The US has the worst healthcare system among 11 high-income countries assessed in a new report by the Commonwealth Fund, despite the fact that it spends nearly twice as much of its gross domestic product on medical costs as other wealthy nations. According to the report, a lack of universal health insurance coverage is the main driver of the nation’s poor healthcare outcomes, resulting in alarmingly high rates of preventable deaths.

Of the 11 countries – the Netherlands, US, UK, Canada, Norway, Sweden, Germany, Switzerland, France, Australia, and New Zealand – the US "trails far behind other high-income countries on measures of health care affordability, administrative efficiency, equity, and outcomes," the report concluded. 

“The US rate of preventable mortality (177 deaths per 100,000 population) is more than double the best-performing country, Switzerland (83 deaths per 100,000),” write the researchers, before stating that the US “has exceptionally poor performance” on other healthcare outcomes such as maternal mortality.

“The US rate of 17.4 [maternal] deaths per 100,000 live births is twice that of France, the country with the next-highest rate (7.6 deaths per 100,000 live births).”

Infant mortality rates currently stand at 5.7 deaths per 100,000 live births, which is considerably worse than in any other country, while average life expectancy for those over the age of 60 is just 23.1 years in the US – another last-place score.

Overall, Norway is ranked as having the best healthcare system, followed by the Netherlands and Australia. The US came in last, far behind its nearest competitor, Canada.

The report assessed each country’s healthcare system across five domains, including access to care, care process, administrative efficiency, equity, and healthcare outcomes. The US ranked last in four of these categories but came second for process of care.

“The US has managed to keep pace with or exceed other countries on several measures of care process included in the report, such as influenza vaccination rates for older adults, lower rates of postoperative sepsis after abdominal surgery, and more use of patient-facing health information technology for provider communications and prescription filling,” the authors noted.

However, the US remains the only country on the list not to offer universal healthcare, and with 70 million Americans having either no insurance or inadequate coverage, it’s little surprise that the nation’s medical system continues to perform so poorly.

For instance, the researchers explain that the cost of maternal care – from conception all the way through to the postpartum period – is a major driver of the country’s excessive maternal deaths. Meanwhile, a lack of free access to mental health care has resulted in huge numbers of preventable deaths due to suicide, while low standards of nutritional guidance, education, and other vital services have led to high rates of obesity, heart disease, and other illnesses.

The picture that the report paints is one of unequal access to what is a highly sophisticated healthcare system, whereby those with decent insurance packages benefit from an excellent quality of care, while others miss out completely. A labyrinth of administrative tasks and paperwork also make medical services more difficult to access for large numbers of people – something that all other countries involved in the report have taken steps to simplify.