The United States has, by far, the most expensive healthcare system in the world. We might reasonably expect that our outsized expenditures on healthcare would produce significantly better health outcomes than in countries that spend far less. 

But despite our massive investment, the United States consistently fares far worse than almost all of the rest of the world’s rich, democratic countries on a range of the most important basic health indicators. 

In 2024, the United States spent 17.2 percent of its GDP on healthcare, substantially more than every other democratic country with a roughly comparable standard of living (Figure 1). 

Figure 1

According to data from the Organization for Economic Cooperation and Development (OECD), US spending was almost five percentage points more than the level in the second-highest comparable economy, Germany (12.3 percent). In about half of the remaining comparable economies in Figure 1, the share was between 10.0 percent (Netherlands) and 11.8 percent (Austria and Switzerland). In the other half of countries, the share was below 10 percent. 

Even with these much higher levels of healthcare spending, the United States performs poorly on foundational measures of health outcomes.

Life expectancy in the United States (78.4 years) is much lower than the vast majority of the other rich democracies in Figure 2, which range from 81.0 years in the United Kingdom to 84.2 years in Switzerland. The United States outperforms China (78.0 years) by a small margin, but lags behind Chile (81.6 years) by more than three years.

Figure 2

The infant mortality rate in the United States is also higher than every other comparable economy (Figure 3). About 5.6 of every 1,000 live births in the United States die within the first year of life. This rate is more than twice the rate in Spain (2.6), South Korea (2.5), Italy (2.5), Denmark (2.4), Sweden (2.1), and Norway (2.1), and more than three times the rate in Japan (1.8), Finland (1.8), and Iceland (1.4). The US rate is better than Chile (6.1), but worse than China (4.5).

Figure 3

The United States does particularly badly when it comes to maternal mortality (Figure 4). At 21.1 deaths per 1,000 live births, the United States is sandwiched between China (23.0) and Chile (15.0), with the Chilean rate 29 percent better than in the United States. Among comparable economies, the United States has a maternal mortality rate almost double Portugal (11.8), three times New Zealand (7.0), more than four times Ireland (5.0), and more than six times Spain (3.4). 

Figure 4

Some defenders of the existing US healthcare system argue that it is wrong to judge US healthcare by this set of core indicators because the main drivers of these poor outcomes are tied to US patterns of diet, exercise, driving, and violent crime. To the extent that this is true, the generally much better results in peer economies still suggest that we could divert large portions of current healthcare spending to address those other causes of poor outcomes without having a negative impact on the quality of care we provide.

Data Notes

All the underlying data presented here were assembled and made internationally comparable by the OECD. See https://data-explorer.oecd.org/ for data and details.

For maximum comparability, countries included all were: relatively rich; democracies; and not part of the former socialist bloc countries. Including Eastern Europe countries where the data are available does not alter the relative position of the United States. To add an additional comparative element, the figures also include data for two lower-income countries, Chile and China.

Data on infant mortality do not control for some national differences in measurement. Controlling for these definitional differences does not affect the relative position of the United States, but would require excluding many of the countries in the figure.