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US health report card: 'A' for spending, F' for performance

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Bang for your buck? No such luck—not even close.

The United States health-care system has finished dead last—yet again—in a comparison of first-world countries, despite vastly outspending those nations on health services, according to a new study released Monday.

Adding insult to injury, the Commonwealth Fund-issued study ranked the United Kingdom in first place in the rankings despite the fact that the UK spent just $3,182 per capita on health—the second-least amount of the 11 countries surveyed.

And Canada, which was just above the U.S. in the overall rankings, spent just $4,522 per person on health services.

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In contrast, the U.S. spent $8,508 per person on health care, or 17.7 percent of the gross domestic product.

"The claim that the United States has 'the best health care system in the world' is clearly not true," stated the Commonwealth Fund report.

"To reduce cost and improve outcomes, the U.S. must adopt and adapt lessons from effective health- care systems both at home and around the world," said the report, which examined 80 separate indicators from the countries related to five overall areas of performance: health, quality, efficiency, access and equity.

The Commonwealth Fund is a private foundation whose self-stated goals are promoting "a high-performing health-care system that achieves better access, improved quality and greater efficiency."

The study found that after the United Kingdom, the top-ranked health systems were those of Switzerland and Sweden, followed by Australia, a tie between Germany and the Netherlands, a tie between Norway and New Zealand, France took ninth place, with Canada and the U.S. bringing up the rear. The most recent report, in 2010, had looked at just seven countries. This year, France, Sweden, and Switzerland were added to the mix.

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In each of the four prior versions of the report the fund issued since 2004 "the U.S. has been systematically in last place," noted report co-author Karen Davis, of the Johns Hopkins Bloomberg School of Public Health.

But Davis said she expects that the ongoing implementation of the Obamacare, which is targeted at getting health coverage to tens of millions of people who lack insurance, could put an end to that dismal run.

"I think the Affordable Care Act is going to make a huge difference in U.S. performance," she said.

Contributing to America's failing grade this year was the fact that the country ranked dead last in all measures of cost-related access.

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Many less-affluent U.S. residents experienced longer-than-average wait times in seeing doctors and in being able to afford those services in the first place. The U.S. was also last in rankings on infant mortality, and second-to-last in healthy life expectancy at age 60, the study found.

And America was ranked last in efficiency, as a result of excessive time and money spend on dealing with insurance administration, lack of communication between medical providers and duplicative tests.

Davis noted nearly 40 percent of Americans did not visit a doctor in the past year because it would cost them too much money, compared to less than 1 in 10 people who reported the same thing in the United Kingdom, Canada, Sweden and Norway.

And 40 percent of U.S. adults said they sought treatment at an emergency room for conditions that could have been treated by a regular doctor if one had been available, the Commonwealth Fund report found. In contrast, just 16 percent of patients in the U.K. reported such a problem in access to a doctor.

Davis said that in recent years, the U.K. has made "huge progress" in reducing wait times for elective surgeries and visits with specialists, and is among the average or top half of performing countries in wait times.

She said the U.K.'s experience, as well as other countries with universal health coverage—which the U.S. does not have—puts the lie to the argument that such systems will invariably lead to longer-than-acceptable wait times for treatment.

"Patients in the U.S. have rapid access to specialized health-care services; however they are less likely to report rapid access to primary care than people in leading countries in this study," the report said. "There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable—however, the Netherlands, U.K. and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services."

"Basically, there's no wait times in countries like Germany, so it's not true that there's a tradeoff," Davis said. "Canada has long waits for specialists, but Canada and the U.S. have long waits just to get in to see your primary doctor."

It wasn't all bad news for the U.S. in terms of rankings.

America ranked in the middle overall for health-care quality metrics. And the country came in third and fourth place for effective care and patient-center care, although it fell short in measures of safe or coordinated care.

And the report underscores the fact that even when America ranks high relative to most other countries in some metrics, it is doing so while spending a grossly disproportionate amount of money to do so.

"For all countries, responses indicate need for improvement," the report said. "Yet, the other 10 countries spend considerably less on health care person person, and as a percent of gross domestic product than does the United States."

"These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation's substantial investment in health."

—By CNBC's Dan Mangan

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