America is behind on health insurance coverage

It is no secret that the U.S. has a complex health insurance landscape, standing out from its peers for lacking a universal health insurance system. Indeed, the U.S. is only joined by Mexico in lacking universal healthcare, with around a fifth of residents remaining uninsured.

Still, Mexico is slated to close that gap. The nation does have a system set up intended for universal health coverage. According to the Commonwealth Fund, Mexico is reforming its system to close that gap and ensure free public health insurance for all residents by 2027.

In the U.S., around 8% of adults, or 27 million people, don't have insurance. That rate is higher among Hispanic, Black and American Indian/Alaska Native (AI/AN) people. Notably, the U.S. uninsured rate is expected to climb under new health policies.

U.S. underperforms on key health outcomes measures

U.S. life expectancy at birth is three years lower than that of other developed nations, at 79 years of age. The highest life expectancy is 84.3 years in Switzerland, and the OECD average is 81.2 years.

Again, there are serious disparities at play in the U.S. as Black (74 years) and AI/AN people (70.1 years) have lower life expectancy than non-Hispanic White (78.4 years) and Hispanic people (81.3 years).

Avoidable mortality, too, is higher in the U.S. than in its peer nations. This is a key clinical performance indicator, as excess avoidable deaths can indicate lapses in public and population health. In the U.S., the avoidable mortality rate is 312 per 100,000 people. The only country with a higher avoidable death rate is Mexico at 418 per 100,000 people.

Relatedly, the U.S. has above-average years of potential life lost (YPLL), a public health measure that estimates the average number of years a person would've likely lived had they not prematurely died up until age 75.

Having a higher YPLL number means there are more avoidable deaths among younger people. In the U.S., YPLL is 7,384 per 100,000 people, the second highest among OECD nations (Mexico is 9,209). The OECD average YPLL is 4,762 per 100,000 people.

U.S. a 'global outlier' for healthcare affordability

The U.S. performs markedly worse than its peer nations in healthcare affordability, with the Commonwealth Fund calling it a "global outlier."

The U.S. spent 18% of its GDP on health between 1990 and 2024. The next highest spender was Germany, at 12.3%.

Moreover, the U.S. spends far more per person on healthcare than any other developed nation. The cost of care per person in the U.S. is $12,649. The next highest spender was Switzerland at $7,927. Notably, Switzerland had higher out-of-pocket spending per individual than the U.S., with Swiss individuals spending $2,459 of their own money on healthcare, compared to $2,110 in the U.S.

These high costs come with consequences, as Americans are significantly more likely to skip care because of cost. Around a quarter (23.1%) of Americans skip care because of high costs. In Canada, that figure was 11.3%. In every other OECD nation, fewer than 1 in 10 patients skip care due to cost.

U.S. doctor shortage limits healthcare delivery and access

The report showed that the U.S. has a doctor shortage problem, with the nation graduating fewer physicians than its peers.

In the U.S., there are 8.6 physician graduates per 100,000 people, likely due to the exorbitant medical school tuition in the country. The OECD average is 14.5 physician graduates per 100,000 people. Only Japan, Korea, Canada and Israel produce fewer physicians.

Still, the U.S. is lagging in primary care providers, which is arguably a dire situation considering that all individuals are recommended to have a primary care clinician or usual source of care.

In the U.S., there are only 0.3 primary care providers per 1,000 people, compared to the OECD average of 1.1 per 1,000 people. This leads to serious supply and demand issues in the U.S., resulting in extremely long wait times and many going without a usual source of care.

The U.S. performs well in patient experience

The good news is that American patients report positive healthcare experiences. For example, 83.5% of patients said their doctor spends enough time with them, 92.1% say it's easy to understand their doctor's advice and 89.1% are regularly involved in clinical decision-making.

Importantly, these positive patient-provider relationships are evident in other OECD nations, too. However, it is still a positive finding that American patients are satisfied with the care that can so often be hard to access.

U.S. policy limits advances in health outcomes

Relatively poor health outcomes in the U.S. are likely the result of underinvestment in universal healthcare coverage -- the U.S. is one of two countries not to provide this -- and primary care, the Commonwealth Fund said.

To improve across metrics, investment in primary care, retention of a more robust medical workforce and leveraging advanced technology will be critical.

However, the Commonwealth Fund acknowledged that progress will likely be slow, as changes to the Affordable Care Act and Medicaid eligibility will likely prevent more people from accessing comprehensive health insurance coverage, perpetuating longstanding cost and outcome trends, the Commonwealth Fund indicated.

"Americans pay more for health care and get less in return," Reginald D. Williams II, the Commonwealth Fund's senior vice president and leader of the International program, said in the press release.

"That's not inevitable," Williams added. "It's the result of different choices. Other countries have shown that alternatives work. What's striking isn't the absence of solutions; it's our reluctance to implement them. The failure of the U.S. health system is not a failure of ideas. It's a failure of will to act on them."

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.