The U.S. has the most expensive health care system but it ranks last among 11 peer nations in quality, according to a study released Monday that cues up new questions about whether Obamacare will improve things.
The Commonwealth Fund analysis said the U.S. system performs poorly on a spectrum of measures, including infant mortality and preventable deaths, while more than one-third of American adults reported forgoing a test or treatment because it cost too much.
The private foundation has conducted its "Mirror, Mirror" comparison study five times since 2004, and the U.S. has ranked last every time.
Researchers said too much of the country lacks access to affordable care compared to other nations in the study, which ranked the United Kingdom first overall.
"The U.S. is the only country without a major system of coverage for everybody," said lead author Karen Davis, a professor at the Johns Hopkins Bloomberg School of Public Health, in an interview.
Researchers also examined Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland.
The study underscored the mismatch between health care costs and outcomes in America, which spent $8,508 per person on health care in 2011, compared to $3,406 in the U.K.
Researchers relied on data collected before Obamacare's full implementation, making the overhaul a significant wild card for future evaluations. The law extends subsidized coverage to qualified consumers and Medicaid for many of the lowest-earning Americans.
Proponents of the Affordable Care Act (ACA) say it is narrowing health care inequities and will allow more people to take care of themselves, reducing costs over time.
"I think there are some areas where the ACA is going to make a really big difference," said Timothy Jost, a health policy expert at Washington and Lee University School of Law who has testified to Congress in support of the law.
He said the uninsured rate has dropped around the country in recent months, and "if all goes well, it should continue to drop."
But even if Obamacare closes the gap in some areas, observers say high deductible health plans and a lack of primary care doctors to treat patients remain concerns.
"There will still be areas we need to improve," Ms. Davis said.
Some critics say Mr. Obama's overhaul does not go far enough. They want to see a government-administered, single-payer system like the ones that higher-ranking countries have to ensure universal coverage and set rates and prices for health services and drugs.
The Commonwealth study pushed back on assertions that universal coverage comes with longer waiting times, citing the Netherlands, U.K., and Germany as places in the study "with low out-of-pocket costs while maintaining quick access to specialty services."
For all its negatives, the study found America's system does to some things well. Its quality of actual care ranked within the high end of the pack, and Ms. Davis said doctor-patient communication rates highly.
Americans are more likely than those in some nations to receive reminders about preventative care or advice about diet and exercise.
The U.S. also has lower smoking rates than other western countries, although its high obesity rate holds it back.
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