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Among 10 equivalent developed countries, a recent survey again rated the United States health system last when measured across different domains of healthcare service.

The COVID pandemic revealed gaps and strengths in healthcare systems around the world with regard to infection control, treatment, and public health resilience.

The Commonwealth Fund is a foundation that supports independent research around healthcare issues and offers grants to improve healthcare practices.  In addition, the Fund carries out a variety of health-related surveys, from health insurance to health care, and topics in between.  Roughly every four years, the Fund compares international health systems.

The survey uses 71 metrics clustered within five domains to compare the effectiveness of health systems in 11 high income countries.  Countries involved in the survey include the United Kingdom, the US, Switzerland, Germany, France, the Netherlands, New Zealand, Norway, Sweden, Australia, and Canada.

The survey points out that no two countries have the same healthcare system.  That said, factors that signal a stable healthcare system are shared among top performing healthcare systems.  According to the survey, the stability of each healthcare system can roughly be assessed by looking at performance measures in five domains which include:

  • Care process: The care process is measured by looking at the safety of care, preventative and coordinated care, patient engagement and preferences.
  • Administrative efficiency:  Administrative tasks can limit the amount of time clinicians can see patients, while insurance boondoggles can prevent access to timely, high-quality care. 
  • Equity: This measure looks at accessibility and the care process as it relates to healthcare consumers across income levels.
  • Healthcare outcomes:  This measure is the most complex of the five domains and includes ten measures that look at mortality, life expectancy, and care outcomes.
  • Access to care:  Affordability and timely care are sub-topics within this domain, which measures how quickly patients can obtain and afford good quality health care.

Overall, the US ranks last among all the countries, while Norway, the Netherlands, and Australia occupy the top three spots.

What do they have that we don’t?

The survey outlines four areas where the US just does not measure up to countries with solid, safe, accessible healthcare programs.  Those areas are:

  • Investment in social services, with focus on working age adults and young children
  • Universal healthcare coverage with care taken to remove cost barriers
  • Investment in primary care practices that ensure equitable, good quality health care access across populations
  • Reduction of administrative challenges that drain time, spending, and effort from healthcare services

Given the instability, access difficulty, costs, and insurance problems in the US, it is likely this country will be bringing up the rear of the line for this survey for the foreseeable future.

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