Global Comparison: U.S. Healthcare Spending vs. Outcomes
U.S. Healthcare Spending vs. Outcomes (Global Comparison)
The U.S. spends far more on health care than comparable high-income countries, yet it still ranks worse on several core outcomes (life expectancy, infant and maternal mortality, and avoidable deaths). Below is a clean, source-labeled snapshot that separates internationally comparable metrics (OECD-style) from U.S. national accounting (CMS NHE).
Key numbers (latest available)
Comparable-country average: $7,393 per person (≈ 1.8× lower than the U.S.). Source: Peterson-KFF / OECD.
The U.S. remains far above peer-country levels on this measure. Source: Peterson-KFF / OECD.
Comparable-country average: 82.5 years (gap ≈ 4.1 years). Source: Peterson-KFF / OECD.
OECD average: 4.0 per 1,000 (3-year average 2021–2023). Sources: CDC (U.S.), OECD (OECD average).
Healthcare spending: U.S. vs. comparable countries
Important: International comparisons typically rely on OECD-style definitions so that countries are comparable. For U.S. budgeting and policy detail, the standard reference is CMS National Health Expenditures (NHE). Both are useful — this page labels which one is being used.
Table 1 shows a “clean” two-row comparison (U.S. vs peer average) so the layout stays readable on desktop and converts to cards on mobile. No horizontal scroll is used anywhere.
| Group | Per capita spending (USD), 2023 | Health spending (% of GDP), 2023 |
|---|---|---|
| United States | $13,432 | 16.7% |
| Comparable-country average | $7,393 | Below U.S. level (peer average) |
United States
Comparable-country average
Chart: Per capita spending (2023) — U.S. vs peer average
U.S. national context (CMS NHE): CMS reports $4.9 trillion in National Health Expenditures for 2023 (about $14,570 per person), equal to 17.6% of GDP. CMS projects the health share of GDP rising to about 20.3% by 2033.
Outcomes: what the U.S. gets for the spending
Outcomes reflect both medical care and “outside-the-clinic” drivers (poverty risk, housing, nutrition, substance use, violence, road safety). Still, cross-country comparisons are useful for one direct question: does paying the most translate into leading health outcomes?
The table below uses: (1) Peterson-KFF for life expectancy (U.S. vs comparable average), (2) CDC for U.S. infant and maternal mortality, (3) OECD “Health at a Glance” for OECD averages, and (4) Commonwealth Fund for cross-national preventable mortality.
| Indicator | United States | Benchmark / context |
|---|---|---|
| Life expectancy at birth | 78.4 years (2023) | 82.5 years (comparable avg, 2023) |
| Infant mortality (deaths <1 year per 1,000 live births) | 5.61 (2023) | 4.0 (OECD avg, 2021–2023) |
| Maternal mortality (deaths per 100,000 live births) |
18.6 (2023) Down from 22.3 (2022) |
10.3 (OECD avg, 2023) OECD uses 3-year averages for comparability |
| Preventable mortality (per 100,000; OECD definition, excludes COVID) | 324 (2022 or latest) |
Range in 10-country comparison: 197–271 U.S. highest in Commonwealth Fund “Mirror, Mirror” dataset |
Life expectancy at birth
Infant mortality (per 1,000 live births)
Maternal mortality (per 100,000 live births)
Preventable mortality (per 100,000)
Chart: Outcome gaps (U.S. vs benchmark)
The pattern is consistent: very high spending does not automatically produce top outcomes. Research comparing large, wealthy countries often points to a mix of higher prices, administrative burden, uneven access, and weaker prevention / social supports as major contributors.
Why the U.S. spends more (and still lags on outcomes)
Cross-country research commonly finds that the U.S. gap is driven mostly by higher prices and system complexity (multi-payer administration, billing, and contracting), while outcomes reflect additional factors: access/affordability, primary care strength, chronic disease burden, and social risk factors.
1) Higher unit prices (not just “more care”)
The U.S. often pays more for similar services and products: hospital care, physician services, procedures, and many pharmaceuticals. Even with comparable utilization in some categories, higher prices can create a large spending gap.
2) Administrative overhead
Fragmentation increases costs: billing and coding complexity, prior authorizations, plan switching, contracting, and compliance work. These costs don’t translate directly into better population outcomes.
3) Access, affordability, and delayed care
Higher out-of-pocket exposure can reduce timely care and medication adherence. Cost-related delays are a known pathway from “treatable” to “worse outcome,” especially for chronic conditions.
4) “Outside-the-clinic” health determinants
Housing stability, food security, education, workplace protections, community safety, and substance-use environments are major drivers of mortality and life expectancy. Countries that combine effective healthcare delivery with stronger prevention and social supports tend to convert spending into better outcomes.
What improves cost-effectiveness (high-impact directions)
Different countries use different policy models, but high-performing systems often share practical features that can be adapted:
- Administrative simplification Standardize billing rules and reduce duplicative paperwork so more dollars reach care.
- Price discipline Increase transparency and reduce extreme price variation for similar services.
- Primary care & prevention Improve access and continuity (especially for chronic disease management).
- Maternal & infant support Strengthen prenatal/postpartum access, workforce capacity, and safety-net supports.
- Drug affordability Policy tools that reduce out-of-pocket exposure can improve adherence and outcomes.
CMS projections show health spending growth outpacing GDP growth over the next decade, pushing the health share of GDP higher. That makes cost-effectiveness improvements economically meaningful even if annual changes appear small.
FAQ
Why do some sources show ~16.7% of GDP, while CMS shows 17.6%?
They use different accounting frameworks. International comparisons often use OECD-style “health expenditures” definitions. CMS reports U.S. “National Health Expenditures (NHE)” for national accounting. Both are valid, but not identical.
Is the U.S. “bad at healthcare” or “bad at population health”?
Many analyses show the U.S. can deliver high-quality care for people who successfully access it, but population outcomes still lag due to affordability barriers, uneven access, chronic disease burden, and social risk factors.
What is the simplest summary in one sentence?
The U.S. pays the most (per person and as a share of GDP) but still posts worse outcomes on several core indicators than comparable high-income countries.
Sources (clickable)
- KFF (Peterson-KFF / OECD) — spending comparison (Apr 10, 2025): How Does Health Spending in the U.S. Compare to Other Countries?
- KFF (Peterson-KFF / OECD) — life expectancy comparison (Jan 31, 2025): How Does U.S. Life Expectancy Compare to Other Countries?
- Peterson-KFF Health System Tracker — life expectancy details (includes 2023 values and peer average): U.S. life expectancy vs comparable countries
- CMS — NHE Fact Sheet (2023 totals; projections to 2033): National Health Expenditure Fact Sheet
- CDC — Infant mortality rapid release (rate unchanged at 5.61 from 2022 to 2023): Vital Statistics Rapid Release (Infant Mortality, 2022–2023)
- CDC (NCHS) — Maternal mortality, 2023 (18.6 per 100,000 live births): Maternal mortality rates in the United States, 2023 (PDF)
- OECD — Health at a Glance 2025: maternal & infant mortality (OECD averages and definitions): Maternal and infant mortality (OECD)
- Commonwealth Fund — Mirror, Mirror 2024 (preventable mortality comparison; OECD definition; excludes COVID): Mirror, Mirror 2024 (PDF)
Data note: indicator years differ because each dataset releases on its own schedule. This page uses the latest values available in the sources above and labels years per indicator.
