Healthcare performance comparison summary

Healthcare Performance Comparison Summary


Which high-income country has best healthcare?


The Common Wealth Fund has recently released a healthcare performance comparison report between 11 countries with the highest incomes.

In this article we breakdown the report into a comprehensive summary of:

  • the key takeaways,
  • overall rankings,
  • healthcare spending and costs,
  • as well as recommendations on how to become a top healthcare performer.

Overview and key takeaways 


The report explores differences in healthcare between 11 high-income countries:

Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States


Comparisons between countries are made against 5 assessment domains:

  • Access to care,
  • Care process,
  • Administrative efficiency,
  • Equity,
  • and Health care outcomes.


  • Top performing countries are: Norway, the Netherlands and Australia
  • Cost of healthcare access and administrative burden are still large healthcare access barriers for many low-income populations
  • The US ranks last in all domains except care process
  • Healthcare spending and performance are not directly linked, it’s the allocation of spending that is considered pivotal to good performance
  • UK provides the most affordable healthcare

Overall rankings 


Countries scoring highest in terms of health care performance were:

  1. Norway
  2. the Netherlands
  3. Australia
Chart representing comparative health care system performance scores
Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021).


Countries scoring the lowest in terms of health care performance were:

  1. Switzerland
  2. Canada
  3. US

The US ranks 11th on 4 out of the 5 domains assessed. It has been excluded from the average performance calculations as its performance falls considerably behind the other countries.

Healthcare spending and costs


The assessment showcases that healthcare spending is not directly linked to performance, instead, it is how the spending is invested matters.

Healthcare spending cs perfomance graph
Source: Eric C. Schneider et al., Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries (Commonwealth Fund, Aug. 2021).

The UK ranks the highest in terms of healthcare affordability.

However, cost-related healthcare access problems are still a big concern for low income populations in some of the other countries. This is particularly true for the US where 50% of the low income population reports costs being a barrier to accessing healthcare, we are hopeful that the new ICER annual report will help to combat this.

How to be a top performer

There are four key differentiators which distinguish the poorer performing countries from top performers which:

  • provide universal coverage and reduce cost barriers,
  • invest in primary care systems to ensure that high-value services are equitably available in all communities to all people;
  • reduce administrative burdens that divert time, efforts, and spending from health improvement efforts; and
  • invest in social services, especially for children and working-age adults.

Additionally, better performance can be achieved by introducing or expanding measures designed to tackle avoidable mortality. Examples include:

  • prioritizing maternal health to avoid maternal deaths.
    • investment in primary care models to ensure care and support is available from conception through to the postpartum period.
    • offering financial support such as social support benefits and or parental leave.
  • prioritizing the diagnosis of mental health conditions.
    • expansion of primary health care teams to include mental health specialists to offer early intervention and treatment.

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