Even though the U.S. spends more than other first world nations on healthcare costs, our health outcomes are worse. In a recently released report covering 10 countries, the U.S. came in dead last.
“The ability to keep people healthy is a critical indicator of a nation’s capacity to achieve equitable growth. In fulfilling this fundamental obligation, the U.S. continues to fail,” said The Commonwealth Fund organization’s report. This is the eighth report of its kind published by the organization since 2004.
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To create its ranking, The Commonwealth Fund addressed 70 performance measures including access to care, care process, administrative efficiency, equity and health outcomes. Countries included in the report were Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the U.K.
Australia, the Netherlands and the U.K.’s healthcare systems were ranked the best. Meanwhile, the U.S. was the only clear outlier with dramatically lower scores. It ranked lowest in access to care and health outcomes and ninth in administrative efficiency and equity. The U.S. did rank second in care process, and The Commonwealth Fund said that may be due to pay-for-performance policies regarding preventive care services such as mammograms and flu shots.
“While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage,” said The Commonwealth Fund.
Since 1980, U.S. spending on healthcare has far outpaced other nations, according to the report. As of 2022, the U.S. spent more than 16% of its Gross Domestic Product on healthcare, and that figure is expected to exceed 20% by 2035. Other nations included in the report spent around 8% to 12% of GDP on healthcare costs as of last year.
Even as spending balloons, access to care is spotty.
“In the U.S., lack of affordability is a pervasive problem. With a fragmented insurance system, a near majority of Americans receive their health coverage through their employer,” explained The Commonwealth Fund. “While the ACA’s Medicaid expansions and subsidized private coverage have helped fill the gap, 26 million Americans are still uninsured, leaving them fully exposed to the cost drivers in the system.”
Even for those who have insurance, extensive cost-sharing requirements still make it difficult or impossible for people to visit a doctor. Many skip medical tests, treatments and follow-up visits or avoid filling prescription medications.
“In terms of care availability, U.S. patients are more likely than their peers in most other countries to report they don’t have a regular doctor or place of care and face limited options for getting treatment after regular office hours,” said The Commonwealth Fund. “Shortages of primary care services add to these availability problems.”
Every other country in the study has universal healthcare.
According to the Peter G. Peterson Foundation, the U.S. spent an estimated $12,742 per person on healthcare, the highest costs per capita compared to other similar countries in 2022. Per The Commonwealth Fund’s 2023 international survey, 41% of Americans had spent $1,000 or more on health care out of pocket in the previous year.
Along with poor access to care, the U.S. has poor health outcomes compared to other comparable countries. U.S. life expectancy was more than four years below the 10-country average and it also had the highest rates of preventable and treatable deaths for all ages as well as excess deaths related to the pandemic for people under age 75.
“The ongoing substance use crisis and the prevalence of gun violence in the U.S. contribute significantly to its poor outcomes, with more than 100,000 overdose deaths and 43,000 gun-related deaths in 2023 – numbers that are much higher than in other high-income countries,” said The Commonwealth Fund.
In addition to high costs, the U.S. healthcare system is confusing and time consuming to navigate. An article published in the JAMA journal last year concluded that “complexity” in the nation’s healthcare system was “the enemy of access and affordability.”
“Almost 6 in 10 people with insurance reported a problem with using their health insurance during the past year,” said the article. “The share increases to two-thirds for people in fair or poor health, three-fourths for those who need mental health services, and almost 8 in 10 for people who use the health system the most.”
The Commonwealth Fund described the U.S. healthcare system as “uniquely complex” due to its mix of public and private players. There are thousands of health plans, and each has its own requirements and limits.
“Physicians and other health care providers spend enormous amounts of time and effort billing insurers. Denials of services by insurance companies are also common, necessitating burdensome appeals by providers and patients,” said the fund’s report.
Issues with the U.S. healthcare system are nothing new. In 2021, Robert H.
Shmerling, senior faculty editor for Harvard Health Publishing, wrote that: “An entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.”
He said that the nation’s healthcare system is expensive, complicated, dysfunctional and broken.
In its report, The Commonwealth Fund suggested some areas of improvement to help fix this broken system. These include: increasing investment in primary care, reducing administrative inefficiency, implementing policies that reduce substance abuse and gun violence related health issues, and improving access to affordable healthcare.
Multiple items on that list are connected to what the report called “massive consolidation” of healthcare providers through mergers and acquisitions. That has allowed large providers to negotiate higher prices from private insurers, it said.
“Years of neglect and undercompensation for primary care have resulted, predictably, in nationwide shortages of the clinicians who play a vital role in managing chronic illness and reducing the need for costly and sometimes unnecessary emergency, specialty, and hospital care services,” it explained. “The acquisition of primary care practices by health systems and private equity investors is further disrupting an already fragile primary care capacity, with uncertain short- and long-term consequences.”
Earlier this year, Audacy covered a study published in the PLOS One journal that also found rising executive compensation is contributing to the affordability crisis in American healthcare. Highlighting the human toll of healthcare-related issues, Audacy has recently reported on a study published in the Journal of the American Medical Association that showed mortality rates for children are rising at rates not seen since the 1970s as well as a study that found that the number of women dying in childbirth in the U.S. is rising.
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