Magazine article Clinical Psychiatry News

U.S. Comes in Last on Access, Cost of Health Care: Survey Finds That One-Third of U.S. Adults Had to Forgo Necessary Care

Magazine article Clinical Psychiatry News

U.S. Comes in Last on Access, Cost of Health Care: Survey Finds That One-Third of U.S. Adults Had to Forgo Necessary Care

Article excerpt

Adults in the United States are far more likely than those in 10 other countries to go without health care because of cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to an 11-country survey.

The United States lags significantly on access, affordability and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published in Health Affairs (2010;29:2323-34).

But some of these disparities could be reversed as provisions of the Affordable Care Act (ACA), approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription because of the costs involved. Germany and Australia also scored poorly on those measures - 25% of Germans and 22% of Australians reported going without care because of costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said that they spent a lot of time on health insurance-related paperwork or disputes over medical bills, or that their health insurer had denied payment or had not paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn't guarantee you'll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study. …

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