WEDNESDAY, Oct. 22, 2014 (HealthDay News) -- The U.S. health care system ranks dead last compared to other industrialized nations when it comes to affordability and patient access, according to a new survey.

The 2013 survey of the American health care landscape was conducted by the Commonwealth Fund just prior to the full implementation of the Obama administration's Affordable Care Act (ACA).

"I would say that we found two things that really seem to drive the higher barriers to health care in the U.S.," said David Squires, a senior researcher with the Commonwealth Fund in New York City.

"The first is that we have a huge uninsured population, which at least at the time of the survey was about 50 million people. And, the second is that we have millions more who have some kind of insurance, but the coverage isn't really good enough to protect them fully if they actually become ill," explained Squires.

"And these two issues don't really exist in any of the other countries we looked at. They all have universal health insurance," he noted. "So everyone has access and the insurance they have is generally much more protective. It covers more costs and either has no co-pays or relatively modest co-pays. And there's a ceiling on what a patient would have to pay in any one year, if anything," Squires said.

"That's a huge difference from the American experience. In addition, the U.S. is just a much more expensive health care system. We spend about $9,000 per person a year. That compares, for example, with just $3,000 a year in the U.K., and is overall about 50 to 200 percent more than is spent on our peers in other Western nations. So even if an American has insurance it's still in the context of an extremely expensive situation," Squires added.

The new survey is the subject of a perspective analysis, written by Karen Davis and Jeromie Ballreich of Johns Hopkins, and published in the Oct. 23 issue of the New England Journal of Medicine.