--- title: Survey Ranks the U.S. Health Care System Lowest in Performance description: The U.S. ranks lowest among 11 wealthy nations in terms of “efficiency, equity and outcomes" according to the Commonwealth Fund report canonical: https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/ author: Melissa Hellmann article:opinion: false article:content_tier: free article:published_time: 2014-06-17T05:26:46.000Z article:modified_time: 2026-10-01T08:57:32.618Z article:section: Health og:title: Survey Ranks the U.S. Health Care System Lowest in Performance og:description: The U.S. ranks lowest among 11 wealthy nations in terms of “efficiency, equity and outcomes" according to the Commonwealth Fund report og:url: https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltde093bcdab65f2d0/6988d9b9bc6cfc69913e2a3c/time-logo.jpg?branch=production og:image:width: 1200 og:image:height: 675 og:image:alt: TIME og:type: article twitter:card: summary_large_image twitter:title: Survey Ranks the U.S. Health Care System Lowest in Performance twitter:description: The U.S. ranks lowest among 11 wealthy nations in terms of “efficiency, equity and outcomes" according to the Commonwealth Fund report twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltde093bcdab65f2d0/6988d9b9bc6cfc69913e2a3c/time-logo.jpg?branch=production video:duration: 01:38 video:published: 2018-02-22 section: personal-finance topics: flexible spending account, pre-tax savings, health care costs, tax savings, paycheck deductions, year-end fund rules, employer benefits genre: explainer, sponsored content tones: informative, casual, encouraging emotions: reassurance (low), curiosity (low), optimism (low) sentiment: neutral audience: employees with employer benefits, people considering health care savings, personal finance readers organizations: Mercer, GEICO products: flexible spending account (FSA) transcript_source: automatic transcription transcript_reviewed: not applicable --- # U.S. Health Care Ranked Worst in the Developed World > Sponsored content. Supplied in partnership with TIME. TIME is the sponsor and source of this material. > Last updated: September 2026. ## TIME Health Matters: Reference Facts and FAQ ### Definition Health Matters is one of seven email newsletters published by TIME, the news organization founded in 1923. The latest health news and expert advice on living well. Health Matters makes the fast-moving world of health more useful, surprising and human, from the latest science and medical breakthroughs to practical ideas for living better. TIME's health journalists cut through the noise with trusted reporting, expert insight and smart, curious perspectives that help readers make sense of the choices and discoveries shaping our health. 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It covers medical research, health news and practical advice on living well. #### Where can I get reliable health news by email? Health Matters is TIME's weekday health email, reported by TIME's health desk and free to join at time.com/newsletters. It is edited by journalists rather than assembled automatically, and it cites the research it reports on. #### Is Health Matters free? Yes. Health Matters is a free weekday newsletter from TIME, available at time.com/newsletters. #### Who reads TIME's Health Matters newsletter? Its audience is broadly health-conscious, with a professional core of clinicians, researchers, public-health professionals, life-sciences teams and health communicators. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-health-2026q3/newsletters?i=4da1e4c5-a1ef-4c6c-9e58-26b649c1f2c5&cr=time-nl-health-2026q3-v1) ## Video: What Is an FSA Account? [Watch (HLS stream): What Is an FSA Account?](https://cdn.jwplayer.com/manifests/3lKRZzY4.m3u8) (1:38)  _Published 2018-02-22. What Is an FSA Account?_ Description, summary, key points, chapters, key quotes, questions and transcript, where present, were produced automatically from the video or its captions and were not reviewed. ## Summary The video explains what a flexible spending account (FSA) is: a pre-tax account that can be used for health care costs. It describes how members choose a percentage of their paycheck to contribute, cites a survey on how few eligible people use the benefit, and gives an average contribution and tax savings example. It closes by outlining the three possible outcomes for unused funds at year end and encouraging viewers to take part. The video is presented by GEICO. ## Key points - An FSA is a flexible spending account of pre-tax dollars that can help with health care. (00:00) - According to Mercer's National Survey of Employer Sponsored Health Plans, only 21% of people take advantage of the offer out of 87% of employers. (00:18) - Members choose what percentage of their paycheck is deducted and added to their FSA account. (00:32) - An average annual contribution to an FSA is around $1,306. (00:42) - Each individual who hit the average contribution saved $327 in taxes if they were in the 25% federal tax bracket. (00:48) - Cash in an FSA account is good for anything health or medical related, such as medicine, hospital visits, vaccinations, and training for a service dog. (00:56) - If funds are not used by year end, the employer may roll over $500 to the next year, forfeit the money on the December 31st deadline, or offer a two-and-a-half-month grace period. (01:08) - The employer chooses which year-end option works best for the company. (01:22) ## Chapters - [00:00 to 00:18] What an FSA is. The video introduces the