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BMJ 2017;358:j3442 doi: 10.1136/bmj.

j3442 (Published 2017 July 14) Page 1 of 1



UK has best health system in developed world, US

analysis concludes
Anne Gulland

The UKs healthcare system is the best out of 11 of the worlds The report put the UKs improvement down to major investment
most developed countries, despite having one of the lowest in the NHS from the early 2000s, with an increase in spending
levels of funding. as a share of GDP from 6.2% in 2000 to 9.9% in 2014.
The US health think tank the Commonwealth Fund ranked the The report described the US as an outlier, spending much more
UK number one, closely followed by Australia, then the overall but falling short of the performance achieved by other
Netherlands, New Zealand, Norway, Switzerland, Sweden, countries. The results suggest that the US health care system
Germany, Canada, France, and the US.1 This is the second time should look at other countries approaches if it wants to achieve
in a row that the UK has come at the top of the ranking, carried an affordable high-performing health care system that serves
out every three years.2 all Americans, it said.
The US came last, despite spending by far the most on health: The report highlighted the fact that the US was the only high
16.6% of its gross domestic product, nearly double that spent income country without universal care coverage, and it lauded
by Australia, at 9% the smallest proportion among the 11 the Affordable Care Act, introduced under Barack Obama but
countries, and the UK, at 9.9%. The US spent more than twice being dismantled under Donald Trumps administration, which
per person on healthcare in 2016 than the UK: $9364 (7220; had enabled 20 million more people to gain health coverage.
8205) versus $4094. What this report tells us is that despite the substantial gains in
The Commonwealth Funds analysis ranked health systems coverage and access to care due to the Affordable Care Act, our
across five areas: healthcare system is still not working as well as it could for
Care process, which includes preventive care, safe care, Americans, and it works especially poorly for those with middle
coordinated care, and engagement and patients preferences or lower incomes, said the Commonwealth Funds president,
David Blumenthal.
Access, which looks at affordability and timeliness
Richard Murray, director of policy at the UK health think tank
Administrative efficiency, which includes barriers to care
the Kings Fund, said that the new ranking reflected the strong
and time and effort spent on paperwork
fundamentals of the NHS.
Equity, which compares the experience of lower income He said, Universal access to health services, a founding
and higher income patients, and principle of the NHS, is rightly recognised by the
Healthcare outcomes, which looks at areas such as mortality Commonwealth Fund ranking. Other international comparisons,
and morbidity. which are largely based on measuring the health of the
The UK came top on care process and equity and third on access population of the country, do not always rank the UK as highly.
and administrative efficiency. However, it came 10th on The Commonwealth Fund also recognises these poorer health
healthcare outcomes, mainly because of poorer five year survival outcomes, and this is particularly stark given the cuts to public
from breast and colon cancer than its counterparts. The UK also health spending that were announced recently.
had the second highest rate of deaths amenable to healthcare
1 Commonwealth Fund. Mirror, mirror: international comparison reflects flaws and
(that is, preventable deaths) after the US, with 85 deaths per opportunities for better US healthcare. Jul 2017. www.commonwealthfund.org/publications/
100 000 head of the population. Switzerland had the lowest rate fund-reports/2017/jul/mirror-mirror-international-comparisons-2017.
2 Commonwealth Fund. Mirror, mirror: how the performance of the US healthcare system
of all the countries, with 55 per 100 000. compares internationally. Jun 2014. www.commonwealthfund.org/~/media/files/
However, the report said that the UK had seen the biggest
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improvement in this area over the past 10 years, with a 37%
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decline in mortality amenable to healthcare between 2007 and permissions
2016, whereas the US had only a 16% decline.

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