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U.S. health-care system ranks last among 11 high-income countries, researchers say

Researchers compared the health-care systems of 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

The research relies on 71 performance measures, based on surveys conducted in each country and administrative data from the Organization for Economic Cooperation and Development and the World Health Organization. The measures analyzed fell under five themes: access to care, the care process, administrative efficiency, equity and health-care outcomes.

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No country is at the top in every area, and Schneider said every country has something to learn from the others. But Norway, the Netherlands and Australia were the top-performing countries overall.

The high performers stand apart from the United States in providing universal coverage and removing cost barriers, investing in primary care systems to reduce inequities, minimizing administrative burdens, and investing in social services among children and working-age adults, the Commonwealth Fund found.

The latter is particularly important for easing the burdens on health systems created by older populations, according to Schneider. “These sort of basic supports throughout younger age groups reduce, we think, the chronic disease burden that’s higher in the U.S.,” he said.

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The Netherlands, for example, has a well-organized system of locally placed primary care doctors and nurses who provide care on a 24/7 basis, Schneider said, which helps prevent minor problems from turning into major ones.

The United States was rated last overall, researchers found, ranking “well below” the average of the other countries overall and “far below” Switzerland and Canada, the two countries ranked above it. In particular, the United States fell at the end of the pack on access to care, administrative efficiency, equity and health-care outcomes.

J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, noted that the higher-ranking countries are more homogenous and less populated than the United States, and that they benefit from a stronger societal consensus around “the place that health occupies in the social compact.”

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Morrison called the findings “a pretty stark indictment of the United States.”

The United States has consistently ranked last in the seven comparative reports the Commonwealth Fund has published since 2004, especially on what Schneider described as the related areas of health access and outcomes.

However, on care process — which measures things like preventive care and engagement with patients — the United States performed well in the latest iteration, coming in second place behind New Zealand. The United States has high rates of mammography screening and flu vaccination, for example, and a greater percentage of adults talk with their doctors about topics such as nutrition, smoking and alcohol abuse.

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The data was collected before the pandemic or in its early months, so it does not reflect how the coronavirus has affected health systems. But it sheds light on the state of high-income countries’ health systems heading into the pandemic.

“One could predict, based on the inequities and the relatively weaker primary care, that we would be in a position to struggle in fighting the pandemic,” Schneider said of the United States.

The United States has the highest coronavirus death rate of the surveyed countries, after the United Kingdom.

For those who can afford it, the United States is known internationally for high-quality care. And its resources and capabilities in research and development of treatments made the United States a key player in the development of coronavirus vaccines.

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Coronavirus vaccines are widely available and free for all Americans. But otherwise, many Americans don’t see the benefits of the health system. During the second half of 2019, shortly before the coronavirus reached the United States, 35.7 million people of all ages — or 11 percent of the U.S. population — lacked health insurance, according to data from the Centers for Disease Control and Prevention. And many insured Americans don’t have adequate coverage, Schneider said.

Spending on health care as a share of GDP had grown in all of the countries the Commonwealth Fund surveyed, even before the pandemic. But the increase in the United States has “greatly exceeded” those of other nations. The United States spent 16.8 percent of its GDP on health care in 2019; the next highest country on the list was Switzerland, at 11.3 percent of GDP. The lowest was New Zealand, which spent roughly 9 percent of its GDP on health care in 2019.

Meanwhile, health care in the United States is the least affordable.

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Unlike other countries surveyed, the United States does not have universal health coverage. U.S. doctors are the most likely to face difficulty in getting medication or treatment for patients because of restrictions on insurance coverage, the report found.

“We have almost two health-care systems in America: one for people with means and insurance, and another one that falls short for people who are uninsured or don’t have adequate insurance coverage,” Schneider said.

To examine equity in health care, the study focused on income-related disparities. Australia, Germany and Switzerland have the most equitable systems, the research found, while the United States “consistently demonstrated the largest disparities between income groups” across indicators, apart from those related to preventive services and the safety of care.

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Those inequities contribute to poor health outcomes among marginalized or lower-income groups, Schneider said. The United States ranked last on health-care outcomes among surveyed countries, with the highest infant mortality rate and lowest life expectancy at age 60. The U.S. rate of preventable mortality is more than double that of Switzerland, the highest-performing country in that category.

Health-care disparities fueled underlying conditions in populations with less access to care in the United States, making these populations more vulnerable to covid-19, the disease caused by the coronavirus. Americans are sicker on average than the populations of other high-income countries, according to the report.

Meanwhile, countries such as the United Kingdom — which has universal, and free, primary care coverage — were better able to tap into primary care networks during their coronavirus vaccination rollouts, Schneider said.

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He said the findings demonstrate that the United States should invest more in primary care. The report also emphasizes the need to expand and strengthen insurance coverage, and to focus on “smarter spending.”

“It’s a wake-up call,” Morrison said.

Source: U.S. health-care system ranks last among 11 high-income countries, researchers say

CVS Health raises estimates after strong earnings, but shares fall on investment plans

A view outside a CVS Pharmacy store on July 16, 2020 in Miramar, Florida.

