How often do we hear that the United States’ (U.S.) health system is inferior to other nations? Answer: All the time. But is that really the case?

A notable comparison is the U.S. to Cuba. With the recent uprising in that nation, some took to the streets to protest the Cuban government, including it’s handling of the COVID-19 crisis and begged for humanitarian relief. Hadley Heath Manning, Director of Policy at the Independent Women’s Forum (IWF), has written on the deplorable Cuban system before, including that hospitals are usually poorly maintained as well as short on staff and medicines.

Another comparison often cited is with the U.S. and Venezuela. Unfortunately, the virus has been spreading, many medical professionals have fled the country, and basic needs in hospitals have not been met. IWF’s Patrice Onwuka, Director, Center for Economic Opportunity, has penned that Venezuela’s system included the resurgence of cholera and malaria and hospitals missing vital equipment like x-rays to keep patients alive (among so much more)

How does the U.S. really rank among other nations? What are some key indicators that we should be looking at? When deciding rank, indicators such as patient choice, quality, fiscal sustainability, medical innovation, healthcare costs, and price transparency should remain top of mind and are imperative cornerstones to any healthcare system. 

Health system comparisons

The 2021 World Index of Healthcare Innovation (WIHI) was recently released by the Foundation for Research on Equal Opportunity, a non-profit think tank focused on expanding economic opportunity to those who least have it. What sets this Index apart from existing national health system comparisons is that it includes both patient choice and medical innovation into a holistic evaluation.

The first of its kind WIHI ranks 31 systems on four key indicators:

  1. Quality: level of patient-centered care, measures of preventable disease and health outcomes, health system infrastructure, and pandemic preparedness;
  2. Choice: affordability of health insurance, access to new therapies, and patient portability to choose healthcare services, their doctor, and their insurer;
  3. Science & Technology: number of healthcare related patents, health digitalization, scientific impact and Nobel Prizes in Chemistry and Physiology or Medicine; and 
  4. Fiscal Sustainability: ability of the country to maintain its healthcare spending without punitive taxes or a debt crisis.

When you do a quick Google search of country health care indexes, several results populate. One study by the Kaiser Family Foundation, stated the “U.S. continued to lag behind comparably wealthy and sizable countries” and “the gap has widened between the U.S. health system and those of its peers” around the following criterion: long-term health outcomes, treatment outcomes, hospital-related care, and patient safety.

In a recent book by Ezekiel Emanuel, the U.S. is mentioned as a poor performer due to not having universal coverage as well as complex payment systems and drug pricing mechanisms. According to the U.S. News and World Report, the U.S. does not even rank in the top ten of “Countries With the Most Well-Developed Public Health Care Systems”. There are also state-by-state comparisons, including the Mercatus Center’s product: COVID-19 Health Policy Recommendations: Increasing Access to Care in the States.

The WIHI includes system comparisons on “patient choice” and “medical innovation” into holistic evaluations by country. By including the dimensions of “choice” and “innovation”, the WIHI helps address some of the limitations of existing system comparisons, including some mentioned above.

Universal Coverage and Single Payer

Topping the 2021 national health system rankings are Switzerland, the Netherlands, and Germany—three countries with universal private insurance— with the United States coming in 6th. According to the WIHI, the U.S. ranked #1 in Science and Technology. However, the U.S. ranked third-to-last in Fiscal Sustainability, ahead of only Japan and France. The Science and Technology rank helped with the U.S. overall rank.

The top three rankings may have “universal coverage” but are far from “single payer” healthcare systems. Rather, these countries’ universal private insurance environments allow for more patient choice, better benefit-designed plans, and are more fiscal sustainability because they are not “means-tested” (where patients are phased out with the increase in household income). 

U.S. has more work to be done

Ranking 6th on the WIHI means there is always room for improvement in the U.S. healthcare system. Additionally, the WIHI results indicated that the U.S. response to the COVID-19 pandemic was ranked at 17th out of 31 countries. Some areas for improvement are inpatient choice, quality, fiscal sustainability, healthcare costs and price transparency (among others).

In the months ahead, Jean Morrow, a visiting fellow with IWF, will be exploring further topics to help drive and inform the marketplace of ideas to elevate patient-centered health care, including empowering patient choice and improving quality and outcomes.