Researchers at the Commonwealth Fund compared the U.S. health care system to those in 19 other wealthy nations belonging to the Organisation for Economic Co-Operation and Development (OECD). Their 2026 findings are summarized in the U.S. Health Care from a Global Perspective report. The 19 comparison countries are: Australia, Canada, Chile, Denmark, France, Germany, Israel, Italy, Japan, Korea, Mexico, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, Turkey, and the United Kingdom.
Like the U.S., all of these countries are dealing with rising health care costs, physician shortages, and aging populations. But when it comes to coverage, affordability, care delivery, and health outcomes, the differences are stark, and they do not reflect well on the U.S.
Health Insurance Coverage: The U.S. Stands Nearly Alone
A significant difference between the U.S. and its peers is who gets health insurance. Of the 19 countries the Commonwealth Fund compared, 18 guarantee health coverage for all of their residents. The U.S. does not.
In the U.S., about 27 million people (8% of the population) have no health insurance at all. Uninsured rates are even higher among Hispanic, Black, and American Indian/Alaska Native residents and in states that have not expanded Medicaid. Mexico is the only other country in the study where a large number of residents lack coverage. However, it has announced a plan to achieve universal coverage by 2027.
While the 18 countries with universal coverage differ in how they deliver and pay for care, all provide comprehensive benefits, including preventive care, primary care, prescription drugs, and maternity care. Notably, the U.S. is the only country in the study to have recently enacted policies that reduce, rather than expand, health coverage.
Affordability: Americans Pay More and Get Less
The U.S. has spent more on health care than any other country for more than four decades. Currently, 18% of gross domestic product (GDP) is used for health care in the U.S. That’s nearly twice the average for OECD countries. In 2024, the U.S. one and a half times more per person than Switzerland, which is the second-highest spending country, and ten times more than Mexico.
Americans face higher out-of-pocket costs than people in other countries. On average, Americans spend more than $400 per year on prescription drugs, compared with less than $100 in France. One in four Americans has coverage with high deductibles or out-of-pocket costs, and people in the U.S. are far more likely than people in other wealthy countries to skip needed care or medications because they can’t afford it.
Care Delivery: Fewer Doctors, Fewer Beds
The U.S. health care workforce is stretched thin, in part because it has the highest medical school tuition in the world and not enough doctors. The U.S. trains about 8.6 new physicians for every 100,000 people, compared with an OECD average of nearly 15 and Denmark’s leading rate of 21.
The shortage of doctors hits primary care especially hard. The U.S. has fewer primary care physicians per person than any of the other countries studied. About one-third of Americans do not have a regular place to go for general care. The U.S. also has fewer hospital beds: three beds per 1,000 people, compared with an OECD average of 4.3.
One bright spot: most Americans who do have a regular doctor report a positive relationship with that provider. They say their doctor listens to them, explains things clearly, involves them in decisions, and spends enough time with them. This is also broadly true in most of the countries studied.
Health Outcomes: Americans Die Earlier and Less Equitably
Despite spending far more than its peers, the U.S. has some of the worst health outcomes among wealthy nations. U.S. life expectancy reached a peak of 79 years in 2024 — two years below the OECD average and third lowest among the countries in the study, ahead of only Mexico (75.5 years) and Turkey (77.3 years). In Switzerland, Japan, and Spain, people live five or more years longer on average than Americans.
The U.S. also has the second-highest rate of avoidable deaths, trailing only Mexico. These are deaths that could have been prevented through good public health measures or timely medical care.
Health inequities in the U.S. are among the widest of any country studied. In every country, women live longer than men, but the gender gap in avoidable deaths is especially wide in the U.S. For every 100,000 people, 160 more men die from avoidable causes. In the Netherlands, Sweden, and Switzerland, that gap is less than 60 deaths per 100,000 people.
Maternal mortality in the U.S. is the highest among the countries studied. On average, nearly 19 mothers die for every 100,000 live births in the U.S. In 11 of the 18 other countries, the rate is below 5 deaths per 100,000 live births. For Black women in the U.S., the rate reaches 50 deaths per 100,000 live births.
The U.S. has the third-highest suicide rate among the countries studied; Korea has the highest. Suicide rates in the U.S. are consistently higher and rising faster in rural areas than in cities. Americans in rural communities are one and a half times more likely to die by suicide than those in cities, partly due to limited access to mental health care.
Can We Do Better?
The U.S. and the 19 countries in this study share many of the same health care challenges: costs are rising everywhere, doctors are experiencing burnout, and populations are getting older. But on the measures that matter most — who has coverage, how much people pay, how healthy they are, and how equitably outcomes are distributed — the U.S. measurably lags behind its peers.
Americans pay more for health care than anyone else in the world, yet live shorter lives, lose more mothers in childbirth, and are more likely to go without needed care because of cost. The inequities within the U.S. are further worsened by race, gender, geography, and income differences.
Future policy briefs in this series will take a closer look at how the U.S. compares to individual countries, what those countries do differently, and what the U.S. might learn from them.