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The Roger C. Lipitz Center for Integrated Health Care

Posted date: June 16, 2014
New Commonwealth Fund Report Ranks U.S. Health System Last, Outlines U.S. Health System’s Shortcomings
Karen Davis, Kristof Stremikis, David Squires,
Cathy Schoen, and Emily Van Oeveren
Although the U.S. spends significantly more on health care, its health system ranks last when compared to other industrialized countries.  In the newest edition of the Commonwealth Fund report, Mirror Mirror On The Wall: How The Performance of the U.S Health Care System Compares Internationally: 2014 Update, eleven countries’ health systems are measured by their performance in five key areas:  the health and length of life for residents, their access to care, the quality of health care, the efficiency of the system, and equity of care.   
This report was produced previously in 2004, 2006, 2007, and 2010. In all five reports, past and present, the United States ranked last. In 2014, four countries were added to the rankings.  These include Switzerland, Sweden, Norway, and France.  Other countries ranked are the United Kingdom, Australia, Germany, the Netherlands, New Zealand, and Canada. According to the 2014 report, the United States’ dismal ranking is due to a number of problems, especially a pervasive lack of access to primary care, administrative inefficiencies, and health disparities.  The report’s authors, Karen Davis of the Roger C. Lipitz Center for Integrated Health Care, Kristof Stremkis of the Pacific Business Group on Health, and researchers from the Commonwealth Fund, David Squires, and Cathy Schoen, outline these shortcomings while also discussing the potential for improvement in the future with the recent expansion of health insurance coverage under the Affordable Care Act.
In addition to an overall low ranking, the U.S. ranks last of 11 countries in four of the five key areas that were measured for the 2014 version of the Mirror Mirror report: access, equity, efficiency, and health outcomes.  The U.S. ranks last for infant mortality and mortality amenable to health care, and ranked last in every measure related to cost-related access to health care problems.  Compared to 4 percent of adults in the U.K., 37% of U.S. adults said they had difficulty accessing the care they needed because of the cost.  
American health care quality is ranked highly in terms of effectiveness, but less so when the quality is measured in patient safety and coordination of care.  On measures of efficiency and equity, the U.S. ranked last.  The cost of insurance administration and lack of communication among providers has led to inefficiency in the system. Inequity was measured in part by how many adults with below average incomes reported not visiting a physician because of the expense.  Adults with lower incomes in the U.S. also reported waiting longer than adults with higher incomes for care.  The study reveals real financial challenges that prevented individuals with lower incomes from accessing needed and timely care, as well as a significant imbalance in who receives access to care and when.
The U.S stands out from other countries because of its lack of universal health insurance coverage.  The Affordable Care Act is currently expanding insurance coverage and access to care to millions of uninsured Americans.  Further, the Affordable Care Act provisions on prevention and innovation in payment and delivery of services have potential to improve care and health outcomes at lower cost for all Americans which should contribute to improved health system performance in the U.S. in the future.