News & Events

New Seven-Nation Study Ranks U.S. Last on Health System Performance

Despite having the most expensive health care system, the United States ranks last in overall performance compared with six other industrialized countries—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—a new Commonwealth Fund report finds.

The study’s authors, who compared performance on measures of quality, efficiency, access to care, equity, and the ability to lead healthy and productive lives, found that while each country has room for improvement, the U.S. stands out for not getting good value for its health care dollars. Per capita health care spending in the U.S. was $7,290 in 2007, compared with $3,837 in the Netherlands, which ranked first in overall performance.

"It is disappointing, but not surprising that, despite our significant investment in health care, the U.S. continues to lag behind other countries," said Commonwealth Fund president Karen Davis, the report’s lead author. "With enactment of the Affordable Care Act, however, we will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high quality, efficient health care."

Visitors to can use an interactive Web tool to view side-by-side comparisons of country rankings and raw scores on individual performance indicators.

Other New International Resources 

  • Health Care Abroad and Reform at Home: The latest podcast from the Fund’s "New Directions in Health Care" series examines the costs of providing medical services in other parts of the world and considers how health care reform might change the bottom line in this country. 
  • International Profiles of Health Care Systems: These overviews, covering Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.S., provide detailed information for each nation on health insurance coverage and benefits, health system financing, delivery system organization, quality assurance mechanisms, efforts to improve efficiency and control costs, and recent innovations and reforms.

Also, be sure to visit the new International Health Policy Center on to use our interactive data tool for comparing health system performance by country and to download Fund publications, podcasts, and PowerPoint charts.