Overall performance scores and ranking: For each country, we calculated the mean of the five domain-specific performance scores. Health Care in the U.S. But as U.S. spending accelerated over the decades, the U.S. was spending a substantially larger share of its GDP on health care by 2019 than every other high-income country. The other four countries varied in order between the fourth and seventh ranks. Watch our new video to learn how. U.S. disparities are especially large when looking at financial barriers to accessing medical and dental care, medical bill burdens, difficulty obtaining after-hours care, and use of web portals to facilitate patient engagement. An expert advisory panel reviewed the proposed changes. You may not be able to access certain secure sites and member pages on the Aetna International website unless you have previously registered for them or hold applicable policies. In countries where private insurance companies compete for customers, such as the Netherlands, standards including a mandatory minimum basic benefit package, community rating to keep premiums lower for sicker individuals, and cost-sharing caps to simplify choice for beneficiaries. As such, many employers provide health insurance for their international personnel. Is technology keeping workers healthy or making them ill? In other areas where there are problems like a lack of public money and poor infrastructure, access to adequate health care can be difficult. No two nations are alike when it comes to health care. To inform action, country performance should be examined at the level of individual measures in addition to the domains we have constructed. The U.S. population is sicker on average than the populations of other high-income countries, with a high prevalence of chronic conditions like obesity, diabetes, heart disease, and respiratory ailments. Whether its preventative measures such as immunisation, the management of ongoing conditions, or critical illness and emergency treatment, everyone wants the reassurance that their mental and physical well-being is in safe hands. Certain groups, such as people under 20, get free care. Access to care includes measures of health cares affordability and timeliness. Two new 2021 measures are related to patient use of health IT and one measure of patient-reported levels of medical or medication mistakes. By continuing on our website, you agree to our use of the cookie for statistical and personalization purpose. Along with the U.K. and Sweden, the U.S. achieves higher performance on the preventive care subdomain, which includes rates of mammography screening and influenza vaccination as well as the percentage of adults who talked with their provider about nutrition, smoking, and alcohol use. The care process domain encompasses four subdomains relevant to health care for the general population: preventive care, safe care, coordinated care, and engagement and patient preferences. In 2019, 86 percent of Australians faced no out-of-pocket costs for primary care visits. The administrative efficiency domain includes five measures. We examined correlations among indicators within each domain, removing a few highly correlated measures. The high U.S. death toll during the COVID-19 pandemic illustrates the difficulty of achieving good health care outcomes if the population is sicker and access to preventive and primary care is limited, particularly because of affordability barriers. Germany abolished copayments for physician visits in 2013, while several countries have fixed annual out-of-pocket maximums for health expenditures (ranging from about USD 300 per year in Norway to USD 2,645 in Switzerland). Certain services such as dentistry, specialists, and radiology also have to be funded by the patient. With nearly 4 doctors per 1,000 inhabitants, the country invests a very generous 11.9% of its GDP in health care, and it shows. Outside the U.S., a larger proportion of clinicians are devoted to primary care and are geographically distributed to match population needs. Please read the terms and conditions of the Aetna International website, which may differ from the terms and conditions of www.interglobalpmi.com. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021). As described above, our sensitivity analyses suggests that country rankings in the middle of the distribution (but not the extremes) are somewhat sensitive to small changes in the data or indicators included in the analysis. In top-performing countries, workforce policy is geared to ensuring access within communities, especially those that have been historically marginalized. The public scheme, subsidised by the government but managed at local level, charges a nominal fee to patients. Switzerland, New Zealand, Australia, Norway, and France perform well on measures related to communication between primary care doctors and specialists. The timeliness subdomain includes six measures (one reported by primary care clinicians) summarizing how quickly patients can obtain information, make appointments, and obtain urgent care after hours. With nearly 3 doctors per 1,000 inhabitants, it is well staffed but the systems structure of regional trusts means that there can be wide differences in levels of care. For our assessment of health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, we used indicators available across five domains: For more information on these performance domains and their component measures, see How We Measured Performance. Data for this report were derived from several sources. They reduce the administrative burdens on patients and clinicians that cost them time and effort and can discourage access to care, especially for marginalized groups. One patient-reported measure evaluates barriers to care because of limited availability of the regular doctor. The U.S. rate of preventable mortality (177 deaths per 100,000 population) is more than double the best-performing country, Switzerland (83 deaths per 100,000). The normalized scoring approach assumes that results are normally distributed. Care Process. Denmark spends 10.8% of its GDP on its health care system, putting it in one of the highest brackets in the world and care is delivered by a high ratio of doctors (3.5 per 1,000 people). Although the U.S. health system has many unique features, there are lessons to be learned from countries that succeed in ensuring access to affordable, quality care. According to the World Health Organization, good health care provision relies on the availability of well-maintained and equipped facilities, well-trained and paid staff, infrastructure and information and, to underpin all of these things, a reliable source of adequate funding. One 2017 measure was not available from a recent survey. With the highest-ranking health care system in the world (according to WHO), there are over 1,000 excellent hospitals, specialist clinics and treatment centres across the country, staffed by a good proportion of a little over 3 doctors per 1,000 inhabitants (comparable with countries like the Netherlands and Australia). First, many process measures focus on the care available to people who actually have access to care. The U.S. also spends less on supports for workers, such as unemployment protections and labor market incentives. To evaluate the potential impact of double-counting these four measures, we examined the correlations between each of the four measures and the two composite measures and recalculated the performance scores after removing these four measures. What explains the apparent disconnect? Since 1998, in collaboration with international partners, the Commonwealth Fund has supported these surveys of the publics and primary care physicians experiences of their health care systems. New Zealand and the U.S. perform best on the safe care subdomain, with higher reported use of computerized alerts and routine review of medications. This modification changes a countrys performance scores relative to the mean but does not affect the ranking of countries relative to one another. The downside is that you will have to pay for many treatments up front (out-of-pocket), claiming reimbursement from the state insurance company for up to 70% of the cost. On this domain, Australia, Norway, and Switzerland rank at the top of our 11-nation group (Exhibit 1). Low-income people who work long hours or those with limited health literacy or support from family, friends, or neighbors may have difficulty navigating complex insurance eligibility rules, a maze of application procedures, or getting online access. Public provision is supported by government subsidy and the National Insurance Scheme (NIS), which everyone living and working in Norway must contribute to though their wage packet.

