11 Countries Compared: How Does the U.S. Healthcare System Measure Up?

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By J. E. Hinners, MD MPH

Country Healthcare Ranking, Commonwealth Fund, jpg
Country Healthcare Ranking, Commonwealth Fund’s “Mirror, Mirror on the Wall, 2014 Update”

If the U.S. has the most expensive healthcare in the world, how does its healthcare system measure up internationally?

The Commonwealth Fund regularly puts out an international healthcare review (“Mirror, Mirror on the Wall”) that includes data from patient and physician surveys; healthcare outcome data is also included from the World Health Organization, the Commonwealth Fund, and the Organization for Economic Cooperation and Development.

The review examines 5 healthcare categories:

  • Quality Care (effectiveness, safety, coordination, patient centeredness)
  • Access (cost, timeliness)
  • Efficiency
  • Equity
  • Health Lives

11 countries were compared in the 2014 review, and the overall ranking was as follows, with “1” being the best and “11” being the worst:

1) UK

2) Switzerland

3) Sweden

4) Australia

5) Germany & Netherlands (tied)

7) New Zealand & Norway (tied)

9) France

10) Canada

11) U.S.

While the U.S. has the most expensive healthcare in the world, its healthcare system ranked last out of the 11 countries measured.


Healthcare quality measurements included effective care, safe care, coordinated care, and patient-centered care. UK ranked #1, followed by Australia; Norway ranked last, and the U.S. ranked #5.


Healthcare access was assessed by cost and timeliness. UK ranked #1, and Germany ranked #2; France ranked last, and the U.S. ranked #9.


Healthcare efficiency was evaluated by avoidable emergency room use, duplicative medical testing, administrative hassles, and national and administrative health costs. UK ranked #1, followed by Sweden at #2; the U.S. ranked last.


Healthcare equity studied how equally healthcare was received between those with low versus high incomes. Sweden ranked #1, and #2 was tied between the UK and Switzerland; the U.S. ranked last.


“Healthy lives” measured several indicators of health: infant mortality, mortality due to healthcare, and healthy life expectancy at age 60. France ranked #1, followed by Sweden; the U.S. ranked last.

While patient and physician assessments may be somewhat affected by individual and cultural differences in expectations, the U.S. could still clearly use significant systemic improvement in healthcare–and on a number of fronts. Those in the UK, Switzerland, and Sweden, however, can enjoy some of the best healthcare in the world!

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