Despite having the most costly health system in the world, the U.S. consistently lags on most dimensions of performance, relative to other countries, according to new research from the Commonwealth Fund. Compared with Australia, Canada, Germany, the Netherlands, New Zealand and the U.K., the U.S. ranks last overall.

Karen Davis, PhD, president of the New York-based healthcare foundation, and colleagues studied and compared healthcare data from 2007-2009 from seven countries to confirm earlier findings. The annual report is titled "Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally."

In 2007, U.S. health expenditure per capita was $7.2 million, compared with The Netherlands, which ranked first overall--with per capita spending of $3.8 million--and was included for the first time in the 2010 edition of the annual study, according to the report.

“Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as is shown in earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency and equity,” wrote Davis and colleagues.

The most notable way the U.S. differed from other countries is the absence of universal health insurance coverage. The U.S. ranked first on preventive care and was strong on waiting times for specialist care and nonemergency surgical care, but was weak on access to needed services and ability to obtain prompt attention from primary care physicians, the report found.

The report's key findings were:

• Quality: The U.S. fared best on provision and receipt of preventive and patient-centered care. However, its low scores on chronic care management and safe, coordinated care pulled its overall quality score down.
• Access: Due in part to the absence of universal coverage, people in the U.S. more often go without needed healthcare because of cost than people do in other countries, the report found. “In countries like the U.K. and Canada, patients have little to no financial burden, but experience wait times for such specialized services…the U.S. ranks lowest on overall accessibility of appointments with primary care physicians.”
• Efficiency: On indicators of efficiency, the U.S. ranks last among the seven countries, with the U.K. and Australia ranking first and second, respectively. “The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of IT, rehospitalization and duplicative medical testing.”
• Equity: Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting recommended tests, treatment or follow up care, or not seeing a dentist when needed because of costs.

Many U.S. hospitals are improving their process of care, yet the U.S. can learn from other countries in areas including public reporting of quality data, payment systems that reward high-quality care and a team approach to management of chronic conditions, according to the authors.

“With the enactment of the American Recovery and Reinvestment Act, the U.S. has accelerated its efforts to adopt health IT and provide an integrated medical record and information system that is accessible to providers and patients,” the report concluded. “Those efforts must come to fruition soon for the nation to deliver more effective and efficient care.”

The report can be found in its entirety here.