Kansas Health Institute | Information For Policy Makers. Health for Kansans.

NEW YORK CITY — The U.S. has the world's most expensive health care system, but it continues to underperform those in other industrialized countries, according to a newly updated report from The Commonwealth Fund.

The report titled, "Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update," ranked the U.S. last or next to last in five measurements of high performance when compared to the United Kingdom, Australia, Canada, Germany, the Netherlands and New Zealand.

The study, based on surveys of patients and primary care physicians in each country, ranked the Netherlands first closely followed by the U.K. and Australia.

The five measurements of performance focused on quality, access, efficiency, equity, and healthy lives.

The report's authors predicted that the newly enacted federal health reforms will begin correcting the U.S. system's problems by extending coverage to more people, improving disease management and care coordination, resulting in better health outcomes over time.

The report said the biggest difference between the U.S. system and those of the other countries was the absence of universal health insurance coverage.

"Without reform, it is not surprising that the U.S. currently underperforms relative to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes," the authors wrote.

Earlier versions of the rankings were done in 2007, 2006 and 2004. The U.S. ranked last in each of those reports, too.

According to the report, 45 percent of those surveyed in the U.S. reported not visiting a doctor in the past year because of cost compared with 5 percent of those surveyed in the U.K. and 4 percent of those surveyed in the Netherlands.

Twenty-eight percent of those surveyed in the U.S. reported having to wait six or more days for a doctor's appointment versus 14 percent in the U.K. and 2 percent in the Netherlands.

The surveys showed that U.S. patients were generally content with their doctors. But costs of care were a major problem.

"Cost-related access problems are particularly acute in the United States, where more than 46 million citizens are currently uninsured," the authors wrote. "Uninsured adults were more likely than insured adults to report difficulties getting needed care or going without care because of costs...Compared with their counterparts in the six other countries, low-income Americans were significantly more likely to have access problems related to cost, even after controlling for health status and insurance."