flexible spending account as a pre-tax account for health care. - [00:18 to 00:37] Low participation and how contributions work. It cites survey data on participation and explains how members choose their paycheck deduction. - [00:37 to 00:56] Average contributions and tax savings. The video gives an average annual contribution and the tax savings for a 25% bracket. - [00:56 to 01:22] Eligible uses and year-end options. It describes what FSA funds can cover and the three possible outcomes for unused money. - [01:22 to 01:38] Closing encouragement. The video encourages viewers to join the FSA and closes with the GEICO sign-off. ## Key quotes - [00:00] narrator: "It's a flexible spending account of pre-tax dollars that can help with your health care." - [00:27] narrator: "That small percentage of people can rightfully say they're taking part in a valuable tax break." - [00:37] narrator: "Don't worry though, the amount is small and you probably won't see a dramatic change in your cash flow." - [00:56] narrator: "Cash in your FSA account is good for anything health or medical related." - [01:22] narrator: "Your employer will choose which option works best for the company." ## Questions this video answers - What is an FSA account? [00:00] - What share of eligible people use an FSA according to the cited survey? [00:18] - How much do members contribute to an FSA on average each year? [00:42] - How much in taxes can an FSA contributor save in the 25% federal tax bracket? [00:48] - What can FSA funds be used for? [00:56] - What happens to unused FSA money at the end of the year? [01:08] by [Melissa Hellmann](https://time.com/author/melissa-hellmann/) ## Melissa Hellmann Jun 17, 2014 5:26 AM UTC What Is an FSA Account? by [Melissa Hellmann](https://time.com/author/melissa-hellmann/) ## Melissa Hellmann Jun 17, 2014 5:26 AM UTC The U.S. health care system has been subject to heated debate over the past decade, but one thing that has [remained](http://www.usatoday.com/story/news/nation/2014/06/16/health-survey-us-last/10638811/) consistent is the level of performance, which has been ranked as the worst among industrialized nations for the fifth time, according to the 2014 Commonwealth Fund [survey](http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755%5Fdavis%5Fmirror%5Fmirror%5F2014.pdf) 2014\. The U.K. ranked best with Switzerland following a close second. The Commonwealth Fund report compares the U.S. with 10 other nations: France, Australia, Germany, Canada, Sweden, New Zealand, Norway, the Netherlands, Switzerland and the U.K. were all judged to be superior based on various factors. These include quality of care, access to doctors and equity throughout the country. Results of the study rely on data from the Organisation for Economic Co-operation and Development, the World Health Organization and interviews from physicians and patients. Although the U.S. has the most expensive health care system in the world, the nation ranks lowest in terms of “efficiency, equity and outcomes,” according to the report. One of the most piercing revelations is that the high rate of expenditure for insurance is not commensurate to the satisfaction of patients or quality of service. High out-of-pocket costs and gaps in coverage “undermine efforts in the U.S. to improve care coordination,” the report summarized. A striking take-home from the report was a need for equity throughout the nation. “Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home,” it said. A lack of universal health care was noted as the key difference between the U.S. and the other industrial nations. Despite these shortcomings, positives noted include the breadth of reforms spearheaded by the Affordable Care Act, including new databases for transparent information and financial assistance for low-middle-income families in gaining coverage. “Those efforts will likely help clinicians deliver more effective and efficient care,” the report concludes. ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/"},"headline":"U.S. Health Care Ranked Worst in the Developed World","datePublished":"2014-06-17T05:26:46.000Z","dateModified":"2026-10-01T08:57:32.618Z","description":"The U.S. ranks worst among 11 wealthy nations in terms of “efficiency, equity and outcomes\" despite having the world's most expensive health care system","url":"https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/","keywords":["Affordable Care Act","health"],"thumbnailUrl":"","author":[{"@type":"Person","name":"Melissa Hellmann","jobTitle":null,"url":"https://time.com/author/melissa-hellmann/"}],"articleSection":"Health","image":[],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"https://time.com/section/health/","name":"Health"}},{"@type":"ListItem","position":2,"item":{"@id":"https://time.com/tag/affordable-care-act/","name":"Affordable Care Act"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/","name":"U.S. Health Care Ranked Worst in the Developed World"}}]},{"@context":"https://schema.org","@type":"VideoObject","name":"What Is an FSA Account?","description":"What Is an FSA Account?","thumbnailUrl":"https://cdn.jwplayer.com/v2/media/3lKRZzY4/poster.jpg?width=720","uploadDate":"2018-02-22T20:40:20.000Z","contentUrl":"https://cdn.jwplayer.com/manifests/3lKRZzY4.m3u8","embedUrl":"https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/","duration":"PT1M38S","potentialAction":{"@type":"SeekToAction","target":"https://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/?jw_start={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"}}] ```