The U.S. health care system ranked last, compared with six other industrialized nations, on measures of quality, efficiency, patient safety, access to care, and equity, according to a new report by the Commonwealth Fund.
One of the main reasons for the low ranking is the lack of universal health insurance, according to the report. Although the United States spends the most overall on health care, it fails to provide access for low-income individuals. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don’t have a medical home.
The United States ranked first, however, on areas such as preventive care, wait time for specialist care, and nonemergency surgical care.
One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in the other six countries studied—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—low-income patients in the United States are less likely to visit a physician when they’re sick, see a dentist, or receive recommended tests, treatments, or follow-up care.
“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” according to the report. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”
The report is the result of a compilation of mortality data from seven countries and surveys of approximately 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care. The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.
The findings indicate that U.S. physicians and patients believe that given the amount of money spent on health care, the country could have a better health care system, according to the study.
The study authors expressed hope that the health reform laws and their promise of increased Medicare and Medicaid payments would encourage more medical students to choose primary care as one way to improve health system performance for all U.S. patients.
“These findings are clearly disappointing for U.S. patients and their families,” Karen Davis, the president of the Commonwealth Fund, said during a press briefing on the study. “Fortunately, the recently enacted health reform legislation holds substantial promise for transforming the U.S. health care system into a more effective, efficient, and patient-centered system.”
The Commonwealth Fund report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,” updates information that was last published in 2007, when the United States also ranked at the bottom overall.