Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

by Michelle M. Doty; David Squires; Dana O. Sarnak; Eric C. Schneider; Arnav Shah

Jul 14, 2017

ABSTRACT

Issue: The United States health care system spends far more than other high-income countries, yet has previously documented gaps in the quality of care.

Goal: This report compares health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Methods: Seventy-two indicators were selected in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Data sources included Commonwealth Fund international surveys of patients and physicians and selected measures from OECD, WHO, and the European Observatory on Health Systems and Policies. We calculated performance scores for each domain, as well as an overall score for each country.

Key findings: The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands. Based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries' approaches if it wants to achieve an affordable high-performing health care system that serves all Americans.

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