Eleven years ago New York Times columnist Thomas Friedman wrote an opinion piece titled “We’re No. 1(1)!”
The title was in reference to a Newsweek ranking of the 100 best countries in the world. The U.S. didn’t even make the top 10; we came in at No. 11. Not bad, but it seems that for a country with our resources we could do much better.
I was reminded of that article earlier this week when I read that the U.S. had come in at No. 11 in another world ranking. The only problem this time around was that there were only 11 countries included in the ranking.
The ranking report is the seventh international comparison of countries’ health systems by the Commonwealth Fund since 2004, and the United States has ranked last in every edition, David Blumenthal, MD, president of the Commonwealth Fund, told reporters during a press briefing.
Researchers analyzed survey answers from tens of thousands of patients and doctors in 11 high-income countries. They analyzed performance on 71 measures across five categories — access to care, care process, administrative efficiency, equity, and health care outcomes.
Here are the countries, ranked from best to worse:
- the Netherlands
- the United Kingdom
- New Zealand
- United States
One of the biggest problems with the health care system in the U.S. is inequality.
Half of the lower-income adults and 27% of higher-income adults say costs keep them from getting needed health care. “In no other country does income inequality so profoundly limit access to care,” according to David Blumenthal, MD, president of the Commonwealth Fund.
Blumenthal notes that “to catch up with other high-income countries, the [Biden] administration and Congress would have to expand access to health care, equitably, to all Americans, act aggressively to control costs, and invest in the social services we know can lead to a healthier population.”
Here are some specific metrics:
- the United States has the highest infant mortality rate (5.7 deaths per 1,000 live births) and lowest life expectancy (living on average 23.1 years after age 60) compared with the other countries surveyed
- The U.S. maternal mortality rate of 17.4 deaths per 100,000 live births is twice that of France, the country with the next-highest rate (7.6 deaths per 100,000 live births).
- The only category in which the United States did not rank last was in “care process,” where it ranked number 2 behind only New Zealand. The care process category combines preventive care, safe care, coordinated care, and patient engagement and preferences.
- The United States and Germany performed best on engagement and patient preferences, although US adults have the lowest rates of continuity with the same doctor.
- New Zealand and the United States ranked highest in the safe care category, with higher reported use of computerized alerts and routine review of medications.
- the United States is only one of the 11 countries that lacks universal coverage and nearly 30 million people remain uninsured.
- Top-performing countries in the survey have universal coverage, annual out-of-pocket caps on covered benefits, and full coverage for primary care and treatment for chronic conditions
- more than two-thirds of U.S. adults say their potential out-of-pocket costs would figure prominently in their decisions to get care if they had coronavirus symptoms
What makes our poor ranking even more striking is that that the U.S. spends more than twice as much of its GDP (17% in 2019) as the average country studied.
I guess my family and I have been among the lucky ones. We have had access to high-quality healthcare, at relatively little cost, since I began teaching over 35 years ago.
As an example, the cost of a recent three-day stay I had at a local hospital, along with several imaging tests, was nearly $80,000. My out-of-pocket cost for all of that care has been less than $200. I do have monthly health insurance premiums in addition to those direct care out-of-pocket costs, but such insurance premiums come nowhere near that $80,000 cost.
I am quite grateful to have access to such good health care, but I realize there are many people in the U.S. who do not. That is part of the disparity noted in this report.
It seems like the first step is to join the rest of the world and provide universal health care. Hopefully from there, the rest will follow and we will see improvements in these various metrics.
Hopefully, we can crack the top 1o next time…