The 2021 World Index on Healthcare Innovation, conducted by the Foundation for Research on Equal Opportunity (FREOPP), ranked the United States in 6th place among the world’s healthcare systems˳ The analysis finds that the United States is a global leader in scientific advancement but that our healthcare system is fiscally unsustainable˳
The Index evaluated the national healthcare systems of 31 high-income countries on four key dimensions: quality, choice, fiscal sustainability, and science and technology˳ Those categories were chosen to examine not only the quality of each healthcare system, but also the ability of that system to improve over time through scientific and medical advances˳
The Index finds that the top five national healthcare systems — Switzerland, the Netherlands, Germany, Ireland, and Israel — have all achieved universal coverage in part by relying on private insurance˳ In fact, Switzerland, the Netherlands, and Israel have universal private healthcare systems in which all citizens are covered by mandatory private insurance˳ Those countries empower patient choice and allow private insurers to innovate without delays from political or regulatory inaction˳ In addition, those systems tend to be more fiscally sustainable because subsidies are phased out for wealthier patients˳
Ultimately, the United States ranked 6th overall, a result of excellent scientific advancement (1st), good quality (10th), moderate choice (20th), and poor fiscal sustainability (29th)˳ Such rankings allude to the nation’s relative strength in research and development along with its struggle to control rising government spending on healthcare˳
The Index emphasizes the importance of innovation in improving healthcare outcomes˳ Advances in scientific development, healthcare service delivery, and personalized care are recognized as essential components of high-quality healthcare systems˳ FREOPP calculated the strength of each national healthcare system using 13 elements based on 33 separate measures, from the number of primary care physicians per capita to the national debt-to-GDP ratio˳ The Index was updated in 2021 to emphasize measures of pandemic preparedness and assess the effectiveness of each national healthcare system’s response to COVID-19˳
Science and Technology
The United States ranked first in science and technology by a wide margin˳ That result stems from U˳S˳ leadership in the number of new drugs and medical devices gaining regulatory approval˳ The country also ranks near the top in scientific Nobel prizes per capita, scientific impact in academia, and research and development expenditures per capita˳ Those achievements make some of the most innovative and cutting-edge medical treatment options in the world available to Americans before they are accessible elsewhere˳
Quality
The United States ranked 10th in quality, a consequence of mixed results on the element’s measures˳ The nation performed well on measures of patient-centered care, including relatively low wait times for care and good patient involvement in medical decisions˳ However, the United States ranked lower for pandemic preparedness and response (17th)˳ It also was judged to have relatively poor healthcare infrastructure, with the lowest number of primary care physicians per capita among the nations surveyed˳ Those rankings highlight that scientific advancement does not necessarily guarantee better healthcare outcomes˳ In fact, the United States does not perform particularly well compared to other developed nations on a number of different healthcare outcomes, as measured by the Organisation for Economic Co-operation and Development (OECD)˳
Choice
The United States ranked 20th in choice, despite the availability of most new medical advancements˳ This is because choice encompasses more than just new treatment availability; it also includes the affordability of health insurance and the freedom to choose healthcare services˳ The United States ranked last in affordability as a result of high healthcare prices, highlighting that treatment availability does not guarantee accessibility for ordinary Americans˳
Another way the Index measures the freedom to choose healthcare services is through the amount of out-of-pocket healthcare expenditures; FREOPP judges that healthcare markets are most efficient when patients are directly spending on their own care˳ This is because higher out-of-pocket spending on a national level indicates that individuals can choose the type of care that fits within their own budget˳ Despite several nations in the Index with single-payer systems, the United States ranked second to last in out-of-pocket healthcare expenditures˳
Fiscal Sustainability
The United States ranked 29th in fiscal sustainability, ahead of only France and Japan˳ Healthcare costs in the United States are far higher than those in other countries˳ In 2020, U˳S˳ healthcare expenditures were $10,948 per capita — nearly three times the average of other OECD countries˳ Such spending is likely to continue growing rapidly; the Congressional Budget Office projects that spending on major federal healthcare programs will rise from 5˳7 percent of GDP in 2022 to 9˳4 percent in 2051 — an increase of 64 percent˳
What Does the Index Imply for U˳S˳ Healthcare?
FREOPP’s report reflects the United States’ role as a world leader in scientific and technological advancement in healthcare˳ At the same time, spending on healthcare in the United States has far outpaced other major healthcare systems without yielding better outcomes˳ The Index makes clear that further innovation, beyond pure scientific advancement, is necessary to control rising costs and ensure high-quality healthcare is accessible to every American˳ Achieving higher healthcare performance will also contribute positively to America’s ongoing fiscal challenges˳
Related: Why Are Americans Paying More for Healthcare?
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