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Why the U.S. Healthcare System Ranks Worst in the Developed World

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The U.S.’s expenditures are higher than any other developed nation’s when it comes to healthcare. When you consider how poorly the U.S. measures up against countries spending less money, it might make you wonder where all that money does end up.

So, what happened?

Even though the U.S. is spending money on healthcare, the healthcare system remains unstable. The key findings from the Commonwealth Fund’s report shed some light on the weakest areas of the U.S. healthcare system.

 Quality of Care: including effectiveness, safety, coordination and patient-centeredness.

  • Access to Care: including problems related to cost as well as timeliness.
  • Efficiency
  • Equity
  • Healthy Lives
  • Overall Healthcare Expenditures/Capital


When it comes to providing quality healthcare, the U.S. is making steady progress of integrated patient-centered care initiatives into hospitals and practices. The problem is safety: since safety and coordinated care scores are low, it brought down the U.S. quality scores overall. The big question on the table now is, with the advent of electronic health records (EHRs) will the issues with coordination resolve- or just get worse?


Up front, the major difference between the U.S. and other healthcare systems is the lack of universal coverage. That being said, the U.S. can’t compete in the area of access because so many Americans are simply uninsured. Major barriers to access in the U.S., of course, are often related to cost. While the U.S. is on the forefront of technology for specialized services, a lack of universal coverage prevents utilization of such services.


The short answer is that the U.S. sees high utilization of emergency services for conditions that could be, and routinely are in other countries, managed by the patient and their primary physician. That being said, high utilization drives up costs, and issues with access to routine care may be contributing to uninsured Americans treating the emergency room like a primary care office.


As previously mentioned, not everyone in the U.S. has health insurance coverage so, quite simply, the U.S. ranked dead last in terms of equity. The socioeconomic disparity between the insured and uninsured is stark, and more importantly, unsettling. A third or more lower-income Americans reported that in the last year, they did not seek healthcare they needed when they were injured or sick because they couldn’t afford treatment. 

Healthy Lives

Unsurprisingly, again, the U.S. ranks dead last in measures of health – mortality, infant mortality and healthy life expectancy. The U.S. ranked highly in deaths from conditions amenable to medical care compared to other countries.

So, if the U.S. spends more money on healthcare than any other country, why are they doing so poorly in comparison? Why are so many Americans without insurance, and why are we a sicker nation than countries who spend less money?

What are your thoughts? Why do you think the U.S. healthcare system is weak compared to other countries where less money is spent annually on healthcare?

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