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National healthcare systems ranked!

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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.

Heathcare system performance rankings

More detail is provided on the graph:

Comparative Health Care System Performance Scores

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.

Health Care Spending as a Percentage of GDP

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:

  1. Provide for universal coverage and remove cost barriers so people can get care when they need it and in a manner that works for them.
  2. Invest in primary care systems to ensure that high-value services are equitably available locally in all communities to all people, reducing the risk of discrimination and unequal treatment.
  3. Reduce the administrative burdens on patients and clinicians that cost them time and effort and can discourage access to care, especially for marginalized groups.
  4. Invest in social services that increase equitable access to nutrition, education, childcare, community safety, housing, transportation, and worker benefits that lead to a healthier population and fewer avoidable demands on health care.

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