Top-performing countries have had success in preventing maternal deaths through the removal of cost sharing for maternal care. Each year, in collaboration with researchers in the 11 countries, a common questionnaire is developed, translated, adapted, and pretested. With nearly 30 million people still uninsured and some 40 million with health plans that leave them potentially underinsured, out-of-pocket health care costs continue to mar U.S. health care performance. Exhibit 2 shows the extent to which the U.S. is an outlier: its performance falls well below the average of the other countries and far below the two countries ranked directly above it, Switzerland and Canada.

Then, we ranked each country from 1 to 11 based on this summary mean score, again with 1 representing the highest overall performance score and 11 representing the lowest overall performance score. Residents of these countries are also less likely to report difficulty in paying medical bills (Appendix 4). Depending on the domain, some countries have quantitatively similar performance scores, meaning that very small differences can produce changes in rankings. But by learning from whats worked and what hasnt elsewhere in the world, all countries have the opportunity to try out new policies and practices that may move them closer to the ideal of a health system that achieves optimal health for all its people at a price the nation can afford. In fact, this is why the U.S. is the only country among those compared here that employs health navigators to help direct patients through both insurance and the wider health care system. Geography may pose a problem, with remote and rural areas having very little or no medical facilities. For more on the differences between the 2017 and 2021 editions of this report, please see How We Conducted This Study. We calculated performance differences as the standard deviation from average performance a measure of the degree of difference between countries given the range of variation in this set of countries. We replaced 17 of the 2017 measures with 16 new measures to reflect newly available data as well as to better represent previously defined performance domains and subdomains. The analysis stratifies the surveyed populations based on reported income (above-average vs. below-average, relative to the countrys median income) and calculates a percentage-point difference in performance between the two groups. It appears, then, that the U.S. health system delivers too little of the care thats most needed and often delivers it too late especially for people with complex chronic illness, mental health problems, or substance use disorders, many of whom have faced a lifetime of inequitable access to care. The U.K.s drop in rank from #1 to #4 is associated with that countrys lower performance on several domains (such as access to care and equity) compared to 2017. Third, the relationship between health care outcomes and care process is inevitably complex, especially if the population is less healthy because of economic and social policies that produce inequities or fail to mitigate their consequences. These changes should be interpreted with caution. The wording or timeframe differed slightly for three measures. In the year prior to the COVID-19 pandemic, primary care clinicians in Sweden and Australia were the most likely to report using video consultations. A positive performance score indicates the country performs above the group average; a negative score indicates the country performs below the group average. Countries like the Netherlands, Sweden, and Australia more frequently include mental health providers on primary care teams. Wording of four measures was modified slightly since 2017. Then we ranked each country from 1 to 11 based on the mean domain performance score, with 1 representing the highest performance score and 11 representing the lowest performance score. Consider whether you might need: Choosing the right health care insurance provider can make all the difference. In another sensitivity analysis, we excluded the U.S. and other countries from the domains in which they were outliers, but the results were essentially similar. In the end we included 16 new measures across the five domains (see How We Measured Performance for details). If youre planning to move or travel overseas and need more information on private health care insurance for a specific country, get in touch with one of our expert sales consultants today. The U.S. ranks #11 last. A comparison of the features of top-performing countries and poorer-performing countries suggests that top-performing countries rely on four features to attain better and more equitable health outcomes: Prioritizing maternal health is critical for reducing maternal mortality. Appendix 9 presents the number of respondents and response rates for each survey, and further details of the survey methods are described elsewhere.4,5,6. Language Assistance:||Kreyl Ayisyen| Franais| Deutsch |Italiano | | || Polski| Portugus| P|Espaol | Tagalog |Ting Vit.