Americans see doctors less often than people in most other countries and have one of the lowest rates of practicing doctors and hospitals. By continuing to browse our website, you accept our use of the cookie for statistical and personalization purposes. Learn more Mirror, Mirror 2024 is your chance to explore the impact of political decisions on health and well-being in 10 countries, including reports from the United States Fund of September 19, 2024 that compare performance in Home Care in Newtown Square PA and 10 other countries. While each country's health system is unique, evolution over decades, sometimes centuries, together with changes in political culture, history and resources, comparisons can provide valuable information to inform political thinking. Perhaps, above all, they can demonstrate the profound impact of national political decisions on a country's health and well-being. Despite their general classification, all countries have strengths and weaknesses: they rank highly in some dimensions and lower in others.
No country is in the top or bottom in all areas of performance. Even Australia, the highest-ranked country, performs worse, for example, when it comes to access to care measures and the care process. And even the U.S. UU.
However, taken together, the nine nations we examined are more similar than they are different in terms of their highest and lowest performance in various domains. However, there is an obvious exception: the United States (see “How we conducted this study”). Record of health outcomes, particularly in relation to the extent to which the U.S. The ability to keep people healthy is a fundamental indicator of a nation's ability to achieve equitable growth.
To meet this fundamental obligation, the U.S. In the U.S. we also rely on published and unpublished data from transnational organizations, such as the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD) and Our World in Data, as well as on national data records and research literature. The United States is in last place overall (annexes 1 and. The three best performing countries in 2024 are Australia, the Netherlands and the United Kingdom.
The two countries with the highest overall rankings, Australia and the Netherlands, also have the lowest healthcare expenditure as a percentage of GDP (chart). The other countries are closely grouped together, with the exception of the United States. USA, USA UU. Access to care focuses on the affordability and availability of health services at the population level. The Netherlands, the United Kingdom and Germany perform the best in terms of overall access, and both the Netherlands and Germany rank first or close to them in terms of the two components of affordability and availability (graphic).
The United Kingdom, the Netherlands, the United Kingdom, the United KingdomIn these countries, universal coverage ensures that co-payments for health services, if any, are small, ensuring both access and affordability. In the Netherlands, visits to primary care providers, maternity care and children's health care are fully covered; other health care services are covered once patients pay their annual deductible3. In the United Kingdom, K. In the Netherlands, general practitioners (GPs) must provide 50 hours of after-work care per year, for which they receive separate compensation (as is also the case with home visits). Most GPs are also part of networks that provide care during the evenings or on the weekends.
In Germany, doctors are required to offer care outside working hours, and regulations vary from region to region 7.Australia, the country with the best overall performance in this report, performed quite poorly when it came to access to care. Roughly half of Australian patients who do not choose to purchase voluntary health insurance may have to wait longer to receive services. 8 Affordability is also a notable problem, although new billing incentives have led to improvements in recent years. 9 In the U.S.
With a fragmented insurance system, nearly the majority of Americans receive their health coverage through their employer, 10 While Medicaid expansions and subsidized private coverage under the ACA have helped fill the gap, 26 million Americans remain uninsured, leaving them fully exposed to the system's cost controllers. The cost has also driven the growth of deductibles for private plans, leaving approximately a quarter of the working-age population with insufficient insurance. In other words, extensive cost-sharing requirements mean that many patients are unable to visit a doctor when medical problems arise, causing them to skip medical tests, treatments or follow-up visits, and avoid filling prescriptions or skipping doses of their medications. Regarding the availability of care, American patients are more likely than their peers in most other countries to say that they don't have a doctor or a primary care facility and that they have few options for treatment outside regular office hours.
The scarcity of primary care services adds to these availability problems. The care process analyzes whether the care being provided includes characteristics and attributes that most experts around the world consider essential for high-quality care. The elements of this area are prevention, safety, coordination, patient participation and sensitivity to patient preferences. It is among the best in terms of the care process, ranking second (graphic). New Zealand is in first place, followed closely by Canada and the Netherlands. Performance in the area of care processes is the result of the successful provision of preventive services, such as mammograms and flu shots, and the emphasis placed on patient safety.
With regard to preventive care, the history of the U.S. Department of State could reflect the strong performance-based payment policies implemented by Medicare and other payers to reward the provision of these services.11 Administrative efficiency focuses on measures of the challenges faced by doctors in dealing with insurance issues or medical claims; the requirements for providers to report clinical or quality data to government agencies; and the time that patients spend resolving disputes over medical bills and completing paperwork. Australia and the United Kingdom are practically tied for the best results in these measures (Graphic. Excellence in administrative efficiency by minimizing payment and billing burdens. In Australia, electronic claims processing ensures instant payments from public and private payers.
