Although the United States is renowned for its biomedical research, medical technology, and its hospitals and specialist physicians, our healthcare system as a whole is nowhere near the top in many performance ratings compared to its peer countries.

One major reason is that compared to other advanced countries,  many Americans don’t have access to the healthcare system.  This was improved after the passage of Affordable Care Act, but we still have millions of Americans that are uninsured. 

Another long-standing issue for policymakers and the public has been the quality of care. For example, the U.S. health system is highly fragmented, with limited public health and primary care resources exacerbated by a large uninsured population.

According to a 2017 analysis by Commonwealth Fund, of the 11 advanced countries in the world, the U.S. healthcare system performance came in the last place. Again.  


Of the 11 advanced countries in the world, the U.S. healthcare system performance came in last place.

Where are the weak areas of performance? One weak area is access to care.  Not surprisingly, since we don’t have universal healthcare, fewer people reported that they have access to a regular doctor.  We also have a shortage of primary care doctors in the United States so having access to a “regular” doctor can still be a problem even if you have insurance.  The American healthcare system has resulted in an inefficient distribution of doctors.  There are too many doctors in cities, and too many specialists compared to primary care doctors.

We also rank lowest in affordability.  For example, a third of Americans had problems getting access to medical care that they needed because of costs.


More Americans, than people in advanced countries, report issues of getting medical care because of costs. (Source: Commonwealth Fund 2017)

The U.S. is also doing poorly because of administrative inefficiencies and waste.  For example from the study, only in the U.S. did a majority of doctors report that they spend significant time dealing with getting their patients the treatment that they needed because of insurance coverage restrictions. Another finding of our inefficiencies was that 16% of patients had to go to the emergency room for a condition that could have been treated in a clinic had it been available.

The U.S. also came in last place on quality of care differences between low-income and high-income patients.  Of the eleven countries, we had the biggest gap in the quality of care based on a patient income.

There are two significant outcome measures used in comparing healthcare systems.  One is infant mortality, and the other is life expectancy, and CIA has excellent comparative metrics on this.

According to the CIA, we are 43rd in life expectancy and 55th in infant mortality. Clearly, these ratings don’t reflect well on our healthcare system’s performance. Especially given the fact that we spend more per capita than anywhere else in the world.

Health expenditure

The United States spends more per capita on healthcare than anywhere in the world.

The US life expectancy is lagging behind 16 other advanced countries.  Recently reported that for the second year in a row, U.S. life expectancy has dropped. U.S. life expectancy peaked to 78.9 years in 2014 and fell to 78.8 in 2015 and 78.6 in 2016.

Experts believe one primary reason our life expectancy has been dropping is due to the opioid epidemic which experts are saying to have been started by doctors and pharmaceutical companies.  Last September,  the prominent writer and surgeon Atul Gawande flat out replied “We started it” when asked during an interview about physician roles in the epidemic.

So it appears we are not getting the return on investment on life expectancy that we should be getting. But upon closer examination, the big picture and data show its more complicated and nuanced.  Although life expectancy is used as a significant measure of healthcare outcome, the medical care you receive is only a small fraction in determining life expectancy.

The problem with life expectancy as a healthcare outcome

What contributes to our life expectancy is a lot more than just great medical care.  This is because genetics, socioeconomic factors, and healthy behaviors actually explain the majority of life expectancy.  And Americans have a major health disadvantage compared to other people in advanced countries.

In 2013, a panel of leading experts published a report on U.S. health answering the question ” Why do we have shorter lives, and poorer health?”.

For one, the U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups. But even advantaged Americans appear to fare worse than their counterparts in England and some other countries. That is, Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income groups appear to be in worse health than similar groups in comparison countries. The study also found that in America the large population of recent immigrants have generally better health than native-born Americans.

Our health behavior and environmental conditions are likely a big component of our lower life expectancy.  For one, U.S. communities are designed to rely on automobiles rather than pedestrians for getting around which discourages physical activity.  Less physical activity is not the only downside of our heavy reliance on cars. Deaths from automobile accidents are also higher in the U.S.

More Americans die from injuries, car crashes, and violence than their peer countries. Since the 1950s, U.S. adolescents and young adults have died at higher rates from traffic accidents and homicide than their counterparts in other countries.  Americans are less likely to fasten seatbelts, have more traffic accidents involving alcohol, and own more firearms than their peers in other countries.

Our obesity rates are also one of the highest in the world.  Studies are showing that apart from the opioid epidemic, another major reason for our declining life expectancy is due to our obesity rates.  Americans take in more calories per capita than others in advanced countries. For decades, the United States has had the highest obesity rate among high-income countries. High prevalence rates for obesity are seen in U.S. children and in every age group thereafter.

Obesity is a major risk factor for diabetes and early death.  And from age 20 onward, U.S. adults have among the highest prevalence rates of diabetes among peer countries

Alcohol and illicit drug abuse are also more rampant in our country.  Americans lose more years of life to alcohol and other drugs than people in peer countries, even when deaths from drunk driving are excluded.

Since the 1990s, among high-income countries, U.S. adolescents have had the highest rate of pregnancies and are more likely to acquire sexually transmitted infections. The United States has the second highest prevalence of HIV infection among the 17 peer countries and the highest incidence of AIDS. Teen pregnancies are associated with lower economic well-being later in life and lower educational achievements which are linked to lower life expectancy.

So yes, we have plenty of work to do to fix the healthcare system and it is badly needed.  Doctors and hospitals should focus on improving their quality of care and improving access to care for patients.  But the buck shouldn’t stop there.  Communities and the public should become more aware of negative determinants of health, and play a more active role in improving our conditions for better health.  Leadership and action are needed from both the private and public sector to make well-being and health a priority for Americans.  There is a lot we can do to change.  With the winds of a strong economy at our backs, right now is a prime time to invest in meaningful innovations to improve our well-being.

I am a gynecologic oncologist, a husband, and a father. My blog is mostly about our healthcare system and well-being, but occasionally I get inspired to write about other "stuff" too.

5 Comment on “Why only fixing U.S. healthcare won’t make us healthier

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