Intended for healthcare professionals


US lags in health care despite largest investment, survey shows

BMJ 2006; 332 doi: (Published 13 April 2006) Cite this as: BMJ 2006;332:869
  1. Nellie Bristol
  1. Washington, DC

    Ill people in the United States were more likely than those in other countries to report receiving the wrong drugs and incorrect or delayed test results, shows a survey of similar patients in six developed countries.

    The survey, which was conducted by the New York based Commonwealth Fund, a private foundation that works towards improving healthcare coverage and quality, showed that the United States scored last in four of six categories—efficiency, patient centredness, equity, and patient safety—even though it spends upwards of $2500 (£1440; €2700) more per person on health care than the next highest spending country surveyed.

    The survey showed that the amount spent on health for each person in the US, adjusted for cost of living, was $5635.

    The country spending the least, at $1886 per person, was New Zealand.

    Germany scored the highest overall, coming first in three of the six categories, followed by New Zealand, then the United Kingdom, Australia, and Canada. The UK was top in patient safety and equity.

    “These findings indicate that, from the perspective of the patients it serves, the US health care system could do much better in achieving high quality performance for the nation's substantial investment in health care,” the study states. Karen Davis, president of the Commonwealth Fund, led the research team.

    In assessing efficiency, the survey showed that ill Americans visited emergency departments more often than citizens of other countries for treatment of conditions that could have been handled in primary care clinics had they been available. They also were more likely to report that laboratory test results and medical records failed to reach their doctor's office in time for their appointment.

    Concerning the issue of equity, more than two fifths of US adults on a low income said that they went without care they needed because of the cost.

    However, the US ranked highest in the effectiveness category, which included provision of preventive care and care for chronically ill patients.

    Embedded Image


    • Embedded ImageLonger versions of these articles are on

      Mirror, Mirror on the Wall: An Update on the Quality of American Health Care through the Patient's Lens is available at

    View Abstract

    Log in

    Log in through your institution


    * For online subscription