In the United Kingdom, on the other hand, they are directly compensated by the National Health Service based on monthly data collected from patients' electronic medical records. It performed poorly on most of our administrative efficiency measures. They are forced to deal with medical billing issues and, in both countries, patients are comparatively more likely to seek treatment in emergency services for conditions that can be treated in outpatient settings, such as a primary care physician's office. 15 In the complex U.S. system of public and private payers, which includes thousands of health plans, each with their own cost-sharing requirements and coverage limitations, doctors and other healthcare providers spend an enormous amount of time and effort billing insurers.
Denial of services by insurance companies is also common, requiring onerous appeals from providers and patients. 16 The fragmentation of the provision of health services in Switzerland's many cantons and municipalities may also be hampering efficiency for both providers and patients. 17 Our equity domain reflects how people with below and above average incomes differ in their access to healthcare and their care experience. Australia and Germany rank first in terms of equity, meaning that they are the countries with the smallest differences in access to health care and care experiences among residents with lower than average and above average incomes (graph). They rank last in equity, as they have the largest income-related differences in terms of access problems related to reported costs and cases of unfair treatment or a sense that health professionals do not take health problems seriously because of their racial or ethnic origin.
We have included several new measures of equity in this edition of Mirror, Mirror. One examined the percentage of patients who reported that they had been treated unfairly or that they had not been taken seriously when receiving medical care. The other looked at self-reported health status as a substitute measure for health outcomes. Two other new measures (which were not analyzed based on income due to sample size limitations) were based on questions from a survey asking doctors if they thought that health systems treated patients unfairly because of their racial or ethnic origin, and if their patients had ever told them that they were being treated unfairly or that they were not being taken seriously when receiving medical care because of their racial or ethnic origin.
Australia offers free care in all public hospitals, and the universal national Medicare system provides all Australians with full or partial coverage of the cost of GP and specialist visits and diagnostic tests, with additional subsidies available for private hospital care.18 Meanwhile, the country's Pharmaceutical Benefit Plan regulates and subsidizes drug costs to keep them affordable, 19 The wide variation in performance between the 10 countries included in this edition from Mirror, Mirror suggests extensive international learning opportunities. For example, nations that want to improve the equity, administrative efficiency and health outcomes of their health systems could turn to Australia for information. Those who wish to address access issues could turn to the Netherlands. With regard to care outcomes, Australia, Switzerland and New Zealand deserve a study. And to improve performance in the care process, countries could examine the performance of New Zealand and the United States, which would otherwise be lagging behind, in relation to the care process is particularly interesting.
One possible explanation lies in the vigorous pay-for-performance efforts, or value-based care, that U.S. public and private payers have undertaken in recent years. While criticism of these initiatives is common in the U.S. Although the outcomes of care processes are comparatively high, the health outcomes in the U.S.
The U.S. is the worst of the 10 countries included in this analysis, showing that the care process may not be the main driver of health outcomes. Additional research should examine the factors that lead to the United States being atypically strong. However, despite its track record in the care process, the United States is still lagging behind other countries in almost every other aspect.
Figure 4, which compares the overall performance of the 10 countries in terms of health care with their expenditures on health care, shows in a spectacular way the enduring situation in the United States. The dilemma of spending large quantities on generally deficient products results in the very definition of a low-value health system. The problems that underlie this failure are well documented. Financial Barriers to Health Care in the U.S.
While the successful implementation of the Affordable Care Act (ACA) has resulted in historically low uninsured rates, 26 million Americans, between 7 and 8 percent, still lack coverage. 26 All of the countries we used in the comparison in our study have universal coverage. The quality of coverage is also worse in the U.S. Among insured Americans, nearly a quarter are underinsured and face high deductibles and co-payments that reduce the effectiveness of their insurance in ensuring access to needed care.27 None of the other countries included in our analysis place their covered residents in such financial danger.
The health service delivery system also suffers from multiple deficits. The first is the lack of investment in primary care. The years of neglect and lack of compensation in primary care have caused, as was to be expected, a shortage across the country of doctors who play a vital role in treating chronic diseases and reducing the need for expensive and sometimes unnecessary emergency, specialized and hospital services. The acquisition of primary care offices by health systems and private equity investors is further disrupting an already fragile primary care capacity, with uncertain short- and long-term consequences. The fragmented nature of the U.S.
healthcare system makes it difficult, even for many well-insured patients, to access convenient and effective care. A second area of improvement is administrative inefficiency. With thousands of health insurance products, a wide variety of benefits, and complex utilization management policies, healthcare in the U.S. it can be a nightmare maze for both patients and care providers.
