We Don’t Even Come Close to Having the World’s Best Health Care Systems

A doctor and patient discuss an injury.

A doctor and patient discuss an injury. | Joe Raedle/Getty Images

We like to think America is No. 1. While it may be true on the basketball court, in military spending, and in our hearts, it’s a different story when it comes to health care. Our health care system is, for lack of a better word, a mess. Although we have a system that incentivizes everyone to purchase health insurance, millions of people still go without. We also spend an incredible amount of money, all for worse outcomes than many of our peer nations.

The worst part? The plans being floated to improve our system might end up making it worse. So, just to get to the point across, we have a system in which we pay more for less, and it doesn’t cover everyone.

The American system differs from almost every other country in several ways. But the most obvious of all is we don’t have a government-run health care system — or a single-payer system, as some call it. Under these systems, everybody is covered, and taxes fund the program. We have variations of this for segments of our population, such as Medicare and Medicaid. But for the rest of us? It’s easy to get left out.

This is one of the reasons our system ranks so poorly among our peers. A new comparison all but proves it. The comparison, released by The Commonwealth Fund, pits the U.S. against 10 other countries and ranked them, worst to first. While there are many positive elements to our system, reading down the list shows there is a lot to be desired.

We’ll start with the country that came in dead last per The Commonwealth Fund’s list: the good old U.S. of A.

11. United States

We could write volumes about the troubles with the American system. But we’ve already covered the basics — namely that it’s expensive, it excludes a large number of people, and the outcomes often lag behind when compared to other countries. The report looked at a few key areas when developing its rankings. And according to the report, “The U.S. ranked last on performance overall and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes.”

Clearly, there’s a lot of work to do. One country we could look to emulate? France.

10. France

paris houseboat with view of eiffel tower

The French system functions relatively well. | Airbnb

Americans don’t like to be compared to or try to emulate the French. But when it comes to health care we might want to reconsider. Sure, France did rank near the bottom on this particular list, but unlike the U.S. there are some outlying areas where the country’s system really shines. For France, this area was health care outcomes, which means though the country’s system can be bumpy, it performs its function relatively well.

How about America’s closest neighbor?

9. Canada

Canada's fans celebrate

Canada’s strengths are in care process and administration. | Alexander Nemenov/AFP/Getty Images

Like France, Canada’s system didn’t rank high when compared to many peer nations. But also like France, there were some areas where the Canadian system stood out. The report says Canada’s major strengths are care process and administrative efficiency, which should make any American jealous. Things are far from perfect, however, as Canada’s overall performance falls below the average for the 11-country group.

Next, we head to Europe to see how the German system stood up to The Commonwealth Fund’s scrutiny.

8. Germany

View of the Berlin skyline

Germany combines public and private insurance. | John MacDougall/AFP/Getty Images

Few things are as mindnumbingly dull and yet vitally important as health care policy. Dipping one toe into the pool will all but prove it. And the German system is one of the most difficult to get your head around. For example, it combines private and public insurance to make sure everyone is covered. This allows it to beat out the U.S. Germany also scored particularly well in access, which means its dual insurance system is working.

North of Germany, things get even better.

7. Sweden

Panorama of Stockholm, Sweden

Sweden actually ranked last in care process. | iStock.com/scanrail

The Scandinavian countries have a reputation, at least in the U.S., for having robust and popular social programs. Health care is one of them. And according to the report, Sweden’s system performs quite well. The Swedish system ranked well in most categories, with the big exception being care process. In fact, in that category, it ranked dead last — and way behind the U.S.

The Swiss, on the other hand, are renowned for their chocolate and army knives. But how about their health care?

6. Switzerland


The Swiss system shines in equity. | Mike Hewitt/Getty Images

As it turns out, the Swiss do health care as well as they do bank accounts. That is, pretty darn well. Like many other European countries, the Swiss system performs at a high level — at least when compared to the U.S. For the Swiss, its system really shines in two areas: equity and health care outcomes. Across the board, with those exceptions Switzerland’s system scored at an average level, which explains its final ranking in the middle of the pack.

Now, we go to the other side of the globe.

5. New Zealand

A small trip in Milford Sound, located in New Zealand, South Island

New Zealand performs well in care process and efficiency. | iStock.com/Eduardo_Zapata

No comparison list is complete without including some of the most far-flung countries, including Australia (which we’ll get to) and its neighbor, New Zealand. The Kiwis evidently have a robust and effective system, at least according to the report. Though there is room for improvement. “New Zealand performs well on measures of Care Process and Administrative Efficiency, but below the 11-country average on other indicators,” the report said.

Now, in fourth place, we have another Scandinavian nation.

4. Norway

people hiking Besseggen ridge overlooking the lakes in Norway

The Norwegian system ranks high in health outcomes. | Tina Stafren/Visit Norway via Facebook

Norway beats out its neighbor Sweden handily in terms of overall health care. But like Sweden, Norway suffered low marks in one key area: care process. Still, it managed to land within the top four out of the 11 representative countries. To do so, the Norwegian system ranked near the top in most other categories, particularly in health outcomes and administrative efficiency.

Next up, we have the Dutch.

3. Netherlands

A Netherlands fan waves a flag

The Netherlands’ health care system performs well in care process. | Stuart Franklin/Getty Images

Netherlands is usually associated with marijuana cafes and Amsterdam’s Red Light District. But it should also be synonymous with kick-ass health care. According to The Commonwealth Fund, Netherlands’ health care system is one of the best in the world. “The Netherlands is among the top performers on Care Process, Access, and Equity; its performance on Administrative Efficiency stands out as an area for improvement,” the report said.

For second place, we have to go down under.

2. Australia

A kangaroo hops through the outback

Australia ranks well in efficiency and outcomes. | Ian Waldie/Getty Images

It’s a good thing Australia’s health care system is such a high performer, given the amount of dangerous plants and animals that call the continent home. “Australia ranks highest on Administrative Efficiency and Health Care Outcomes, is among the top-ranked countries on Care Process and Access, but ranks low on Equity,” the report said.

And there was only one other country that beat it out. Can you guess what it is?

1. United Kingdom


The U.K. performed better than all other countries The Commonwealth Fund ranked. | iStock.com

You can’t beat the Brits — at least not in terms of health care, according to The Commonwealth Fund. The United Kingdom ranks first overall in the report, edging out Australia. According to the report, “In general, the U.K. achieves superior performance compared to other countries in all areas except Health Care Outcomes.” Perhaps it’s all the tea.

See the complete report from The Commonwealth Fund.

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