NEW YORK - The United States trails far behind other high-income countries on measures of health care affordability, administrative efficiency, equity, and outcomes, said the latest yearly report issued by the Commonwealth Fund.

"The United States ranks last overall, despite spending far more of its gross domestic product on health care," said the report released Wednesday.

The United States remains the only high-income country lacking universal health insurance coverage, the report said.

With nearly 30 million people still uninsured and some 40 million with health plans that leave them potentially underinsured, out-of-pocket health care costs continue to mar US health care performance, added the report.

"In no other country does income inequality so profoundly limit access to care as it does here," said David Blumenthal, president of the Commonwealth Fund.

Blumenthal added half of lower-income US adults reported that they did not receive care because of the cost, compared to just over a quarter of higher-income Americans.

By contrast, only 12 percent of people with lower incomes and 7 percent with higher incomes said they faced such financial barriers in the United Kingdom.

Still, the United States was ranked in the second place in care process like the rates of mammography screening and influenza vaccination for older adults as well as the share of adults who talked with a health care provider about nutrition, smoking and alcohol use.

US health spending reached nearly 17 percent of GDP in 2019, far above the 10 other countries compared in this report including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

Achieving better health outcomes will require policy changes within and beyond health care like expanding insurance coverage, extending primary care to every local community and having smarter spending, suggested the report.