Commonwealth Fund Finds U.S. Underperforms Peers Despite Highest Health Care Spending

A Commonwealth Fund analysis, described as “U.S. Health Care from a Global Perspective, 2026,” says the United States continues to underperform against peers in public health measures despite spending more on health care than any other nation.

“An updated analysis comparing healthcare systems across 20 countries finds once again that the US system is an outstandingly poor performer, summarized as being a “persistent failure” for its high costs, poor health outcomes, and premature deaths”

Ars Technica

The report attributes the mismatch to how the U.S. “choose[s] to use” resources, with Commonwealth Fund president Joseph R. Betancourt, M.D., saying, “We spend more than any other nation on health care, so our poorer health outcomes aren't due to a lack of resources -- it is about how we choose to use them.”

Ars Technica

The analysis places the U.S. life expectancy at 79 years and reports an avoidable mortality rate of 312 per 100,000 people, with Mexico listed as the only country with a higher avoidable death rate at 418 per 100,000 people.

It also says the U.S. has above-average years of potential life lost, reporting 7,384 per 100,000 people, while the OECD average is 4,762 per 100,000 people.

Ars Technica’s summary of the same Commonwealth Fund comparison characterizes the U.S. as a “persistent failure” tied to “high costs, poor health outcomes, and premature deaths.”

The Commonwealth Fund comparisons cited by TechTarget say around 8% of adults, or 27 million people, in the U.S. do not have insurance, and that the uninsured rate is expected to climb under new health policies.

TechTarget also reports that about 23.1% of Americans skip care because of high costs, compared with 11.3% in Canada and fewer than 1 in 10 patients in every other OECD nation.

IEDM/MEI

On the supply side, TechTarget says the U.S. has 8.6 physician graduates per 100,000 people versus an OECD average of 14.5, and it reports only 0.3 primary care providers per 1,000 people compared to an OECD average of 1.1 per 1,000 people.

In Canada, La Presse says a Commonwealth Fund analysis finds Canada has 2.7 practicing physicians per 1,000 people compared with 2.6 for the United States, while Norway is listed at 4.8.

La Presse adds that Canadians are slightly above average in life expectancy at 82 years, while Americans are at 78.6 years and are described as at the bottom of the list despite the highest health care spending.

While the Commonwealth Fund comparisons focus on cross-country performance, a separate Quebec policy discussion in IEDM/MEI centers on expanding pharmacists’ frontline responsibilities to reduce wait times and improve access.

“(Toronto) According to a new report, Canada outpaces the United States, but lags far behind 10 other countries among the wealthiest in terms of the number of physicians per capita”

La Presse

The publication says that in December 2011, the Quebec government adopted Bill 41 aimed at broadening the scope of practice for pharmacists and, in principle, authorizing pharmacists to offer seven new pharmaceutical services.

It lists examples of those services, including extending or adjusting a prescription, substituting a medication in the event of a supply disruption, and prescribing a medication for minor conditions that do not require a diagnosis.

IEDM/MEI says the reform has been slow to implement and that these new acts are still not offered, given the stalemate in remuneration negotiations between the government and the Quebec Association of Owner Pharmacists.

The same text frames the expanded role as “a step in the right direction,” arguing that it is likely to improve access to care for patients and generate savings that the public system needs.