US healthcare labelled 'persistent failure' in international cost-outcome comparison
The Commonwealth Fund’s 2026 report, based on 2024 data, finds the US system outspends all 19 comparator nations yet delivers poor outcomes, including high avoidable mortality and significant racial disparities.
The US healthcare system has been described as a "persistent failure" in a new international comparison study, which highlights a stark disconnect between expenditure and health outcomes. The 2026 analysis by The Commonwealth Fund, drawing on 2024 data, ranks the US as a poor performer across 20 countries, including Australia, Canada, and the UK. The report concludes that Americans pay more for care than their global peers while receiving less in return and remaining more exposed to illness and financial insecurity.
In 2024, the US spent 18 per cent of its gross domestic product on healthcare, nearly double the group average of 9.3 per cent. Germany was the second-highest spender at 12.3 per cent. Despite this disproportionate investment, the US ranked third lowest for life expectancy at birth at 79 years, compared to the group average of 81.2 years. Only Turkey (77.3 years) and Mexico (75.5 years) recorded lower life expectancies, while Switzerland, Japan, and Spain led the group with figures exceeding 84 years.
The study identified critical structural weaknesses, noting the US has the fewest primary care providers per capita among the nations assessed. The US records 0.3 primary care providers per 1,000 people, significantly below the group average of 1.1 and the highest-ranking countries, Australia and the Netherlands, which both have 1.8. Consequently, the US recorded the second-highest avoidable mortality rate and the second-highest years of potential life lost, with only Mexico performing worse in these metrics.
Health outcomes in the US are not evenly distributed, with the report highlighting severe inequities. Maternal mortality for Black women reached 50 deaths per 100,000 live births in 2023, compared to the group average of 9.5. The overall US maternal death rate was nearly 19 per 100,000, the highest in the study. Additionally, rural areas face high and rising suicide rates, exacerbated by limited access to doctors and mental health services.
The analysis notes that the US is the only high-income peer country lacking universal health coverage, although Mexico also lacks universal coverage, it has plans to implement it starting in 2027. The Commonwealth Fund concluded that while other nations have successfully adopted strategies to reduce costs, strengthen primary care, and address inequities, the US has failed to pursue these proven alternatives.
