Previous page Adjust text size

Brief analytical summaries or syntheses #26

The U.S. Health System in Perspective :

A Comparison of Twelve Industrialized Nations


This paper analyzes 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Health care spending in the U.S. towers over the other countries and findings suggest opportunities for cross-national learning to improve health system performance.


Findings from this cross-national comparison of health care systems can inform public policy, highlight areas where nations could improve, and yield benchmarks for high performance. The Organization for Economic Cooperation and Development (OECD) annually tracks and reports on more than 1,200 health-system measures across 34 industrialized countries, ranging from population health status and non-medical determinants of health, to health care resources and utilization. Since 1998, The Commonwealth Fund has sponsored an analysis of cross-national health systems based on OECD health data to place the performance of the U.S. health system in an international context.

Analysis and results

Among the 12 countries, the U.S. stands out on a number of health system measures. Health care spending in the U.S. in 2008 towered over the comparison countries, both per capita and as a percentage of gross domestic product (GDP). The U.S. had a comparatively low number of hospital beds and physicians per capita, and patients in the U.S. had fewer hospital and physician visits than in most other countries. However, hospital spending per visit was highest in the U.S. Prescription drug utilization, prices, and spending all appeared highest in the U.S., as did the supply, utilization, and price of diagnostic imaging. With regard to quality, U.S. performance on a limited set of measures was variable. Five-year survival rates for patients with three types of cancer were relatively high; the U.S. ranked near the middle on in-hospital, case-specific mortality for three conditions within 30 days of admission. The U.S. also had among the highest rates of hospital admissions for five chronic conditions and the greatest number of lower-extremity amputations due to diabetes. These findings suggest that the U.S. health system is not delivering superior results despite being more expensive, indicating opportunities for cross-national learning to improve health system performance.


Despite much higher spending, U.S. performance in terms of quality is variable relative to other countries. While cancer care in the U.S. seems to be of particularly high quality based on five-year survival rates, the high rates of hospital admissions for chronic diseases suggest opportunities for improvement. These results echo previous comparative studies that find the U.S. to have middling or highly uneven quality. A 2010 cross-national study conducted by The Commonwealth Fund ranked the U.S. sixth of seven countries in terms of quality, with average performance on effectiveness and patient-centeredness and low performance on safety and coordination. With chronic disease on the rise as the population ages and accounts for ever more health care spending, more effective treatment and management in primary care settings may have the potential to simultaneously improve patient care and prevent the unnecessary use of scarce and expensive resources.

Implications and recommendations

Spending on health care in the U.S. in 2008 far exceeded that seen in other countries. In both dollar figures and as a percentage of GDP, no country came within 70% of U.S. spending ($7,538 per capita, 16% GDP). This higher spending does not seem to simply reflect higher income. In Norway, the only country studied with higher per capita income than the U.S., health care spending accounted for only 8.5% of GDP. Although much higher health care spending marks the U.S. as an outlier, containing spending growth is a shared challenge among these 12 countries. From 1998 to 2008, all countries experienced a rate of growth that exceeded inflation, with growth expected to continue. A recent analysis from the Centers for Medicare and Medicaid Services projects U.S. national health expenditure to grow at a rate of 6.1% from 2009 to 2019.

There are many forces driving health care spending. An annual series of Commonwealth Fund-sponsored analyses of OECD health data has explored a number of potential factors, including: administrative complexity, the aging of the population, the practice of “defensive medicine” under threat of malpractice litigation, chronic disease burden, health care supply and utilization rates, access to care, resource allocation, and the use of technologically advanced equipment and procedures. These and other studies have found, contrary to often-cited explanations, that the U.S. has a relatively young population, average or below-average rates of chronic conditions, and comparatively few doctor visits and hospitalizations compared with other industrialized countries. Instead, these studies suggest major reasons for higher spending include substantially higher prices and more fragmented care delivery that leads to duplication of resources and extensive use of poorly coordinated specialists.


The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

Gouvernement du Québec
© Gouvernement du Québec, 2018