United States residents are more likely to go without care because of costs compared to other nations

An 11-country survey by the Commonwealth Fund found that adults in the United States are by far the most likely to go without care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with insurers or payments denied.

Key findings from the survey:

  • Thirty-three percent of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared with as few as 5 percent of adults in the United Kingdom and 6 percent in the Netherlands.
  • One-fifth of U.S. adults had major problems paying medical bills, compared with 9 percent or less in all other countries.
  • Thirty-one percent of U.S. adults reported spending a lot of time dealing with insurance paperwork, disputes, having a claim denied by their insurer, or receiving less payment than expected. Only 13 percent of adults in Switzerland, 20 percent in the Netherlands, and 23 percent in Germany reported these concerns.
  • The study found persistent and wide disparities by income within the U.S., even for those with insurance coverage. Nearly half of working-age U.S. adults with below-average incomes who were insured all year went without needed care, double the rate reported by above-average-income U.S. adults with insurance.
  • The U.S. lags behind many countries in access to primary care when sick. Only 57 percent of adults in the U.S. saw their doctor the same or next day when they were sick, compared with 70 percent of U.K. adults, 72 percent of Dutch adults, 78 percent of New Zealand adults, and 93 percent of Swiss adults.
  • U.S., German, and Swiss adults reported the most rapid access to specialists. Eighty percent of U.S. adults, 83 percent of German adults, and 82 percent of Swiss adults waited less than four weeks for a specialist appointment. U.K. (72%) and Dutch (70%) adults also reported prompt specialist access. 

The authors conclude that more negative access and cost experiences in the United States, plus wide disparities by income, underscore the importance of the Affordable Care Act's emphasis on insurance expansion, benefit standards, and limits on costs for those with lower incomes.

(Source: The Commonwealth Fund, http://commonwealthfund.org, November 17, 2010)