A survey of 11 industrialized nations reveals that adults in the U.S. are by far the most likely to go without health care or skip filling a prescription because of costs. Among the reasons: a health care system that lags those of other modern countries, with high out-of-pocket medical expenses and lack of access to medical care due to costs.
U.S. adults were "significantly more likely than adults in other countries to have gone without care because of cost, to have spent $1,000 or more out of pocket on medical care, and to have had serious problems paying medical bills during the previous year," the authors write in the study, published in Health Affairs.
The survey, conducted by The Commonwealth Fund, a nonprofit group that advocates health care reform, relied on interviews of more than 19,000 adults in 11 countries with wide variations in their health insurance systems, from wholly public systems to hybrid systems of public and private insurance, with varying levels of cost-sharing. The countries were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K, and the U.S.
Among the study's main findings:
One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs. In Germany, 25% of adults went without care, while in the U.K., only 5% did.
Twenty percent of U.S. adults had major problems paying medical bills, compared with 9% or less in all other countries surveyed.
When it came to insurance complexity, 31% of U.S. adults reported spending a lot of time dealing with insurance paperwork, disputes, having a claim denied by their insurer, or receiving a smaller reimbursement than expected. By contrast, only 13% in Switzerland reported such concerns, 20% in the Netherlands, and 23% in France and Germany.
Americans were also much less confident than people in all other countries except Sweden and Norway that they would receive the most effective treatment when needed. U.K., Swiss and Dutch adults were the most confident.
Americans also exhibited the widest disparities when reporting health care experiences by income. For example, coverage was especially uncertain and unstable for adults with below-average incomes: 50% reported being uninsured or being uninsured earlier in the year. Among adults with average incomes, 24% were uninsured or had been uninsured earlier in the year.
According to the most recent statistics, about 60% of Americans are insured through their employers, 9% purchase insurance privately, and almost 28% are insured by the government, mostly in the form of Medicare or Medicaid. This leaves over 45 million that remain uninsured.
The authors then conclude the study "underscores the importance of the Affordable Care Act's emphasis on insurance expansion, benefit standards, and limits on costs for those with lower incomes." But they add the importance of monitoring access and affordability as health care reform gets under way.