The Commonwealth Fund releases its fifth report on health care systems in 11 wealthy countries

policy digest

25 / 07 / 2017

Mirror Mirror 2017: International comparison reflects flaws and opportunities for better US Health Care
The Commonwealth Fund, July 2017

In its fifth ‘Mirror Mirror’ report, the Commonwealth Fund takes aim at the US healthcare system, whilst championing the NHS as an example of best practice across five different metrics. Although the NHS was voted best health system overall, coming first in two metrics and third in another two, it placed tenth out of eleven in health care outcomes.

Charting a comparison of healthcare systems in eleven of the world richest countries, the report highlights shortcomings in some of the lower ranking health systems, outliers in some of those which ranked highly and offers an explanation for what the relationship between metrics in individual countries says about their approach to healthcare policy.

The rankings are as follows

  • UK
  • Australia
  • Netherlands
  • New Zealand-Norway (tied)
  • Sweden-Switzerland (tied)
  • Germany
  • Canada
  • France
  • US

The five metrics used to establish these rankings are 

  • Care Process
  • Access
  • Administrative Efficiency
  • Equity
  • Healthcare outcomes

The UK placed first in care process and equity, third in access and administrative efficiency and tenth in healthcare outcomes. Other notable achievers include Australia (first in administrative efficiency and healthcare outcomes) and the Netherlands (first in access).

The Commonwealth Fund acknowledges that the UK has taken steps to improve its healthcare outcomes, citing the largest reduction in mortality amenable to health care during the last ten years, however it notes that its health care outcomes are no less concerning because of it, placing the UK ahead of only the US in this metric.

Addressing the variance in health care spending as a percentage of GDP, the report highlights the fact that the US spends 16.6 per cent of GDP whilst gaining the poorest outcomes. It also notes that at 9.9 per cent of GDP, the UK spends a relatively modest amount given how highly it ranks, although at nine per cent, Australia spends the least on its system and ranks second overall, arguably representing better value for money.

The study cites the variety of health systems in the top three countries as evidence that no single system is perfect. Utilising the Beveridge system (UK), the single-payer system (Australia) and the multipayer system (The Netherlands), each of the top three countries provides universal coverage and access. This, the paper argues, suggests that the issue with poor healthcare is less to do with money or organisational approach and more to do with ensuring that the component parts of a system work well independently and as part of an integrated model.

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