Key Findings from the 2024 World Index of Healthcare Innovation

Executive Summary

There was a fair amount of movement in FREOPP’s fourth annual World Index of Healthcare Innovation (WIHI). But at the top, there was one constant: Switzerland, which ranked first in the 2024 rankings, as it did in 2022, 2021, and 2020. (Note: FREOPP did not complete a 2023 version of WIHI due to data limitations among various countries. We will add 2023 results to the next version of WIHI to show year-by-year trends through 2025. In addition, the 2022 version of WIHI was released in early 2023, due to delays in country data reporting and analysis. For WIHI 2024, we return to naming each version of WIHI based on the year of the report’s release.)

Four countries earned an Elite overall rating: Switzerland (1st), Ireland (2nd), Germany (3rd), and the Netherlands (4th). Switzerland was consistently strong across all dimensions

While Switzerland’s performance has been consistent through the years, a number of other countries have moved significantly within the rankings since 2020. France (+11) is now the biggest mover up the charts, driven by across-the-board improvements in the Quality and Choice dimensions. Notably, Nordic countries Finland (+9), Denmark (+8), Norway (+7), and Sweden (+7) all improved substantially. Denmark’s rise is driven by better access to new treatments; Sweden’s improvements came from patient-centered care and performance during the pandemic; and Norway significantly slowed the growth of public health spending relative to the size of its economy.

The most significant declines in the rankings since 2020 belong to the Czech Republic (-12), Singapore (-6), Israel (-6), and Austria (-6). All four declines were in part the result of declines in Fiscal Sustainability. The Czech Republic declined on the Quality and Science & Technology dimensions, while Singapore declined mostly on Choice. Austria experienced declines across all dimensions, while Israel saw the greatest drop in Quality.

The United States climbs back to 7th

The United States’ rise to 7th place reverses a trend of decline in previous years of the Index. The rise is primarily fueled by improvements in the pandemic preparedness and response element (7th in 2024 vs. 23rd in 2022). The United States also experienced modest yet vital increases in the fiscal sustainability dimension as well as the Choice dimension because of greater access to biosimilar drugs.

The United States continued its dominance atop the rankings for Science & Technology (78.64) over second-ranked Switzerland (62.25).

About the Index

The World Index of Healthcare Innovation, begun in 2020, is the most comprehensive comparison of healthcare systems in high-income countries. WIHI examines healthcare systems across four dimensions: Quality, Choice, Science & Technology, and Fiscal Sustainability.

WIHI includes the 32 countries with populations over five million people and who have the highest gross domestic product per capita on a purchasing-power (PPP) basis. In 2022, the Index added the Kingdom of Saudi Arabia, which met these criteria.

Notably, WIHI includes five high-income Asian countries that are not members of the Organisation for Economic Co-operation and Development (OECD): Hong Kong, Saudi Arabia, Singapore, Taiwan, and the United Arab Emirates. This is significant because most other comparisons of health systems only examine OECD countries, and thereby exclude a number of nations with high-performing healthcare.

For more on the methodology used in the Index, click here. For more on what makes the Index different from other institutions’ comparisons of national healthcare systems, click here.

The success of universal private health insurance

Contrary to the perception–particularly in the United States – that universal coverage can only be achieved through a “single-payer” system in which private health insurance is abolished and replaced by a government-run insurer, four of the top five countries in the 2024 Index have achieved universal coverage using private insurance: Switzerland, Ireland, Germany, and the Netherlands. Two other nations in the top 10 also achieve universal coverage through strong private markets. Ninth-ranked Australia achieves universal coverage through the availability of both public and private insurance, much like how Americans have the freedom to choose public schools, or pay extra for private education. And 10th-ranked Belgium offers coverage through private non-profit insurers as well.

Why do countries with universal private insurance do so well in the FREOPP survey? There are several reasons. Private insurance systems empower patient choice and create room for insurers to organically evolve their benefit designs without having to wait for politicians or regulators to act. In addition, universal private systems tend to be more fiscally sustainable because countries can means-test their subsidies and phase them out as patients ascend the income scale.

Notably, the United States, with its hybrid public-private system, does not meaningfully means-test its subsidies. Wealthy individuals over 65 get heavily subsidized coverage through Medicare, and high earners under 65 receive large subsidies through the tax code for employer-based coverage.

The highest-ranking single-payer country was Norway (5th).

The Index rated countries ranked 5th through 16th as having Good healthcare systems. Norway (5th), Denmark (6th), the United States (7th), Sweden (8th), Australia (9th), and Belgium (10th) rounded out the top 10 overall in the Index. These were followed by Israel (11th), the United Kingdom (12th), Taiwan (13th), Finland (14th), Singapore (15th), and the Hong Kong special administrative region (16th).

Countries ranked 17th through 27th were rated Moderate, including France (17th), Canada (18th), the Czech Republic (19th), Spain (20th), New Zealand (21st), South Korea (22nd), Portugal (23rd), Austria (24th), Greece (25th), United Arab Emirates (26th), and Japan (27th).

Countries rated Poor hailed mostly from southern and eastern Europe: Slovakia (28th), Hungary (29th), Italy (30th), Poland (31st), and Saudi Arabia (32nd).

Other predictors of success

Entering the fourth year of the Index, certain patterns have emerged for measures that strongly predict higher rankings in the Index. 

One such measure is treatable mortality. Poor-performing countries on treatable mortality had the lowest overall scores in the Index, with improvements in treatable mortality correlating with higher overall WIHI scores. Once a country ranked in the 75th percentile of treatable mortality, the effects appeared mostly flat in terms of overall WIHI score. We delve deeper on treatable mortality as a key measure of health system success in a companion WIHI paper soon to be released.

Perhaps most stunning was the strong association between each country’s Science & Technology dimension score and overall score, with a 20-point increase in Science and Technology associated with a 15-point increase overall. While causative factors should be explored, the results suggest that the nations that have a good balance of quality, choice, and fiscal sustainability should further invest in science and technology to make the biggest overall gains in health system performance.

Paradoxically, Fiscal Sustainability metrics had a smaller impact on final WIHI scores and rankings than we expected, given the relative weight of each individual measure in the dimension.

The impact of COVID-19 on our rankings

As detailed in our methodology paper [TK link TK], WIHI weighs each country’s response to the COVID-19 pandemic relative to other factors. For this year’s Index, we also incorporated a series of measures to predict which countries would be most prepared for the next pandemic; therefore, performance during the COVID-19 pandemic itself has taken on a diminished role as it recedes into memory. Countries that are best prepared for the next pandemic have systems in place to prevent and detect emerging pathogens and to treat exposed individuals. They also are supported by strong political institutions and the rule of law. 

The winner this year in the pandemic preparedness and response element was Australia, a country that not only performed well during the COVID-19 pandemic but also demonstrated a high degree of preparedness for the next one.

<Figure>

The United States ranked 7th overall in pandemic preparedness and response. Despite ranking 23rd in COVID-19 performance, the United States has world-class prevention and detection systems and a resilient healthcare system to treat patients once they are infected.