Report: US outspends high-income nations on health care yet has worst health outcomes

Despite spending nearly twice as much on health care than other wealthy countries, Americans have worse overall health.

The United States continues to spend more on health care than any other wealthy country, but Americans’ health has little to show for it, according to a new report from The Commonwealth Fund. For the analysis, U.S. Health Care from a Global Perspective, researchers used data from the Organisation for Economic Co-operation and Development (OECD) and the Commonwealth Fund International Health Policy Survey 2022 to compare U.S. health care spending and health outcomes with 12 other high-income countries, including Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom.

Of all wealthy nations examined in the report, the U.S. spent nearly double the average health care spending of the other countries, spending 17.8 percent of gross domestic product on health in 2021 compared to the OECD average 9.6 percent. However, the report underscored a disconnect between health care spending in the U.S. and Americans’ health outcomes. Despite the U.S. continuing to spend more on health care, researchers found a range of worse health outcomes among Americans, such as a lower life expectancy, a higher rate of preventable deaths, a higher rate of infant mortality and maternal deaths, obesity, and chronic health conditions.

Here's a deeper look at key findings included in the report:

• Of all the countries in the analysis, the U.S. is the only country that does not guarantee health coverage.
• The American life expectancy in 2020 (77 years) is three years lower than the OECD average, and racial and ethnic disparities have caused even worse outcomes for communities of color. Black Americans’ life expectancy is four years lower and American Indians or Alaska Natives’ life expectancy seven years lower than white Americans.
• The rate of preventable deaths in the U.S. per 100,000 population are higher (336) than the OECD average (225).
• The U.S. has the highest rate of infant and maternal deaths. The infant mortality rate in the U.S. in 2020 was 5.4 deaths per 1,000 live births compared to the lowest rate of 1.6 deaths per 1,000 births in Norway. The U.S. also had nearly 24 maternal deaths for every 100,000 live births, which is more than three times the rate than most of the other high-income countries included in the report.
• The U.S. has the third highest suicide rate (14.1 per 100,000 population).
• Deaths from assault were significantly higher in the U.S. (7.4 deaths per 100,000 people) compared to the OECD average (2.7 deaths per 100,000 people).
• The U.S. obesity rate (42.8) is nearly double the OECD average (25.0).
• Americans are most likely to have multiple chronic health conditions compared to the other high-income countries. The U.S. rate of chronic conditions (30.4 percent) was nearly twice that of France’s (17 percent).

The report authors included three steps the U.S. can take to improve health outcomes across the country:

1. Ensure equitable access to affordable health care.
2. Contain costs, including health care and administrative costs, to reduce overall health spending.
3. Improve the prevention and management of chronic health conditions through increased investment and capacity of providers.

“The findings of our international comparison demonstrate the importance of a health care system that supports chronic disease prevention and management, the early diagnosis and treatment of medical problems, affordable access to health care coverage, and cost containment—among the key functions of a high-performing system,” wrote researchers. “Other countries have found ways to do these things well; the U.S. can as well.”