The UK has been ranked at the top of an 11-nation league table for the performance of its healthcare system, although the survey finds that it lags “notably” on health outcomes.

And the US ranks last in the survey, which is conducted by US health policy think tank the Commonwealth Fund to examine the healthcare systems of the 11 nations in terms of quality, access, efficiency and equity, as well as indicators of healthy lives such as infant mortality.

The Fund grades the UK system best overall, followed by Switzerland, then Sweden, Australia, Germany, The Netherlands, New Zealand, Norway, France, Canada and finally the US. 

The UK come first for quality of care, and for all the sub-sections in this category – effective care, safe care, coordinated care and patient care. It is also top for efficiency and for access, and for the “cost-related problem” subsection of access, but drops to third for timeliness of care behind Switzerland and the Netherlands, placed first and second respectively.

The UK is first for efficiency and second for equity, behind Switzerland – but drops to 10th place in terms of healthy lives, ahead only of the US. France comes first in this category, followed by Sweden and Switzerland.

Also, in 2011, healthcare spending per capita in the UK was the second lowest for the group, at $3,405, behind New Zealand at $3,182, the study reports. Australia spent $3,800, Sweden $3,925, France $4,111, Germany $4,495, Canada $4,522, the Netherlands $5,099, Switzerland $5,643, Norway $5,669, while the US spent $8,508.

While the US healthcare system is the world’s most expensive, it consistently underperforms relative to other nations. Most troubling, it fails to achieve better health outcomes than the other countries, and ranks last or near last on dimensions of access, efficiency and equity, the Fund reports.

The lack of universal healthcare coverage in the US means that people there go without needed care because of cost more often than citizens of other countries, although they do have rapid access to specialised services, the survey finds. While it notes the “frequent misperception that trade-offs between universal coverage and timely access to specialised services are inevitable,” it reports that, in fact, “the Netherlands, UK and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.”

Also, US physicians face particular difficulties receiving timely information, coordinating care and dealing with administrative hassles. “Other countries have led in the adoption of modern health information systems, but US physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems,” says the study.