US spends most on health care but has worst health outcomes among high-income countries, new report finds

By Jacqueline Howard, CNN

The United States spends more on health care than any other high-income country but still has the lowest life expectancy at birth and the highest rate of people with multiple chronic diseases, according to a new report from The Commonwealth Fund, an independent research group.

The report, released Tuesday, also says that compared with peer nations, the US has the highest rates of deaths from avoidable or treatable causes and the highest maternal and infant death rates.

“Americans are living shorter, less healthy lives because our health system is not working as well as it could be,” the report’s lead author, Munira Gunja, senior researcher for The Commonwealth Fund’s International Program in Health Policy and Practice Innovation, said in a news release. “To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population.”

People in the US see doctors less often than those in most other countries, which is probably related to the US having a below-average number of practicing physicians, according to the report, and the US is the only country among those studied that doesn’t have universal health coverage. In 2021 alone, 8.6% of the US population was uninsured.

“Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services,” researchers at the Commonwealth Fund, headquartered in New York, wrote in the report. “Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.”

An outlier on spending and outcomes

The researchers analyzed health statistics from international sources, including the Organisation for Economic Cooperation and Development, or OECD, which tracks and reports on data from health systems across 38 high-income countries. The data was extracted in December.

The researchers examined how the United States measured against Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland and the United Kingdom. They also compared the US with the OECD average for 38 high-income countries.

The data showed that in 2021 alone, the US spent nearly twice as much as the average OECD country on health care — and health spending in the US was three to four times higher than in South Korea, New Zealand and Japan.

Globally, health care spending has been increasing since the 1980s, according to the report, driven mostly by advancements in medical technologies, the rising costs of medical care and a higher demand for services.

The US has the highest rate of people with multiple chronic health conditions, the data showed, and the highest obesity rate among the countries studied.

Life expectancy at birth in the US in 2020 was 77 years — three years less than the OECD average — and early data suggests that US life expectancy dropped even further in 2021. Since the start of the Covid-19 pandemic, more people died from coronavirus infections in the US than in any other high-income country, according to the report.

Deaths caused by assaults also appeared to be highest in the US compared with all peer countries. The researchers found that deaths from physical assault, which includes gun violence, occurred at a rate of 7.4 deaths per 100,000 people in the US in 2020, significantly higher than the OECD average of 2.7 and at least seven times higher than most other high-income countries in the report.

Where the US appeared to do well was in cancer prevention and treating cancers early. Along with Sweden, it had the highest number of breast cancer screenings among women ages 50 to 69, and the US exceeded the OECD average when it came to screening rates for colorectal cancer.

A separate paper published in mid-January said that the US cancer death rate has fallen 33% since 1991, which corresponds to an estimated 3.8 million deaths averted.

Overall, the new Commonwealth Fund report “continues to demonstrate the importance of international comparisons,” Reginald D. Williams II, who leads The Commonwealth Fund’s International Program, said in the news release. “It offers an opportunity for the U.S. to learn from other countries and build a better health care system that delivers affordable, high-quality health care for everyone.”

‘We’re not getting the best value for our health care dollar’

Much of the data in the new report shows trends that have been seen before.

“It validates the fact that we continue to spend more than anybody else and get the worst health outcomes. So we’re not getting the best value for our health care dollar,” said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the new report.

“The big takeaway for me is that Covid did not become the great equalizer [among nations]. It did not help our case at all,” Benjamin said. “If anything, it exposed the existing holes in our health care system.”

To help fix the holes in the US health care system, Benjamin referenced three steps the nation can take.

“We’re still the only nation that does not have universal health care or access for all of our citizens,” Benjamin said.

Second, “we don’t do as much primary care prevention as the other nations, and we still have a public health system, which is fractured,” he said. “The third thing is, we under-invest compared to other industrialized nations in societal things. They spend their money on providing upfront support for their citizens. We spend our money on sick care.”

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CNN’s Deidre McPhillips contributed to this report.