Premature deaths from conditions that are considered preventable with timely access to effective and quality health care,10 including diabetes, hypertensive diseases, and certain cancers, are termed “mortality amenable to health care˳” This indicator is used by several countries to measure health system performance˳11 The U˳S˳ has the highest rates of amenable mortality among the 11 countries with 112 deaths for every 100,000˳ It is notable that the amenable mortality rate has dropped considerably since 2000 for every country in our analysis, though less proportionately in the U˳S˳ The U˳S˳ rate was two times higher than in Switzerland, France, Norway, and Australia˳ This poor performance suggests the U˳S˳ has worse access to primary care, prevention, and chronic disease management compared to peer nations˳
Conclusions and Policy Implications
While the United States spends more on health care than any other country, we are not achieving comparable performance˳ We have poor health outcomes, including low life expectancy and high suicide rates, compared to our peer nations˳ A relatively higher chronic disease burden and incidence of obesity contribute to the problem, but the U˳S˳ health care system is also not doing its part˳ Our analysis shows that the U˳S˳ has the highest rates of avoidable mortality because of people not receiving timely, high-quality care˳ The findings from this analysis point to key policy implications, as well as opportunities to learn from other countries˳
First, greater attention should be placed on reducing health care costs˳ The U˳S˳ could look to approaches taken by other industrialized nations to contain costs,12 including budgeting practices and using value-based pricing of new medical technologies˳ Approaches that aim to lower health care prices are likely to have the greatest impact, since previous research has indicated that higher prices are the primary reason why the U˳S˳ spends more on health care than any other country˳13
Second, our findings call for addressing risk factors for, and better management of, chronic conditions˳ We can start by strengthening access to care and primary care systems˳ Our findings show that the U˳S˳ has a relatively lower rate of physician visits compared to other nations˳ This is surprising given U˳S˳ adults’ seemingly greater health needs˳ We do know from previous Commonwealth Fund surveys that adults in the U˳S˳ experience greater affordability barriers to accessing physician visits, tests, and treatments˳14 Increasing access to affordable health care and strengthening primary care systems are two of the most important challenges for the U˳S˳ health care system˳15
Third, the U˳S˳ should promote incentives to use effective care and disincentives to discourage less-effective care˳ For example, a recent analysis estimated that as much as one-quarter of total health care spending in the U˳S˳ — between $760 billion and $935 billion annually — is wasteful˳16 Overtreatment or low-value care — medications, tests, treatments, and procedures that provide no or minimal benefit or potential harm — accounts for approximately one-tenth of this spending˳ The U˳S˳ can learn from other countries; for example, our comparably high use of MRI scans and surgeries for hip replacement suggests we should assess when these interventions bring the greatest value˳ The global Choosing Wisely campaign promotes conversations around evidence-based care between physicians and their patients to help evaluate which tests and treatments are truly necessary and free from harm˳17
In sum, the U˳S˳ health care system is the most expensive in the world, but Americans continue to live relatively unhealthier and shorter lives than peers in other high-income countries˳ Efforts to rein in costs, improve affordability and access to needed care, coupled with greater efforts to address risk factors, are required to alleviate the problem˳
