US spends the most on health care but has the worst health outcomes among high-income countries, new report finds


The United States spends more on health care than any other high-income country, but still has the lowest life expectancy at birth and the highest percentage of people with multiple chronic diseases, according to a new report by The Commonwealth Fund, an independent research group .

The report, released Tuesday, also said that compared to comparable nations, the U.S. has the highest death rates from preventable or treatable causes and the highest maternal and child mortality rates.

“Americans are living shorter and less healthy lives because our health care system is not working as well as it could be,” said the report’s lead author, Munira Gunja, a senior researcher at the Commonwealth Fund’s International Program for Innovation in health policy and practice, in a news release. “To catch up with other high-income countries, the administration and Congress will need to expand access to health care, act aggressively to control costs, and invest in health equity and social services that we know can lead to to a healthier population.”

People in the U.S. see doctors less often than those in most other countries, which likely has to do with the fact that the U.S. has a below-average number of medical practitioners, according to the report, and the U.S. is the only country surveyed that does not have universal health coverage. In 2021 alone, 8.6% of the US population was uninsured.

“Not only is the US the only country we examined that does not have universal health coverage, but its health system may appear designed to discourage people from using services,” researchers from the Commonwealth Fund, based in New York, wrote in the report. “Affordability remains the main reason some Americans don’t sign up for health insurance, while high out-of-pocket costs cause nearly half of working-age adults to skip or delay getting the care they need.”

The researchers analyzed health statistics from international sources, including the Organization for Economic Co-operation and Development, or OECD, which tracks and reports data from health systems in 38 high-income countries. The data was retrieved in December.

The researchers examined how the United States compared to Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland and the United Kingdom. They also compare the US to the OECD average of 38 high-income countries.

The data shows that in 2021 alone, the US spent almost twice as much as the average OECD country on healthcare – and healthcare spending in the US was three to four times higher than in South Korea, New Zealand and Japan.

Globally, health care spending has been increasing since the 1980s, according to the report, driven mostly by advances in medical technology, rising costs of medical care and greater demand for services.

The U.S. has the highest rate of people with multiple chronic conditions, the data show, and the highest rate of obesity among the countries surveyed.

Life expectancy at birth in the US in 2020 was 77 years – three years below the OECD average – and early data suggest US life expectancy will drop even further in 2021. Since the start of The Covid-19 pandemic has seen more people die from coronavirus infections in the US than in any other high-income country, according to the report.

Deaths caused by assaults also appear to be the highest in the US compared to all similar countries. The researchers found that deaths from physical assault that included gun violence occurred at a rate of 7.4 deaths per 100,000 people in the US in 2020, significantly higher than the OECD average of 2. 7 and at least seven times higher than most other high-income countries in the report.

Where the US seems to be doing well is in cancer prevention and early cancer treatment. Along with Sweden, it had the highest number of breast cancer screenings among women aged 50 to 69, and the US exceeded the OECD average for colorectal cancer screening rates.

A separate paper published in mid-January said cancer deaths in the US had fallen 33% since 1991, equivalent to roughly 3.8 million deaths averted.

Overall, the Commonwealth Fund’s new report “continues to demonstrate the importance of international comparisons,” Reginald D. Williams II, who directs the Commonwealth Fund’s International Program, said in the media release. “This offers an opportunity for the U.S. to learn from other countries and build a better health care system that provides affordable, high-quality health care for all.”

Much of the data in the new report shows trends that have been seen before.

“It confirms the fact that we continue to spend more than anyone else and get the worst health outcomes. So we’re not getting the best value for our health care dollar,” said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the new report.

“The big takeaway for me is that Covid has not become the great equalizer [among nations]. It didn’t help our case at all,” Benjamin said. “If nothing else, it exposed the existing holes in our health care system.”

To help plug the holes in the U.S. health care system, Benjamin outlined three steps the nation can take.

“We are still the only nation that does not have universal health care or access for all of our citizens,” Benjamin said.

Second, “we don’t do as much primary prevention as other nations, and we still have a public health system that’s broken,” he said. “The third thing is that we underinvest compared to other industrialized nations in public affairs. They spend their money on providing advance support for their citizens. We spend our money on sick leave.”

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