Despite spending more on health care than other high-income countries, the United States still has the lowest life expectancy at birth and the highest rate of people with multiple chronic illnesses, CNN writes, per a recent report.

Independent researchers with The Commonwealth Fund analyzed international health statistics, including data from the Organization for Economic Cooperation and Development, or OECD, which reports on data from health systems in 38 high-income countries. They compared statistics in the U.S. to Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, the United Kingdom, and the OECD average. 

Researchers found that, in 2021, the U.S. spent almost twice as much on health care as the average OECD country, and that the U.S. has the highest death rates from avoidable or treatable causes, the highest maternal and infant death rates, and the highest obesity rate. They also found that Americans visit doctors less often than people in peer nations, which they attributed to a below-average number of physicians in the U.S. and the fact that America was the only country in the study without universal health coverage. 

“Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services,” researchers wrote in the report. “Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.”

“To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population,” said Munira Gunja, senior researcher and the report’s lead author, per CNN.