Which Country Has The World’s Best Health Care
Ezekiel J. Emanuel is the Vice Provost for Global Initiatives and Co-Director of the Healthcare Transformation Institute at the University of Pennsylvania. He also serves as the Special Advisor to the Director-General of the World Health Organization. In Which Country Has the World’s Best Health Care, published in 2020, Emanuel addresses questions frequently asked by American audiences and uses international comparisons to identify insights for reforming the U.S. health care system. He evaluates health systems in the United States and ten other countries—Australia, Canada, China, France, Germany, the Netherlands, Norway, Switzerland, Taiwan, and the United Kingdom—through seven lenses: history, coverage, financing, payment, delivery, pharmaceutical regulation, and workforce. Notably, Emanuel observes that global rankings of public health system preparedness has little relation to how effectively countries responded to the COVID-19 pandemic.
Which Country Has The World’s Best Health Care reaffirms the widely held view that the United States underperforms across multiple dimensions. On average, drug prices in the U.S. are 56% higher than in European countries, making pharmaceuticals the single largest driver of higher health care costs. The U.S. lags in coverage, quality, and cost efficiency, hindered by ideological divides, insufficient subsidies, and systemic complexity that continues to block the path to universal coverage. Despite this, Emanuel remains cautiously optimistic. He notes the strength of the U.S. in health care delivery innovation, particularly in chronic care coordination. Like the Netherlands, the U.S. has pockets of excellence—pilot programs and institutional innovations that offer promise and deserve further study or replication.
Emanuel offers several actionable lessons from abroad that could be adopted in the U.S.:
Implement automatic enrollment and increase subsidies to move toward universal coverage.
Provide free coverage for children.
Simplify the health care system to reduce administrative burdens and costs.
Prioritize and increase compensation for primary care providers.
Expand best practices in chronic and mental health care.
Join the global consensus on regulating drug prices.
Importantly, Emanuel emphasizes that no country has found a fully sustainable and efficient model for addressing mental health care, curbing rising costs of chronic conditions, or eliminating low-value care. Across systems, issues like administrative inefficiency and financial strain remain pressing. Which Country Has The World’s Best Health Care identifies seven major challenges common to all high-income health care systems:
Rising cost pressures across the board
Escalating drug prices
Inefficiencies and unnecessary care
Poorly developed proactive chronic care coordination
Misalignment between care delivery models and chronic health needs
Lack of integration between mental and physical health care
Unresolved long-term care funding and provision
These challenges are intensifying due to two global mega-trends: aging populations and the proliferation of expensive medical technologies. As a result, health systems face increasing burdens: a growing population with multiple chronic conditions, greater demand for coordinated care, and rising needs for long-term care services.
Country highlights that stood out to me:
France: Prescription drug spending is kept in check with a national annual growth cap; companies must rebate 50–70% of revenue that exceeds the cap.
Germany: Highly favorable for patient choice and one of the few countries with a dedicated tax to fund long-term care.
Switzerland: Lacks chronic care coordination and integrated mental health care. National data on provider performance and health equity is also missing.
Australia: Political leadership has historically alternated between the center-left and center-right coalitions, influencing health policy accordingly.
China: A fragmented system with wide disparities across regions. The hospital-centric model, unequal resource distribution, and a lack of trust between doctors and patients present serious challenges. Mental health remains highly stigmatized, with fewer than 10% of those affected seeking treatment.
Key Takeaways:
Universal health coverage is a relatively recent achievement, even in high-income countries.
Although the paths differ, no country has reversed course once universal coverage is in place.
Health systems are path-dependent and shaped by history and politics.
In summary, politics play a central role in shaping health care policy—a theme that I notice throughout the book. Which Country Has the World’s Best Health Care is a compelling, accessible read for policymakers, researchers, political scientists, and health economists alike. It challenges readers to think globally while advocating for practical, evidence-based reforms at home.
