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U.S. Trails Other High-Income Countries on Measures of Health Care Affordability, Administrative Efficiency, Equity, and Outcomes

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A report from The Commonwealth Fund found the United States trailing far behind other high-income countries on measures of health care affordability, administrative efficiency, equity, and outcomes. The report – Mirror, Mirror 2021: Reflecting Poorly – compared the performance of health care systems of 11 high-income countries. For the comparison, researchers analyzed 71 performance measures across five domains — access to care, care process, administrative efficiency, equity, and health care outcomes — drawn from Commonwealth Fund international surveys conducted in each country and administrative data from the Organisation for Economic Co-operation and Development and the World Health Organization. Top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.

The report concluded four features distinguish top performing countries from the United States:

  1. they provide for universal coverage and remove cost barriers;
  2. they invest in primary care systems to ensure that high-value services are equitably available in all communities to all people;
  3. they reduce administrative burdens that divert time, efforts, and spending from health improvement efforts; and
  4. they invest in social services, especially for children and working-age adults.

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