The global coronavirus pandemic has highlighted the value of an excellent healthcare system. As travel slowly resumes and expats and digital nomads get back to work, living in a place with access to high-quality healthcare has become an absolute must. The question of the best healthcare system in the world is compelling and more relevant today than ever.
Recently, the Commonwealth Fund published its influential Mirror, Mirror 2021 report comparing health system performance in 11 high-income countries, and the United States ranked last in every category, except for one.
NHS slumps down the rankings
The United Kingdom has ranked number one in previous editions of the Commonwealth Fund study in 2014 and 2017, but on this occasion, the NHS has dropped to number 8, outperformed by its European neighbours.
The slump to number 8 demonstrates the deep-rooted challenges facing the NHS today, especially with difficulties in providing access to care, as millions of patients around the country wait their turn for delayed elective procedures. The UK also ranked ninth for health outcomes this year.
How were the health systems evaluated?
Evaluating health systems alongside each other is a tricky exercise since every country has to navigate within its financial constraints, health system policies, medical talent pool and provider infrastructure.
The methodology included international surveys conducted in each country and insights drawn from the OECD and WHO. The 11 health systems were analysed using 71 performance measures across five categories:
- Access to care
- Care process
- Administrative efficiency
- Health care outcomes
The full health system rankings
The Commonwealth Fund’s top-ranked health care systems are Norway, Netherlands and Australia.
Why is the US health system ranked the worst?
The US spends more on healthcare than any other country, but falls desperately behind other high-income nations in the Commonwealth Fund’s health system rankings.
The US spent almost 17% of its GDP on health care in 2019, followed by Germany at number two, who spent 11.7% of its GDP on healthcare. Yet, the outcomes in the report show Germany leaps and bounds ahead of the US.
Unfortunately, the US demonstrates the worst healthcare outcomes with the highest infant mortality rate, maternal mortality rate, lowest life expectancy, and the highest rate of avoidable mortality.
The US ranks last on access to care, administrative efficiency, equity, healthcare outcomes, except for care process, where it ranks second.
An area where the US struggles compared to other high-income nations is in the provision of medication for treatment. Doctors are faced with difficulties in getting medications for their patients due to barriers and limitations in insurance coverage.
As a consequence, patients and healthcare providers in the US spend a lot of time on administrative paperwork related to medical bills.
The Commonwealth report reveals several factors that distinguish the top-performing health systems from the US. These include the provision of universal healthcare coverage, removal of cost barriers, widespread investment in primary healthcare, emphasis on health system improvement and investment in social services, especially for children and young adults.