The US could have saved more than 338,000 lives and more than $105bn in healthcare costs in the Covid-19 pandemic with a universal healthcare system, according to a study.

More than 1 million people died in the US from Covid, in part because the country’s “fragmented and inefficient healthcare system” meant uninsured or underinsured people faced financial barriers that delayed diagnosis and exacerbated transmission, the report states.

The US had the highest death rate from the virus among large wealthy countries and is also the only one among such countries without universal healthcare. It spends almost twice as much on healthcare per capita as the other wealthy countries, according to Kaiser Family Foundation data.

“The current healthcare system in the US is economically inefficient and leaves millions of Americans without adequate access to medical treatment,” said Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health and the lead author of the study, published in the Proceedings of the National Academy of Sciences.