HealthDay News — The United States’ health-care system ranks last when compared with other industrialized nations in regards to affordability and patient access, according to the results of a survey published in the New England Journal of Medicine.

“The United States has been unusual among industrialized countries in lacking universal health coverage,” wrote Karen Davis, PhD, of  the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“Financial barriers to care, particularly for uninsured and low-income people, have also been notably higher in the United States than in other high-income countries.”

To measure income-related disparities in access to health care among the United States and 10 other industrialized countries, the investigators conducted a survey prior to the full implementation of the Affordable Care Act (ACA).

Among the countries surveyed, the United States ranked last in health-care measures related to financial access to care and availability of care on weekends. At least three in 10 Americans reported that money is a barrier to getting medical attention, compared with roughly one in 10 residents of other countries polled.

Leaders in equitable financial access to care included the United Kingdom, France, Germany, Norway, Sweden, and Switzerland – all countries that provide coverage to its residents through nonprofit private insurances plan with deductibles; public health-care systems for the entire population; or social insurance systems with competing private ‘sickness funds’.

Primary-care providers have been called out for their crucial role in patient care. “Practices that provide patient-centered, coordinated care are considered the foundation of a high-performance system,” wrote the researchers.


  1. Davis K et al. N Engl Med. 2014; doi: 10.1056/NEJMp1406707