The United States spends far more on healthcare than any other wealthy nation yet consistently ranks last in overall performance among peer countries. In 2025 data from the OECD, the US spends $14,885 per person on health, compared to an OECD average of $5,967. That gap between spending and results is the defining feature of the American system, and it shows up in nearly every major category: access, equity, outcomes, and administrative efficiency.
Spending: Nearly Double the Next Closest Country
Healthcare consumes 17.2% of the entire US economy, compared to 9.3% on average across OECD nations. That means roughly one in every six dollars generated in the US goes toward healthcare. No other high-income country comes close to this level of spending, whether they use single-payer systems, multi-payer insurance models, or hybrid approaches.
A significant chunk of that extra spending goes not to patient care but to paperwork. A 2017 comparison found that the US spent $2,497 per person on healthcare administration, versus $551 in Canada. That gap breaks down across every layer of the system: insurers’ overhead ($844 vs. $146), hospital administration ($933 vs. $196), and the costs physicians absorb just to deal with insurance ($465 vs. $87). Administration accounts for 34.2% of all US health spending, compared to 17% in Canada, and that gap has been widening over time, driven largely by the overhead costs of private insurers managing Medicare and Medicaid plans.
The practical consequence is that US medical prices include a built-in surcharge to cover the cost of navigating a fragmented, multi-payer system. Canadians and Americans receive care from similarly trained professionals, but the billing infrastructure behind each visit is vastly different in cost.
Overall Rankings Among Wealthy Nations
The Commonwealth Fund’s Mirror, Mirror 2024 report compared healthcare performance in 10 high-income countries. The US ranked last overall. Australia, the Netherlands, and the United Kingdom took the top three spots.
The US didn’t rank last in every category. It placed second for care process, which measures things like preventive care, coordination between providers, and patient engagement. New Zealand ranked first in that category, with Canada and the Netherlands close behind. This reflects genuine strengths in how American clinicians deliver care when patients can actually get through the door.
But the US fell to the bottom on access, equity, administrative efficiency, and health outcomes. Switzerland and the US came in last for administrative efficiency. On equity, the US and New Zealand ranked lowest, with the widest income-based gaps in cost-related access problems and the highest rates of patients reporting unfair treatment based on race or ethnicity. On health outcomes, which includes life expectancy and preventable deaths, the US also ranked last among all 10 countries.
Where the US Delivers Strong Results
The American system has real advantages in specialized and acute care. Cancer treatment is one area where the US performs well relative to peers. The infrastructure for complex procedures, cutting-edge technology, and rapid specialist referrals is extensive. Only 31% of US patients wait a month or more for specialist care, compared to 55% in the United Kingdom and 62% in Canada. If you need to see a specialist quickly and can afford it, the US system often delivers faster access than universal-coverage systems that manage demand through wait times.
The care process strengths also show up in how well providers coordinate treatment and follow evidence-based guidelines. American medicine, at its best, is highly sophisticated. The problem is that these strengths are unevenly distributed and gated behind cost barriers that many other countries have eliminated.
Life Expectancy and Infant Mortality
Despite outspending every peer nation, the US has shorter life expectancy and higher infant mortality than most of them. The US infant mortality rate has historically ranked alongside countries with a fraction of its wealth. In one analysis, the US rate was 6.78 deaths per 1,000 births, compared to 3.21 in Finland, 3.98 in Austria, 4.40 in Belgium, and 5.33 in the UK.
Part of this gap comes from how births are recorded. The US counts more extremely premature and low-birth-weight infants as live births than some European countries do. When researchers adjusted for these reporting differences, the US disadvantage shrank from 2.5 excess deaths per 1,000 to 1.5. But the gap didn’t disappear, and it actually grew worse after the first month of life. Among normal-birth-weight infants, the US still saw 2.3 deaths per 1,000 compared to just 1.3 in Austria and 1.5 in Finland. That postneonatal gap points to differences in ongoing care, follow-up, and the social support systems that keep infants healthy after they leave the hospital.
Access and Affordability
The most persistent weakness of the US system is that cost prevents people from getting care. While 86% or more of adults in all 10 countries studied by the Commonwealth Fund reported having a regular doctor or place of care, the US, Sweden, and Canada had the lowest rates. American adults were the least likely to have a longstanding relationship with a primary care provider, and only about two in five had been with their primary care physician for at least five years, significantly lower than in most comparison countries.
Lack of affordability is described as a “pervasive problem” in the US. Patients report skipping medications, avoiding visits, and delaying care because of costs at rates far higher than in peer nations. US patients are also more likely to report having no regular doctor at all and facing limited options for treatment outside of normal office hours. The number of US adults without a usual source of care has been growing over the past decade.
In most other wealthy countries, universal coverage eliminates or dramatically reduces the financial barrier to walking into a clinic. Systems differ in how they achieve this. Canada uses a single-payer model funded by taxes. Germany and the Netherlands use regulated multi-payer systems where private insurers compete under strict government rules. The UK runs a government-funded national health service. Each approach has trade-offs in wait times and provider choice, but all of them ensure that cost alone doesn’t keep people from seeking basic care.
Why the Gap Exists
The US is the only wealthy country that doesn’t guarantee universal health coverage. Its system is a patchwork: employer-sponsored insurance for working-age adults, Medicare for those 65 and older, Medicaid for some low-income populations, marketplace plans with subsidies, and no coverage at all for millions who fall through the gaps. Each of these channels has different rules, different provider networks, and different out-of-pocket costs, which drives the administrative complexity that absorbs a third of all spending.
Higher prices also play a central role. The same procedures, medications, and hospital stays cost dramatically more in the US than in other countries, partly because there is no single entity negotiating prices across the system. In countries with universal coverage, the government or a small number of regulated insurers have the leverage to set or negotiate prices with providers and drugmakers. In the US, prices are set through thousands of separate negotiations between insurers, hospitals, and pharmaceutical companies, often with little transparency.
The result is a system that produces excellent clinical care for those who can access it, while leaving a larger share of its population underserved than any comparable nation. The US pays more, covers fewer people, and gets worse population-level health outcomes. The quality of care inside the exam room is competitive with the best systems in the world. The challenge is everything that happens before and after a patient gets there.