Our Work
The Ten Ten Ten Index
America's healthcare report card is a simple, public scorecard for how well our health system actually works. The goal: outcomes up, waste down, equity built‑in.
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The U.S. Health System Current World Rank
U.S. Health Outcomes
(5-factor algorithm)
#48
Out of 183
Countries
Index factors, USA results :
100,000
live births
100,000
live births
Download:
U.S. Health Costs
(as a percentage of GDP)
#182
Out of 183
Countries
Cost as a % of GDP for Top 5 Countries
Average Costs as a Percentage of GDP for :
- 10.2% Top 5 countries for health outcomes listed above.
- 9.5% Top 10 countries for health outcomes.
- 8.3% 47 countries that outrank USA for health outcomes.
- 6.6% All countries (excluding USA).
Download:
Why the index
America spends more on healthcare than any nation, yet too many families still struggle to find care that is timely, affordable, and effective. The conversation is noisy and technical, and the public can’t easily tell whether we’re getting healthier, or just paying more.
America's report card
The Ten Ten Ten index is a straightforward public scorecard that shows whether the U.S. is genuinely progressing toward three clear goals: better outcomes, lower costs, and consistent annual progress. It’s designed to be easily understood by everyone and used by leaders to take action.
What it measures
Health: Are people getting healthier? Today, we’re assessing five categories: life expectancy, healthy life expectancy, maternal mortality, under-5 mortality, probability of premature mortality from NCDs (noncommunicable diseases), ages 30–70. In short: our goal is to live longer and better.
Value: Are we getting value for what we spend? We track what the country spends on healthcare as a share of the economy and spotlight wasteful, low‑value use. In short: we want to pay less for better results.
Trend: Are we heading in the right direction? Year-over-year trends are important. We highlight what is improving and penalize what is not. In short: momentum, regardless of its direction, must be visible and shareable.
Why it matters
Clarity and accountability. A single, transparent score keeps leaders honest and focused on what counts: health, value, and fairness.
Action, not just awareness. Every measurement links to practical playbooks so employers, clinicians, health plans, and policymakers can use what works.
Equity by design (roadmap). We will publish stratified results by race/ethnicity, gender, disability, income, and geography, so progress is shared, and gaps close.
When you’ll see it
Our baseline national Index and public dashboards are planned for April 2026. From there, we’ll refresh regularly and showcase organizations and communities that move the numbers.
Milestones
October 2025
Healthcare Outcomes Index V1
Healthcare Cost V1
- Note: V1s are live (10/1/25)
Healthcare Socioeconomic Equity Index and Ranking V1
- Will include detailed analyses of socioeconomic and geographic variations (income, education, occupation, location).
- Will draw from a wide range of studies and data sources to ensure accuracy and representativeness.
- Will adjust for population, cultural, and racial heterogeneity.
December 2025
February 2026
Healthcare Cultural Equity Index V1.
- This index uses the same data as above, but instead corrects for socioeconomic factors so language barriers, cultural competency barriers and structural racism can be quantified, addressed and tracked separately.
- We want to support and certify solutions that solve these important problems in a specific and targeted manner e.g. cultural competency education.
- Will include detailed analyses of socioeconomic and geographic variations (income, education, occupation, location).
- Will draw from a wide range of studies and data sources to ensure accuracy and representativeness.
- Will adjust for population, cultural, and racial heterogeneity.
Healthcare Value Index
- This will be a marquee single index for TenTenTen that combines the three components.
April-June 2026
June 2026
Willingness-to-Pay Threshold
- This represents the maximum threshold of what we should be willing to pay for each disability-adjusted life year gained.
- This threshold will drive certifications. Solutions must fall under this threshold in terms of total cost to society in order to be certified.
- This threshold is intended to reverse cost trends in the US.
Data sources & governance
Primary sources:
Federal/public datasets (e.g., national expenditures, mortality/outcomes, price transparency), multi‑payer claims, clinical registries, and credible survey/PROMs.
Data partnerships:
We welcome de‑identified data feeds and validation partners.
Open methods:
Code, data dictionaries, and version notes are posted for replication.
Independent review:
External advisors audit methods; comments are logged and addressed in release notes.
Release cadence
Annual major release (vY.0): refreshed benchmarks, weights if needed, and national/state dashboards.
Quarterly minor updates (vY.Q): data refreshes where available and bug fixes.
Who uses the Index — and how
Measures are versioned; final v1.0 list publishes with metadata: definition,denominator, exclusions, data source, refresh cadence.
Health Systems & Clinicians
Track outcomes and equity gaps; use our playbooks to reduce low‑value care and strengthen primary care continuity.
Health Plans
Align network design and benefit incentives to Index measures; reduce administrative drag.
Policymakers & Regulators
Target policy levers and measure impact over time.
(payment reform, transparency, administrative simplification)
Advocates & the Public
Follow simple, honest progress toward Top Ten outcomes and Ten Percent of GDP.
Employers & Purchasers
Compare plan partners on outcomes and value, not unit prices alone.
Tie contracts/bonuses to documented improvements on Index‑aligned measures.
Transparency Promise
- Publish what we measure, how we calculate it, and what changed release‑to‑release.
- Disclose conflicts, funding, and reviewer comments.
- Provide downloadable CSVs and code notebooks for researchers.