for or when to seek further care. France scored relatively poorly on the three measures. France ranked highest overall on the three healthy lives indicators: deaths that could have been prevented with timely and effective care; infant mortality; and healthy life expectancy.

At left, an African migrant receives medicine against scabies from a French doctor during the daily food distribution at the harbor in Calais, northern France, May 27.

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8. Norway

Cost per capita: $5,669

Norway ranked last in quality care, and sicker adults in Norway, along with New Zealand, reported the highest rates of medical errors.

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7. New Zealand

Cost per capita: $3,182

New Zealand ranked second in effective care and coordinated care, and third in patient-centered care. The Fund’s National Scorecard defines patient-centeredness as “care delivered with the patient’s needs and preferences in mind.”

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6. The Netherlands

Cost per capita: $5,099

The Netherlands scored high in timeliness of care. Patients in the Netherlands, Germany, France, and Switzerland have rapid access to elective or nonemergency surgery compared with patients in the U.S.

At left, children attend a Teddy Bear Hospital event in Amsterdam. The Teddy Bear Hospital aims to teach children about being and staying healthy.

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5. Germany

Cost per capita: $4,495

The report states there is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; but Germany is one of the countries, along with the Netherlands and U.K., that provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services. As for coordinated care, physicians in Germany reported one of the highest rates of receiving information from the hospital needed to manage a patient’s care within two days of discharge. Germany is a leader in health care communication indicators.

At left, German Health Minister Hermann Groehe.

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4. Australia

Cost per capita: $3,800

Australia performs well in the chronic care indicators, delivering recommended services to patients with diabetes, as well as providing written instructions to chronically ill patients.

At left, women smoke cigarettes in Melbourne, Australia, where the City Council is considering a plan to make the Melbourne city center smoke-free by late 2016.

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3. Sweden

Cost per capita: $3,925

The surveys measured patient engagement by asking respondents whether their doctor always tells them about their options for care and asks their opinions, discusses goals and encourages them to ask questions, and gives clear instructions about symptoms to watch for and when to seek treatment. Sweden performed poorly in this area, and ranks last on coordinated care measures. But Sweden ranked high on efficiency, equity, and healthy lives indicators.

At left, midwife Sofie Laaftman checks Christina Singelman's pregnancy progress at a pregnancy care clinic in Stockholm last year.

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2. Switzerland

Cost per capita: $5,643

Switzerland, which ranks second overall, is among the leading countries on equity, timeliness of care, and patient-centered care.

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1. United Kingdom

Cost per capita: $3,405

The United Kingdom ranks first overall, scoring highest on quality, access, and efficiency. At left, 10-month-old Maijed Dhaif grabs hold of one of the Duchess’ earrings as the Prince of Wales and Duchess of Cornwall officially open the new Chelsea and Westminster Children's Hospital in London, in March.

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1. United Kingdom

Cost per capita: $3,405



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