On Health Policies, U.S. Lags Other Nations: Survey

THURSDAY Nov. 18, 2010 -- Patients in the United States are more likely to forgo medical care because of cost than residents of other developed countries, a new international survey finds.

Compared with 10 other industrialized countries, the United States also has the highest out-of-pocket costs and the most complex health insurance, the authors say.

"The 2010 survey findings point to glaring gaps in the U.S. health care system, where we fall far behind other countries on many measures of access, quality, efficiency and health outcomes," Karen Davis, president of the Commonwealth Fund, which created the report, said during a Wednesday morning press conference.

The report -- How Health Insurance Design Affects Access to Care and Costs, By Income, in Eleven Countries -- is published online Nov. 18 in Health Affairs.

"The U.S. spent far more than $7,500 per capita in 2008, more than twice what other countries spend that cover everyone, and is on a continued upward trend that is unsustainable," Davis said. "We are clearly not getting good value for the substantial resources we allot to health care."

The recently approved Affordable Care Act will help close these gaps, Davis said. "The new law will assure access to affordable health care coverage to 32 million Americans who are currently uninsured, and improve benefits and financial protection for those who have coverage," she said.

In the United States, 33 percent of adults went without recommended care or drugs because of the expense, compared with 5 percent in the Netherlands and 6 percent in the United Kingdom, according to the report.

In addition, 20 percent of U.S. adults had problems paying medical bills, compared with 9 percent in France, 2 percent in the United Kingdom, 3 percent in Germany and 4 percent in the Netherlands.

More than one-third (35 percent) of U.S. adults paid $1,000 or more in out-of-pocket medical costs in the past year, the authors noted.

The researchers used data reported earlier this year by 19,700 adults included in the Commonwealth Fund's 2010 international health policy survey, which focuses on insurance and access to health care in these 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

In the United States, 31 percent of adults spent a lot of time dealing with insurance paperwork, had claims denied, or their insurer paid less than anticipated. Patients younger than 65 were more likely than those on Medicare to report problems dealing with health insurance providers.

In Switzerland, 13 percent reported these problems as did 20 percent of patients in the Netherlands and 23 percent of patients in Germany. All three countries have competitive health insurance markets, the authors pointed out.

Although the uninsured in the United States were the most likely to go without needed care, insured adults with below-average incomes were twice as likely as higher-income adults to skip medical care because of costs, the report found.

The survey also found disparities between the United States and other countries regarding access to medical care.

For example:

  • Patients in Switzerland, New Zealand, the Netherlands and the United Kingdom were the most likely to have same- or next-day access to doctors when sick.
  • Two-thirds of Dutch, New Zealand and U.K. patients had easy access to after-hours care without going to the emergency room. Meanwhile, two-thirds of Swedish, Canadian, French, and U.S. patients found it difficult to arrange for after-hours care.
  • Access to specialists was higher in the United States than in some countries. Between 70 and 83 percent of U.S., German, Swiss, Dutch and U.K. adults waited fewer than four weeks to see specialists.
  • Only 58 percent of U.S. patients -- the lowest rate of the survey -- were confident they could afford the care they needed. Patients in the United Kingdom, Switzerland and the Netherlands were the most confident they could afford needed care.

"The findings in other countries indicate that it is possible to design insurance benefits and protection, even when cost sharing is included in the insurance design, in a way that values access and assures financial protection, and simplifies experiences with insurance," Cathy Schoen, senior vice president at the Commonwealth Fund, said during the press conference.

Kim Bailey, senior health policy analyst at Families USA, said: "The findings of the Commonwealth Fund's analysis highlight the dire situation that many American families face when it comes to the affordability of care, and the need for the improvements in the quality and availability of coverage that the Affordable Care Act will bring. By comparing the U.S. experience across a range of access and cost-related measures to the experiences of health care consumers in other countries, the magnitude of the problem within our system becomes clear. American families are clearly in need of a helping hand, and the Affordable Care Act will make great strides toward improving access to care while reducing out-of-pocket costs."

Republicans have vowed to scale back the controversial health reform law when the new Congress is seated in January, but it's not clear how much impact they may have.

More information

For more information on health care in America, visit the U.S. Department of Health and Human Services.

Posted: November 2010


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