The affordability of medical care is a sensitive subject area for many Americans. A Gallup poll found that as of the fourth quarter of 2014, roughly 13% of U.S. adults didn’t have health insurance. Although that (13%) number was a vast improvement when compared to the past five years, during which time the uninsured rate reached as high as 18%, it is still not there yet. Insurance and healthcare costs in general are not really “there” yet.
Even those who have insurance may be inadequately covered. Between all of the premium costs, co-pays, deductibles, and costs that are not covered, it’s still expensive to get sick. Let’s not forget to mention the time you may have to spend calling the insurance company, practically fighting to get a procedure covered, simply because it’s a little outside of the box.
With the passing of the Affordable Care Act, some people were optimistic, hoping things would improve and others well, not so much. Although more people have insurance today, the U.S. health care system certainly has a long to go before medical care becomes affordable to every American.
What about medical care in other developed countries? How does it compare to care in the U.S.? While no system is perfect, some other systems have design elements that are more effective or less effective than the U.S. system. Last year, the Commonwealth Fund analyzed the healthcare systems of 11 developed countries. The Commonwealth report ranked each country based on a set of metrics, including access to care, effectiveness of care, efficiency and cost of medical care, as well as accessibility and equity. Using this data, we’ve created a list of developed countries with the best and worst medical care systems.
Best countries for health care
- Overall ranking: 3
- Health expenditures per capita: $3,925
- Quality care ranking: 10
- Access ranking: 4
- Efficiency ranking: 2
- Equity ranking: 1
- Healthy Lives ranking: 2
With relatively low per capita health care costs compared to other developed countries, Sweden ranked highest in equity. This means that people with below-average incomes and those with above-average incomes rated health care services similarly. Both income groups had similar access to health care and rated their care around the same.
Sweden also scored high in efficiency and healthy lives measures, which means that overall, the country manages their time and health care resources effectively, and they scored well in terms of preventable mortality (deaths that could have been prevented by health care) and life expectancy rates.
Sweden scored lower on the quality care measures, which indicate how safe and effective their preventative and chronic care systems are. Quality also takes into account other factors, like how patient-centered health care is.
- Overall ranking: 2
- Health expenditures per capita: $5,643
- Quality care ranking: 3
- Access ranking: 2
- Efficiency ranking: 6
- Equity ranking: 2
- Healthy Lives ranking: 3
Switzerland scored high in equity, healthy lives, quality, and access. The country’s high access score means that the country’s citizens receive relatively timely health care. It also means that a lower percentage of people forgo medical treatment because of costs, and a lower percentage of people skip out on medical tests, skip prescriptions, or have claims denied by insurance.
Switzerland scored pretty well in most measures, but it scored the lowest in efficiency. It had the fourth highest total expenditures on health as a percent of GDP (11%).
- Overall ranking: 1
- Health expenditures per capita: $3,405
- Quality care ranking: 1
- Access ranking: 1
- Efficiency ranking: 1
- Equity ranking: 2
- Healthy Lives ranking: 10
The UK ranked number one overall compared to all of the other countries in the Commonwealth Fund report. It also ranked superior in cost, quality, access, and efficiency. In terms of computerized reminders for follow-up care, the UK scored a 95%. It also scored a 95% for providing diabetes patients with all four recommended services in chronic care. It scored exceptionally high in other quality measures like safety and coordinated care, as well.
Healthy lives was the one area where the UK did not shine, ranking ninth in terms of preventable mortality and healthy life expectancy, and eighth in infant mortality.
Some of the worst developed countries for health care
- Overall ranking: 9
- Health expenditures per capita: $4,118
- Quality care ranking: 8
- Access ranking: 11
- Efficiency ranking: 8
- Equity ranking: 7
- Healthy Lives ranking: 1
Although France had the lowest preventable mortality rate, a high life expectancy, and a low infant mortality rate, the country ranked ninth overall when compared to the other countries in the report. France ranked dead last in terms of access, scoring low in both timeliness and cost of care measures.
- Overall ranking: 10
- Health expenditures per capita: $4,522
- Quality care ranking: 9
- Access ranking: 8
- Efficiency ranking: 10
- Equity ranking: 9
- Healthy Lives ranking: 8
Perhaps the most surprising inclusion on the worst countries portion of this list, Canada ranked tenth overall relative to the other countries in the Commonwealth Fund report. The country ranked the lowest in efficiency, with the largest amount of patients visiting emergency departments for conditions that could have been treated by regular doctors, a high percentage of re-hospitalizations after treatment, and some inefficiencies with medical records that did not reach the doctor’s office in a timely manner. Canada scores a bit better on other measures, like access and effective care.
- Overall ranking: 11
- Health expenditures per capita: $8,508
- Quality care ranking: 5
- Access ranking: 4
- Efficiency ranking: 11
- Equity ranking: 11
- Healthy Lives ranking: 11
Coming in at number 11 on this list — dead last — is the United States. It had the most expensive health care costs per capita, at over $8,500, and the most expensive health care expenditures overall, at 17.7 % of GDP. It scored worse than every other country in the report.
In regards to equity, there appears to be a marked difference in care between those with lower than average incomes and those with higher than average incomes. The U.S. had the highest amount of infant moralities and it ranked second to last in preventable deaths, compared to other countries in the Commonwealth Fund report.
Although it scored low in many areas, the U.S. did fare a bit better in quality and access measures. In regards to access, the U.S. scored low on cost of care measures, but it scored better on timeliness of care.