Recent trends in ownership and control have been added to the dysfunction of the delivery system services. Massive consolidation through hospital mergers or hospital acquisitions of doctors' offices, among other examples, has allowed large providers to negotiate higher prices with private insurers, a key factor in the overall increase in care costs in the U.S. U.S. 28. No other country relies to this extent on the unregulated private market to allocate vital health care resources.
Beyond funding and service delivery, social policies and influences outside health care greatly affect the health of Americans and place additional pressure on the health care system. Gun violence and drug overdoses, for example, take an enormous toll in terms of morbidity and mortality, especially among young men. For centuries, racial discrimination has greatly harmed economic prospects and the health of people in EE. In addition, the general lack of an adequate social safety net to mitigate the threats of hunger, homelessness, and poverty also greatly affects the health of Americans.
During COVID, the lack of funding and the decentralization of the national public health system, which falls to the majority of public health authorities in state and local governments, proved to be a huge obstacle to an effective national response. 29 A second reform of the service delivery system would address the uncontrolled consolidation of health care resources in local markets, helping to increase prices and making insurance less affordable for Americans, 31 In this regard, The proliferation of investor-owned entities that buy and sell primary care offices such as commodity trading deserves close scrutiny because of its long-term impact on the cost and quality of care 32. Although the U.S. health system has many unique characteristics, there are lessons to be learned from countries that manage to ensure access to affordable, quality care. That's why the Commonwealth Fund studies health systems around the world, seeks innovations in policies and practices, and compares the performance of health systems in the United States.
Mirror, Mirror is unique because it relies heavily on surveys designed to capture the perspectives of patients and professionals, the people who receive healthcare in each country. Nearly three-quarters of the measures in the report are derived from patient or physician reports on the performance of the health system. In addition to the survey elements, standardized data were obtained from recent reports from the Organization for Economic Cooperation and Development (OECD), Our World in Data, the World Health Organization (WHO), from mortality data by country, available to the public and non-public, from peer-reviewed publications and from the Agency for Research and Quality in Health Care of the States United. Some are specific to our analysis, while others are inherent to any effort to evaluate the overall performance of the health system.
No international comparative report can summarize all aspects of a complex health system. As described above, our sensitivity analyses suggest that the comparative rankings of countries that are in the middle of the distribution (but not at the extremes) are somewhat sensitive to small changes in the data or indicators included in the analysis, but these changes do not remove these countries from the middle group of the distribution. Second, despite improvements in recent years, standardized transnational data on the performance of health systems are limited. Commonwealth Fund surveys provide unique and detailed data on the experiences of patients and primary care physicians, but they do not capture the important dimensions that could be obtained from medical records or administrative data.
In addition, patients' and doctors' evaluations may be affected by their expectations, which may differ by country and culture. Incorporating survey data into standardized data from other international sources allows us to evaluate population health outcomes and specific diseases, especially with regard to the impact of the COVID-19 pandemic. Some issues, such as hospital care and mental health care, are not well addressed in currently available international data. In addition, it is very difficult to characterize the performance of these institutions through surveys because no one person has a complete perspective on that performance, and surveying several respondents from representative samples of institutions is a logistical challenge and extremely costly.
Third, we base our evaluation of the overall performance of the health system on five areas: access to care, the care process, administrative efficiency, equity, and health outcomes, which we weigh equally to calculate each country's overall performance score. We recognize that there is a limitation surrounding the care process, since we do not measure the quality of acute care, especially in hospitals. Work related to this topic is under way, but it would always fall within the limits of generalization, due to the limitations of studying all imaginable diagnoses. We also recognize that other elements of system performance, such as innovative potential or public health readiness, are important.
We continue to look for feasible standardized indicators to measure other domains. The COVID results, included for the first time in this report, reflect some aspects of public health readiness and system resilience, but are also limited in many ways. Fourth, in defining the five domains, we recognize that some measures could plausibly fit into several domains. The assignment of measures to the domains was extensively reviewed internally and externally with an expert advisory panel.
To substantiate action, countries' performance must be examined from the point of view of individual measures, in addition to the areas we have created. The availability subdomain includes nine measures that summarize how quickly patients can get information, make appointments, and get emergency care outside of business hours. The 2024 report includes two new measures on the percentage of people surveyed who waited less than a week to receive a consultation with a specialist and waited less than a month to undergo non-emergency surgery after being told that they needed it. A measure of digital health use moved from the domain of the care process to the availability subdomain.
