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July 28, 2026
US-based healthcare think tank and funding body The Commonwealth Fund have published their 2021 comparison of the healthcare systems from 11 high-income countries. This is the fourth ‘Mirror, Mirror’ report since the first one was issued in 2010. The series is designed to ‘generate insights about the policies and practices that are associated with superior performance’.
Healthcare systems around the world have been put to the test by the pandemic. How well have they responded? How confident can patients be that they are receiving the best levels of care? How can healthcare systems improve what they do while managing unprecedented stresses?
The Fund has assessed the 11 healthcare systems using 71 performance measures across five domains: access to care; care process; administrative efficiency; equity; and healthcare outcomes. The countries were then ranked for each domain and then overall.
The summary results from the 71 measures are displayed in the table by country and buy domain.
More detail is provided on the graph:
Here, the differences are writ large. The top 3 countries – Norway, the Netherlands and Australia – are close together. There’s a relatively small gap to the next 3 – UK, Germany and New Zealand – and then again to the next countries, dipping a little for Canada. However, the subsequent drop to the 11th country, the US, is considerable, more than the drop from the 1st to the 10th countries.
The inefficiencies of the US healthcare system are further highlighted by the table showing healthcare expenditure as a percentage of GDP. Here, the US spends significantly more than the other 10 countries. Something clearly is not working.
When making the comparisons, the report seeks to identify the factors that lead to an efficient healthcare system that produces better and more equitable outcomes for its patients. They identify 4 factors, stating that the top-performing countries do the following:
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