Mirror, mirror on the wall: an international update on the comparative performance of American health care

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. Compared with five other nations - Australia, Canada, Germany, New Zealand, the United Kingdom - the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill