03/03/2026
U.S. Healthcare System: Spending More for Less
The United States has one of the most advanced medical systems in the world. It has leading hospitals, new medical technology, and highly trained doctors. Even with these strengths, Americans often experience worse health outcomes than people in other wealthy countries (Tikkanen & Abrams, 2020).
Health outcomes are usually measured using life expectancy, infant mortality, maternal mortality, and rates of disease. When researchers compare these measures across developed countries, the United States often ranks near the bottom (OECD, 2023).
One important example is life expectancy, which is the average number of years a person is expected to live. Americans live several years less than people in many other high-income countries (OECD, 2023). This gap has grown in recent years, especially after the COVID-19 pandemic.
Another important measure is infant mortality, which counts how many babies die before their first birthday. The United States has a higher infant mortality rate than most wealthy nations (CDC, 2022). Experts often connect this to differences in access to prenatal care, poverty, and health insurance coverage.
The maternal mortality rate in the United States is also much higher than in other developed countries (CDC, 2022). Many maternal deaths are considered preventable with earlier care, better follow-up, and improved access to medical services.
These patterns show a surprising problem: the country that spends the most on health care does not always produce the best results.
Access to Health Care
One major reason for weaker health outcomes is access to care. Unlike most wealthy countries, the United States does not have universal health coverage. While many Americans receive insurance through jobs or government programs, millions of people remain uninsured or underinsured (Tikkanen & Abrams, 2020).
Even people with insurance sometimes struggle to afford care. High deductibles, copayments, and prescription costs can cause patients to delay treatment. When people skip preventive care or wait too long to see a doctor, health problems can become more serious.
Primary care access is also different in the United States. Other countries often focus on regular doctor visits, prevention, and early treatment. The U.S. system is more focused on specialized and emergency care, which is usually more expensive and happens later in illness.
Chronic Disease
Chronic disease is another major factor affecting health outcomes. Chronic diseases are conditions that last a long time, such as diabetes, heart disease, asthma, and obesity.
The United States has higher rates of several chronic diseases than many other wealthy countries (OECD, 2023). Obesity, in particular, is more common in the U.S., which increases the risk of other health problems.
Chronic illness can lower quality of life and shorten life expectancy. It also increases health care spending because people need long-term treatment and medication.
Prevention plays a big role in reducing chronic disease. Countries that invest more in public health programs, nutrition support, and preventive care often see better long-term outcomes.
Social and Economic Inequality
Health is affected by more than medical care. Social and economic conditions also play a major role. These are often called social determinants of health.
Examples include:
• income
• education
• housing
• access to healthy food
• safe neighborhoods
In the United States, health outcomes vary widely between different groups of people. For example, maternal and infant mortality rates are higher among low-income families and some racial groups (CDC, 2022).
Rural communities may also have fewer hospitals, fewer doctors, and longer travel times for care. These differences can lead to worse health outcomes.
Many wealthy countries invest more in social programs that support families, children, and workers. These investments can improve health over time.
Health Care Costs
The United States spends far more per person on health care than other wealthy countries (Tikkanen & Abrams, 2020). However, Americans do not necessarily visit doctors more often or stay in hospitals longer.
Administrative complexity is another challenge. The U.S. health system includes many insurance companies, payment systems, and rules. This complexity increases costs without improving health outcomes.
High costs can make care harder to afford, which can lead to delayed treatment and poorer health.
Prevention and Public Health
Public health programs focus on preventing illness before it begins. These include vaccinations, screenings, nutrition programs, and education about healthy behaviors.
The United States spends less on public health, as a share of total health spending, than many other wealthy countries (OECD, 2023). When prevention is underfunded, chronic disease and emergency care costs can increase.
Investing in prevention often improves health outcomes over time and reduces long-term costs.
The United States spends more on health care than any other wealthy nation, but health outcomes are often worse. Americans have shorter life expectancy and higher rates of infant mortality, maternal mortality, and chronic disease.
Several factors help explain this problem. These include unequal access to care, high rates of chronic illness, social and economic inequality, and higher health care costs. The U.S. system also spends less on prevention compared to many other countries.
Improving access to care, supporting public health programs, and addressing social factors could help improve health outcomes in the future.
References
Centers for Disease Control and Prevention. (2022). Maternal mortality rates in the United States.
https://www.cdc.gov
Organisation for Economic Co-operation and Development. (2023). Health at a glance 2023: OECD indicators.
https://www.oecd.org/health/health-at-a-glance/
Tikkanen, R., & Abrams, M. K. (2020). U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? Commonwealth Fund.
https://www.commonwealthfund.org
Roughly 55 percent of Medicaid enrollees are working full or part time, and a number aren’t eligible for health insurance through their jobs. Read more in an explainer here.