The report
The Commonwealth Fund's 2024 comparison of ten high-income health systems ranked Australia first overall, ahead of the Netherlands and the United Kingdom. The United States came last, by a wide margin. The report scores 70 measures across five areas, drawing on international surveys of patients and primary care doctors from 2021 to 2023 and on OECD and WHO data.
- Where Australia led: it was effectively tied with the UK for best administrative efficiency, helped by electronic claims that pay doctors almost instantly. It ranked top on equity between income groups, alongside Germany, and among the top three on health outcomes.
- Where Australia lagged: it did poorly on access to care, with longer waits for people without private insurance and affordability noted as a problem.
- Equity beyond income: when rural and gender gaps were added, Australia fell to sixth on equity, largely because of poorer rural results. This wider analysis did not count towards the overall ranking.
- Value: Australia and the Netherlands achieved the best overall results while spending the least on health as a share of GDP.
The authors caution that differences between most countries are small, and that the US is the only clear outlier.
Read the full report · Blumenthal D et al. Mirror, Mirror 2024. Commonwealth Fund, September 2024. doi:10.26099/ta0g-zp66. Mirror, Mirror 2024 is the latest edition; the series is published every few years.
Four systems side by side
The US spends far more of its GDP on health than Australia, England or Sweden, yet has the shortest life expectancy and the highest avoidable and maternal mortality. Australia has the most GPs per head of the four, but patients pay the largest share of health spending out of their own pockets.
| Measure | Australia | England | Sweden | United States |
|---|---|---|---|---|
| Health spending (% of GDP) | 10.4 | 11.1 | 11.2 | 18.0 |
| Out-of-pocket (% of health spending) | 15.3 | 14.6 | 12.9 | 7.2 |
| Life expectancy at birth (years) | 84 | 81 | 82.7 | 78.5 |
| Avoidable mortality (per 100,000) | 97 | 227 | 133 | 312 |
| Maternal mortality (per 100,000 live births) | 2.3 | 8.5 | 3.0 | 19 |
| Private insurance coverage (% of population) | 55 | 12 | 7.4 | 66 |
| GPs (per 100,000) | 114 | 64 | 63 | 37 |
| Specialists (per 100,000) | 148.5 | 118 | 234 | 196 |
| Hospital beds (per 100,000) | 252 | 247 | 187 | 266 |
| Gun deaths (per 100,000) | 1 | 0.17 | 1.3 | 14 |
Years vary by country and measure, from 2021 to 2025. For example, Australia's out-of-pocket share is from 2021 and England's avoidable mortality from 2021, so small differences should be read with caution. The US out-of-pocket share is a smaller slice of a much larger bill.
Source: Commonwealth Fund, Country Comparison Tool, data downloaded November 2026.
My comment
It is worth remembering, in the middle of a heated debate about specialist fees, that independent international comparison rates Australia's mixed public–private system as the best performing of the ten countries studied, and among the most efficient. Our weaknesses are real: access, affordability and rural care. They are reasons to fix the system carefully, not to rebuild it on someone else's model. As I argued in my submission to the House inquiry, the task is preserving a high-performing system through sustainable funding, workforce planning and structural reform.
See also: Specialist fees and access and Seven dollars and the no-gap cliff.
The views in this comment are my own and do not represent any hospital, college or organisation I work with.