An updated analysis comparing healthcare systems across 20 countries finds once again that the US system is an outstandingly poor performer, summarized as being a “persistent failure” for its high costs, poor health outcomes, and premature deaths.
“Americans pay more for health care, get less in return, and remain far more exposed to illness, debt, and insecurity than their peers,” the report concludes.
The report comes from The Commonwealth Fund, a private foundation focused on healthcare system performance, which periodically conducts such comparative analyses. The new report is based on 2024 data and compares the US to 19 countries, including many in Europe, as well as Australia, Canada, Chile, Israel, Japan, Korea, Mexico, New Zealand, Turkey, and the United Kingdom.
As has long been the case, the US spends far more on healthcare than any other of the 19 countries. In 2024, the US spent 18 percent of its gross domestic product on healthcare, nearly twice the average of all the countries, which was 9.3 percent. The second-highest spender after the US was Germany, with 12.3 percent.
Drilling down, the US spends far more on care per person than other countries and spends more on prescription medications. Americans are, by far, the most likely to skip medications, treatments, tests, and consultations due to costs.
US life expectancy at birth ranked third lowest, at 79 years, while the average was 81.2 years. Only Turkey and Mexico had lower life expectancies, which were 77.3 and 75.5, respectively. The highest life expectancies were in Spain (84 years), Japan (84.1 years), and Switzerland (84.3 years).
Uniquely bad
The US had the second-highest avoidable mortality rate—deaths caused by conditions that can be prevented with primary care or treated with timely medical intervention. Only Mexico had higher avoidable mortality. Similarly, the US also had the second-highest rating on years of potential life lost, a measure used to estimate premature death. Again, only Mexico had a higher rating.
The report highlighted critical weaknesses in the US healthcare system, including having the fewest primary care providers of all countries in the analysis. The US has 0.3 primary care providers per 1,000 people, while the overall average is 1.1 providers per 1,000, and the highest-ranking countries, Australia and the Netherlands, have 1.8. The US produces new physicians at one of the lowest rates and also has among the lowest hospital bed capacity levels.
The poor outcomes from America’s failing health system are not evenly distributed, of course. While the US has a higher maternal death rate than any other country in the study, at nearly 19 deaths per 100,000 live births in 2023, maternal mortality for Black women in the US is 50 deaths per 100,000. The average of all the countries was 9.5, with 11 countries having maternal death rates at less than 5 per 100,000 live births. And, while the US had the third-highest suicide rate of the countries assessed, suicide rates in the rural US are significantly higher and rising. Rural Americans are less likely to have access to doctors and mental health services, the study notes.
The report notes that the US uniquely lacks universal health coverage among high-income peer countries. Mexico was the only other country in the study without universal coverage but has plans in place for universal care starting in 2027.
Overall, other countries have already come up with strategies to address the failings seen in the US health system, including reducing healthcare costs, strengthening primary care, and addressing inequities.
“What’s remarkable is not that alternatives exist, but that the United States has failed to pursue them,” the study concludes.
