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Despite having the most expensive health care, the United States ranks last overall among the 11 countries on measures of health system equity, access, administrative efficiency, care delivery, and health care outcomes. While there is room for improvement in every country, the U.S. has the highest costs and lowest overall performance of the nations in the study, which included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. The U.S. spent $9,364 per person on health care in 2016, compared to $4,094 in the U.K., which ranked first on performance overall (Commonwealth Fund, 2017). An overall score of 64% was recently given to the United States for its achievement across 42 core health indicators related to long, healthy, and productive lives; quality; access; efficiency; and equity of health care (Commonwealth Fund, 2012) (see Figure 2.2).

FIGURE 2.2 U.S. scorecard on health system performance.

Source: The Commonwealth Fund. (2012, January 15). Scores Dimensions of a High Performance Health System. Retrieved from https://www.commonwealthfund.org/chart/scores‐dimensions‐high‐performance‐health‐system.

Some major findings from the U.S. Scorecard include the following (Radley, Hayes, & Collins, 2019):

 Rising death rates, high levels of obesity, and gaps in care are pressing challenges for states

 The rise in deaths from suicide, alcohol, and drug overdose is a national crisis

 Regional differences in performance persist, as do within‐state disparities

 Many states are not getting good value for their health care dollars

 States made progress in areas that were the target of efforts to improve

 Per capita spending growth in employer plans is outpacing that in Medicare