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According to a 2024 health care systems ranking among selected high-income countries, the U.S. came last in the overall ranking of its health care system performance. The overall ranking was based on five performance categories, including access to care, care processes, administrative efficiency, equity, and health outcomes. Among the top-ranked countries were Australia, the Netherlands, and the UK, while Switzerland, Germany, and the United States were among the lowest-ranked. Compared to the last report from 2022, Australia became number one in ranking (previous number one was Norway, which was not included in the 2024 report), while Germany dropped four places, and the United States remained an outlier on health system performance.

Administrative efficiency and costs

Generally, in countries like Canada, Australia, and New Zealand, where a single-payer health system is in place, there is higher administrative efficiency and lower health administrative costs. The U.S., with its multi-payer system, on the other hand, generates extra bureaucratic tasks for both health care providers and the patients. In the U.S., an estimated 256 million U.S. dollars are wasted per year due to administrative complexity.

Equity

The United States, without universal health coverage, has expectedly large disparities in health care affordability based on income, as individuals with low income are often uninsured and must pay for all their health care out-of-pocket. These results are in line with the equity rankings of this report, where the U.S. also came last. With the performance category equity, it is important to point out that the report focuses on income-related disparities. Other disparities based on ethnicity, gender, geography, and more have not been considered.