Johnny Louis | Getty Images

CVS Health on Wednesday outpaced analysts' expectations for fiscal second-quarter earnings and raised its forecast for the year, as customers returned to doctors offices and more typical shopping patterns.

Yet shares of the company closed Wednesday down 2.92% to $81.55 as CVS said it anticipated a lower-than-expected number of Covid-19 vaccines and higher-than-expected Covid-related health-care costs this year. It also warned of rising expenses ahead, including an increase in employee wages and investments in technology.

The drugstore chain and health insurer said its business has begun to normalize, as customers buy more items in the front of the store and pharmacists fill more prescriptions. It said use of health-care benefits has returned to a more typical pattern, too, as people resume medical visits and procedures.

Same-store sales rose 12.3% in the second quarter from a year earlier.

However, amid rising Covid-19 cases and the spread of the delta variant, CEO Karen Lynch said CVS remains committed to expanding vaccine access and outreach.

The company said it administered nearly 17 million Covid vaccines and more than 6 million tests in the second quarter.

Ashtyn Evans, an analyst for Edward Jones, said CVS faces risks as it combines its retail, pharmacy and health insurance businesses and tries to become a "one-stop shop" for health care. She said that vision will take time. Plus, she said, it must overcome price pressure in its pharmacy services business. The equity research firm has a hold rating for CVS shares.

Here's what the company reported for the three-month period ended June 30, compared with what analysts were expecting, based on a survey of analysts by Refinitiv:

  • Earnings per share: $2.42 adjusted vs. $2.06 expected
  • Revenue: $72.62 billion vs. $70.3 billion expected
  • CVS reported second-quarter net income of $2.78 billion, or $2.10 per share, down from $2.98 billion, or $2.26 per share, a year earlier.

    Excluding items, it earned $2.42 per share, more than the $2.06 per share expected by analysts surveyed by Refinitiv.

    Revenue jumped to $72.62 billion from $65.34 billion a year earlier, topping expectations of $70.3 billion.

    CVS raised its guidance for the year, saying it expects 2021 earnings per share will range from $6.35 to $6.45, and after adjustments from $7.70 to $7.80.

    As of Tuesday's close, shares of CVS were up about 23% this year. Shares closed on Tuesday at $84, bringing the company's market value to $110.59 billion.

    Read the full press release here.

    Source: CVS Health raises estimates after strong earnings, but shares fall on investment plans

    Special French court OKs most of new law on health pass

    A French constitutional court has validated most aspects of a new law that, starting next week, requires that people carry a special COVID-19 health pass to access cafes, restaurants, long-distance travel and, in some cases, hospitals


    August 5, 2021, 4:14 PM

    • 3 min read

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    PARIS -- A French constitutional court on Thursday validated most aspects of a new law that, starting next week, requires people to carry a special COVID-19 health pass to access cafes, restaurants, long-distance travel and, in some cases, hospitals. But it struck down several measures for not meeting constitutional muster.

    The Constitutional Council ruled that the automatic 10-day isolation of people infected with the virus goes against French freedoms. It was unclear what immediate effect that would have. The court also struck down suspension of short-term contracts for those without a health pass.

    The health pass has ardent opponents, with many claiming their freedoms are compromised. It is issued to people either vaccinated against COVID-19, or who have proof of recent recovery from the infection, or a recent negative test.

    Starting Monday, it will be required for using long-distance travel by train, plane or bus, entering restaurants, cafes and their terraces and rest homes — among a long list laid out in the law and approved in the ruling.

    The Council also approved obliging health care workers to be vaccinated against the virus by Sept. 15. And it ruled that requiring the health pass for hospital visitors and others is justified — if it “doesn't create an obstacle to accessing health care.”

    The legislation was sped urgently through parliament last week as virus infections soared, due to the highly contagious delta variant which now accounts for most cases in France.

    Polls show most French support the pass. But vocal critics complain that it limits their movements outside home — and implicitly renders vaccinations obligatory. Opponents have demonstrated around the country for the past three Saturdays, with more protests expected this weekend.

    The Constitutional Council which examined the law is a special court which, among other things, reviews the constitutionality of legislation.

    Dozens of protesters have been holding sit-ins in front of the Council building in Paris for several days, and on Thursday police chased some out of a nearby square.

    The health pass has been in effect since July 21 for cultural and recreational venues, including cinemas, concert halls and theme parks with capacity for more than 50 people. But the new law to go into effect on Monday vastly extended its application.

    Many restaurant owners say it is not their job to enforce the law, checking each client for a pass. Some health professionals have voiced fears that patients in need of non-urgent treatment could suffer.

    “Quite a few people have told us they wouldn’t be coming back once the health pass is implemented,” said Vanessa Shi, co-owner of a noodle restaurant near the Champs-Elysees Avenue.

    “We’ve been insulted on several occasions, with people calling us sell-outs and worse for saying we would implement the measure,” she said. “But with the bills we’ve racked up during the pandemic ... it’s a matter of survival for us."

    More than 28,700 new infections were reported as of Wednesday evening, a steep climb from one month ago. The pandemic has claimed more than 112,000 lives in France.


    Follow all of AP’s pandemic coverage at, and

    Source: Special French court OKs most of new law on health pass

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