NHS named world’s best healthcare system

A new study comparing 11 healthcare systems in developed nations has put the UK’s national health service (NHS) at the top.

The research was carried out by the US-based health think tank the Commonwealth Fund, which has carried out the survey five times over the past ten years.

Over 12 separate indicators, the NHS was ranked as the leader in nine areas, including quality care, access and efficiency. One area in which the NHS was praised for being streets ahead of other systems was its use of feedback from patients – 84% of doctors in the UK receive patient satisfaction data, well ahead of other nations.

Only in the measure of actual health and survival rates did the NHS disappoint, coming tenth, one ahead of the bottom-placed United States. The researchers said health care systems are just one of many factors in determining a nation’s health, including social and economic well-being.

In fact, despite having the most expensive health care system, the United States was ranked last overall among 11 industrialised countries on measures of health system quality, efficiency, access to care, equity, and healthy lives, according to the report.

The other countries included in the study were Australia, Canada, France, Germany, the Netherlands, New Zealand Norway, Sweden and Switzerland.

The report concluded that while there is room for improvement in every country, the US stands out for having the highest costs and lowest performance – the US spent $8,508 per person on health care in 2011, compared with $3,406 in the United Kingdom, which ranked first overall.

Dr Mark Porter, leader of doctors’ union, the British Medical Association, told The Guardian newspaper that the findings were “clear evidence that our much-maligned NHS is one of the top-performing healthcare systems in the world.”

However, he warned that the health service was facing huge pressures. “A combination of rising patient demand, staff shortages and falling funding is undermining the very foundations of the NHS, as is the constant short-term interference from politicians of all colours.”

Health secretary, Jeremy Hunt, also welcomed the report. “NHS staff work incredibly hard to care for patients and these encouraging results pay testament to that,” he said.

The release of the report coincided with a warning of an impending funding crisis for the NHS, which is faced with growing demand and a static budget allocation from government.

Where has the US gone so wrong?

The Commonwealth authors, based in the US, understandably focused on the problems facing the US rather than the high ranking of the UK.

The United States’ ranking is dragged down substantially by deficiencies in access to primary care and inequities and inefficiencies in its health care system according to Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally, 2014 Update, by Karen Davis, of the Roger C. Lipitz Center for Integrated Health Care at Johns Hopkins Bloomberg School of Public Health; Kristof Stremikis, of the Pacific Business Group on Health, and Commonwealth Fund researchers Cathy Schoen and David Squires.

The authors conclude, however, that reforms to the system brought in with the new Affordable Care Act have already extended coverage to millions of US citizen, and that these can improve the country’s standing in some areas – particularly access to affordable and timely primary care.

“It is disappointing, but not surprising, that despite our significant investment in health care, the US has continued to lag behind other countries,” said lead author Karen Davis. “With enactment of the Affordable Care Act, however, we have entered a new era in American health care. The US performance on insurance coverage and access to care should begin to improve, particularly for low-income Americans. The Affordable Care Act is also expanding the availability and quality of primary care, which should help all Americans have better care and better health outcomes at lower cost.”

The report was also produced in 2004, 2006, 2007, and 2010, with the US ranking last in each of those years. Four countries were added to this year’s report: Switzerland and Sweden, which followed the UK at the top of the rankings, and Norway and France, which were in the middle of the pack. Australia, Germany, the Netherlands, New Zealand, and Norway were also placed in the middle, while Canada was just above the US at the bottom.

Key findings related to the US include:

Healthy lives: The US does poorly, ranking last on infant mortality and on deaths that were potentially preventable with timely access to effective health care and second-to-last on healthy life expectancy at age 60.

Access to care: People in the US have the hardest time affording the health care they need. The U.S. ranks last on every measure of cost-related access. More than one-third (37%) of US adults reported forgoing a recommended test, treatment, or follow-up care because of cost.

Health care quality: The US ranks in the middle. On two of four measures of quality—effective care and patient-centered care—the US ranks near the top (3rd and 4th of 11 countries, respectively), but it does not perform as well providing safe or co-ordinated care.

Efficiency: The US ranks last, due to low marks on the time and dollars spent dealing with insurance administration, lack of communication among health care providers, and duplicative medical testing. Forty percent of US adults who had visited an emergency room reported they could have been treated by a non-emergency room doctor, had one been available. This is more than double the rate of patients in the UK (16%).

Equity: The US ranks last. About four of 10 (39%) adults with below-average incomes in the US reported a medical problem but did not visit a doctor in the past year because of costs, compared with less than one of 10 in the UK, Sweden, Canada, and Norway. There were also large discrepancies between the length of time US adults waited for specialist, emergency, and after-hours care compared with higher-income adults.

“Now that millions more Americans have good coverage, we have to invest in our health care delivery system to be sure all patients – and especially those with the greatest need and whose care is the most costly – can get the high-quality, well co-ordinated health care they need,” said Commonwealth Fund President David Blumenthal, M.D. “Those kinds of improvements will go a long way toward improving peoples’ health while making efficient use of our precious health care dollars.”



Data are drawn from the Commonwealth Fund 2011 International Health Policy Survey of Sicker Adults; the Commonwealth Fund 2012 International Health Policy Survey of Primary Care Physicians; and the Commonwealth Fund 2013 International Health Policy Survey. The 2011 survey targets a representative sample of “sicker adults,” defined as those who rated their health status as fair or poor, received medical care for a serious chronic illness, serious injury, or disability in the past year, or were hospitalised or underwent surgery in the previous two years. The 2012 survey looks at the experiences of primary care physicians. The 2013 survey focuses on the experiences of nationally representative samples of adults ages 18 and older. Additional data on health outcomes were drawn from the Organization for Economic Co-operation and Development and the World Health Organization.


Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally, 2014 Update

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