Difficult to afford Spencer Platt/Getty

A comparison of health systems in 11 wealthy nations has found the US falling short by multiple measures, while the UK’s National Health Service leads in several categories.

“We measured performance quality across five domains, and the USA fell short in all five,” says Eric Schneider of the Commonwealth Fund think tank in Washington DC. The domains were ease of access to healthcare, how equal access is to people of different incomes, administrative efficiency, how well the care process works for people who use it, and how good the health outcomes are.

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The analysis included data from sources including the World Health Organization, the OECD, and questionnaires completed by people and their doctors in the 11 countries examined, which also included Australia, Canada, Germany and Sweden.


Overall, the US ranked last, although it ranked fifth in the care process category. The UK came top overall, but ranked tenth for healthcare outcomes – how well patients fare after treatment.

Unequal access

The US fell particularly short when it came to access to healthcare. The study found that in the US, 44 per cent of people on low incomes have difficulty accessing healthcare, and even 26 per cent of those on high incomes report access problems. The equivalent figures in the UK are only 7 and 4 per cent. “A higher-earning person in the US is more likely to meet cost barriers than a low-income person in the UK,” says Schneider.

The report says that, since President Obama’s Affordable Care Act (ACA) had been introduced, there has been some improvement, with access to healthcare coverage being extended to more than 20 million extra people in the US.

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“The ACA has helped make major strides in coverage and access to care in the US, particularly for lower-income Americans,” says Benjamin Sommers of the Harvard T.H. Chan School of Public Health in Boston, Massachusetts.

“Current proposals being debated in Congress could undo most of that progress by increasing the number of people without health insurance by more than 20 million over the next decade,” says Sommers. “Rather than narrowing the gap with its rivals, the US might fall further behind.”

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