The preventive care subdomain includes four survey topics related to advising health professionals on healthy behaviors, including a new measure on the use of telehealth to assess mental and behavioral health needs, three OECD measures on mammograms and vaccination against influenza and measles, three OECD measures of the rates (standardized by age and sex) of avoidable hospital admissions for three prevalent chronic diseases (diabetes, asthma and insufficiency) congestive heart disease) and a new measure to complete the initial COVID-19 vaccination protocol of Our World in data. The wording of a survey question was changed to include all qualified respondents, not a subsection of respondents, as in the previous edition of this report. The patient participation and preferences subdomain consists of 15 measures that evaluate the provision of patient-centered care, including effective and respectful communication between doctor and patient and care planning that reflects the patient's goals and preferences. The area of administrative efficiency includes four measures.
Three evaluate patients' and primary care doctors' reports of time and effort spent resolving administrative or paperwork issues, as well as disputes related to documentation requirements required by insurance plans and government agencies. One of the measures reported by patients assesses obstacles to care due to the limited availability of the regular doctor. Two measures were combined because of their high correlation. The 2024 report included two additional measures of discrimination, reported by primary care physicians, in the area of equity. These two measures were not stratified according to reported income, since international surveys do not ask primary care physicians about patients' income.
Respondents were then instructed to reflect on their pre-tax income and were asked: “By comparison, is your household income well above, somewhat above average, somewhat below, or far below average? Respondents who indicated that their income was “somewhat below” or “well below” the average were classified as “lower or average income”, while those who reported income “much higher” or “somewhat above” the average were classified as “higher income”. We also included the World Health Organization's measures on the excess of deaths associated with the COVID-19 pandemic among people under 75 and people over 75 to quantify the impact of the pandemic on mortality. Williams II, Vice President of Innovations in International Health Policy and Practices, Commonwealth Funding System Reform, Care Delivery, Care Coordination, Quality of Care, Equity, Coverage and Access in Health, Care Environments, Patient-Centered Care, Primary Care, Access to Care, Medicaid Expansion, Costs and Expenses, Consolidation, Affordability, Affordable Care Act, Public Health, International and International Surveys. Overview and forecasts on current issues Industry and market perspectives and forecasts Key figures and rankings about companies and products Perspectives and preferences of consumers and brands in various sectors Detailed information on political and social issues All key figures about countries and regions Market forecast and expert KPIs for more than 1000 markets in more than 190 countries and territories Information on consumer attitudes and behavior around the world Detailed information about more than 39,000 online stores and marketplaces Statista+ offers additional, data-based services designed for your specific needs.
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We offer a platform to simplify research and support your strategic decisions. Learn more about expert resources to inform and inspire. Quality of locally accessible health care in some countries of the world 2024 Percentage of adults from some countries of the world who agreed that the quality of health care they had access to in their country was good in 2024 Public health expenditure in Brazil 2024, by area Government health expenditure in Brazil in 2024, by area (in billions of Brazilian reais) Percentage of US COVID-19 cases that resulted in hospitalizations on February 12, 2016, by age The most important key figures provide a compact summary of the topic Health Care and take you directly to the corresponding statistics. The main problems of health systems around the world in 2024. Disparities related to access to and use of health care, as well as to the higher prevalence of certain chronic diseases, are also present in the veteran population. Gunja, principal investigator of the Commonwealth Fund's International Program for Innovations in Health Policy and Practices.
Not only do health systems strive to improve patient outcomes and serve their communities, but they also often act as opinion leaders and advocates for important activities in the fields of health and medicine. In Norway, Sweden and Switzerland, respondents were randomly selected from listed or national population records. The resulting historical trauma is an important context for the discourse about the mental health problems faced by Native American communities today. Box 2-1 briefly presents one of these communities and their path to health (see Chapter 4 for a more in-depth analysis of another Native American community that is taking steps to combat health inequity).
Both the Netherlands and Germany have also taken steps to ensure that health services are available after regular office hours. Population and, by 2060, nearly one in five of the country's total population will be born abroad (Colby and Ortman, 201. These systems have or manage more than 6,000 hospitals, which means an average of about six hospitals per health system). Approximately half of Australian patients who do not choose to take out voluntary health insurance may have to wait longer to receive services. There are unique characteristics of urban regions, as well as unique characteristics of the population and barriers to health that shape urban disparities.
