A new study challenges a widely held view in the United States that Americans have the best medical care in the world.

A review of health care in the United States and four other industrialized, English-speaking countries, published Tuesday in the journal Health Affairs (search), found that the United States leads in some areas and trails in others.

Breast cancer survival rates were higher in the United States than in Australia, Canada, England and New Zealand, the report says, citing health data through 2000. American women also were screened for cervical cancer at a higher rate than women in the other countries.

Yet the United States was the only country that registered a rise in deaths from asthma. The rate of infection from hepatitis B also was highest in the United States.

"No country scores consistently the best or worst overall, and each country has at least one area of care where it could learn from international experience," the study said.

Although health care experts are increasingly aware of gaps in the quality of care, the report notes that U.S. politicians frequently state, as President Bush did in his State of the Union address in January, "Americans have the best medical care in the world."

The authors — U.S. academics and international health care officials — say they want to spur debate about health care priorities rather than draw conclusions that explain the differences.

A related report in Health Affairs examines why the United States spends far more on health care than any other nation, and whether the country can afford it.

Authors Uwe Reinhardt (search) of Princeton University and Peter Hussey (search) and Gerard Anderson (search) of Johns Hopkins University conclude that health insurance will become increasingly unaffordable to lower-income workers, forcing lawmakers to choose between some form of universal health care and a system in which there is a stark difference in the quality of care based on ability to pay.