A recent report by The Commonwealth Fund has compared the performance of health systems across 10 countries, revealing key insights into healthcare quality and challenges. The report, titled “Mirror, Mirror 2024,” is the eighth of its kind and aims to highlight lessons that could help improve the healthcare system in the United States.
Overview of the Study
The study examined the health systems of Australia, Canada, France, Germany, New Zealand, Sweden, Switzerland, the Netherlands, the United Kingdom, and the United States. It assessed 70 unique measures across five main categories: care process, access to care, equity, health outcomes, and administrative efficiency. Data were collected through surveys from patients and primary care physicians between 2021 and 2023, combined with standardized data from international organizations like the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD).
Key Findings
Australia, the Netherlands, and the United Kingdom ranked as the top performers, while the United States placed last. Despite the overall rankings, every country had areas of both strength and weakness. For example, Australia struggled with access to care despite its high ranking, while the U.S. performed well in the care process but lagged in other areas.
The report noted that while healthcare spending wasn’t used as a performance metric, the U.S. spent 16.5% of its gross domestic product (GDP) on healthcare in 2023, significantly higher than other nations. By contrast, Australia and the Netherlands had the lowest spending relative to their GDP.
Performance by Domain
Access to Care: The Netherlands, the U.K., and Germany excelled in this domain, particularly in affordability and minimal out-of-pocket expenses. However, Australia performed poorly in terms of access.
Care Process: New Zealand ranked highest, followed by the U.S. and the Netherlands. The U.S.’s strong performance in this area was due to its focus on preventive services, such as mammograms and flu vaccinations.
Administrative Efficiency: The U.K. and Australia led in this category, while the U.S. and Switzerland ranked lowest due to issues with medical claims, insurance, and paperwork.
Equity: Australia and Germany showed the smallest income-related disparities in healthcare access. In contrast, New Zealand and the U.S. had the largest gaps.
Health Outcomes: Australia, Switzerland, and New Zealand performed best in this domain, with the U.S. ranking last. The top countries’ success was partly due to their effective management of the COVID-19 pandemic, while the U.S. struggled with high preventable death rates due to issues like substance abuse and gun violence.
Challenges for the U.S.
The U.S.’s strong performance in the care process has not translated into better health outcomes, as it continues to face financial barriers to care. Despite the Affordable Care Act, 26 million Americans remain uninsured, while other countries in the study offer universal coverage.
Two key areas need improvement for the U.S. healthcare system to become more functional:
Strengthening Primary Care: Increased investment in training and compensating primary care providers is essential.
Addressing Healthcare Consolidation: The unchecked consolidation of healthcare resources is driving up prices, making insurance less affordable.
Additionally, the U.S. must address administrative inefficiencies caused by complex insurance plans and billing practices. Simplifying insurance plans would reduce the burden on patients and providers. The country also needs policies targeting gun violence, substance use, and health disparities affecting marginalized communities.
Conclusion
The “Mirror, Mirror 2024” report highlights significant differences in healthcare performance across the 10 countries, showing opportunities for cross-national learning. While the U.S. continues to underperform, the other nine countries have found ways to meet their residents’ basic healthcare needs, including providing universal coverage. The report emphasizes that improving healthcare in the U.S. will require not only better healthcare services but also addressing social issues such as poverty, substance abuse, and gun violence to drive better health outcomes.
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