By N. Adam Brown, MD, MBA & Genevieve Friedman

We both recently interacted with the healthcare system in other developed regions -- one of us (Friedman) as a patient in Hong Kong and the other (Brown) through conversations with other healthcare professionals in the U.K. Soon after, we got to talking about our experiences and how they differed from care in the U.S. How did the quality and prices compare? And how did the reality of our experiences abroad compare with what we might have expected?

U.S. healthcare gets a bad rap. According to a 2021 Pew Research Center analysis, a median of 48% of respondents from developed nations in Europe and Asia say the U.S. healthcare system is below average and 18% consider it the worst among developed nations. While Americans are somewhat more positive about their own healthcare system, 32% say it is below average compared to other developed nations and 7% say it is the worst. In fact, Americans' perspective on the quality of U.S. healthcare has reached a 24-year low. Yikes!

How does this reputation stack up with reality and how does it compare to what we saw abroad? Let's take a look.

Hong Kong

On my recent journey home from Thailand, I (Friedman) fell ill with a bad case of food poisoning (damn that chicken pesto airport sandwich!). The fun started after takeoff on my flight from Bangkok to Hong Kong where I had a layover. I was hit with the classic symptoms, and after landing, the flight staff told me I'd need to go to the hospital to get a "fit to fly" letter before I could get on a long-haul flight to New York.

Before leaving the airport, I was stopped by health department workers and questioned, perhaps for surveillance or to ensure it wasn't a contagion of some sort. Once satisfied, they put me in an ambulance -- free of charge -- and shipped me off. Upon admission, I paid the equivalent of US $158 for whatever care I needed -- this ended up including IV rehydration and metoclopramide (Maxolon), and a big goody bag of anti-nausea and mild pain medication to take home.

Despite it being a Saturday night, there were just two or three other patients in the emergency department. The healthcare team spoke English well and checked on me regularly. Overall, I felt like I got great care. And for $158 and a free ambulance ride, it felt like a steal. Meanwhile, I couldn't help but think about an op-ed from Surgeon General Jerome Adams, MD, MPH, about his $10,000 bill for a dehydration-related hospital visit in Arizona.

While I had a positive experience, is that how Hong Kong residents see their healthcare system?

The healthcare industry in Hong Kong has undergone significant changes since the 1970s, as Hong Kong transitioned from colonial status to a special administrative region of China. At present, Hong Kong offers universal healthcare in addition to private options. The public system has a reputation for long wait times, overcrowding, and physician shortages, leading two-thirds of residents to report dissatisfaction with public health services. Long working hours have caused many doctors to quit public hospitals. These problems have contributed to growth in the private market: Nearly half of Hong Kong residents had private coverage as of 2019 and the government wants more to buy it to reduce pressure on the government system.

These problems aside, Hong Kong is one of the healthiest places in the world (based on life expectancy), despite its low expenditures compared to the U.S. (We spend approximately 250% more on public healthcare per capita than Hong Kong.)

And, importantly, everyone has access to care. That's a huge win in my book.

The U.K.

As a business school professor teaching future biomedical pharmaceutical executives in Europe -- the very people who should be excited about free markets -- I (Brown) am often struck by a common discussion theme: the widespread belief that the U.S. healthcare system is fundamentally broken.

My students at ESCP Business School in Paris and London, who are European, view our system with confusion and frustration. Even U.S. students -- I also teach at UNC Kenan-Flagler Business School -- acknowledge gaps, especially when it comes to cost, equity, and access.

During a recent trip to the U.K., I had a conversation with a private dentist in London who shared insights on how Britons navigate between the public National Health Service (NHS) and private care. The dentist acknowledged common frustrations with the NHS in terms of both medical and dental care. There are long wait times for non-urgent procedures and routine specialist visits. And, according to data from March 2025, the number of emergency department patients waiting more than 12 hours for admission was about 29 times higher than it was in February 2020.

While a November 2024 Ipsos poll found Britons are frustrated with these waits and want them fixed, about half still say they will not pay for private insurance to supplement their care.

The dentist I spoke with also emphasized something striking: in the U.K., very few people fear being bankrupted by a dental emergency, a hospital visit, or an unexpected diagnosis. NHS offers a safety net that covers everyone, regardless of employment or income. That kind of peace of mind is rare in the U.S., where six in 10 people say they went without needed care because of cost.

I also spoke with an individual whose family splits time between the U.K. and the U.S. In the U.S., the family has faced high insurance premiums, opaque billing practices, and surprise charges. In the U.K., while care may be slower for certain procedures, their financial burden is minimal, and they report that care is more predictable.

The data support these anecdotes. In 2023, U.S. healthcare spending reached $4.7 trillion, accounting for nearly 18% of GDP. The U.K., by contrast, spent approximately 10.9% of GDP on healthcare, while managing to provide universal coverage through the NHS. On a per-capita basis, the U.S. spends more than $13,400 per person per year -- more than double the U.K., which spends just over $6,000.

All Developed Nations Are Not the Same

In the U.S., our health outcomes don't always reflect the fact that we pay more. The U.S. has some of the best cancer survival ratesopens in a new tab or window in the world, up there with China (35.9% in China and 33.1% in the U.S. versus 20.7% in the U.K.), and innovation in specialty pharmaceuticals and complex surgical care is unmatched. But when it comes to life expectancy and managing chronic conditions, we lag behind most peer nations. Preventive care is underutilized. Disparities in access, especially among Black, Latino, rural, and low-income communities, are glaring. And more than 26 million Americans are uninsured -- a number poised to increase under the current administration.

The difference between the U.S. and Hong Kong and the U.K. is that here we view healthcare as a commodity, not a public good. We may have top-tier academic medical centers and cutting-edge biotech innovation, but not everyone benefits. We don't have to copy the NHS or Hong Kong, which face difficult realities too, but we can learn from them. In those countries, healthcare doesn't feel exhausting, confusing, and financially terrifying.

A case of food poisoning shouldn't send someone to the poorhouse. In the U.S., it may. It's time to fix that problem.