U.S. adults spend most; forgo care due to costs, struggle to pay medical bills, and contend with insurance 

Wednesday,4th Dec
Written By: Sweety Rai

A new 11-country survey from The Commonwealth Fund finds that adults in the United States are far more likely than those in 10 other high-income industrialized nations to go without health care because of costs, have difficulty paying medical bills, and encounter time-consuming health insurance paperwork or disputes, including claims that were unexpectedly not paid.

More than one-third (37%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared to as few as 4 percent to 6 percent in the U.K. and Sweden, according to the study published today as a Health Affairs Web First article. In addition, nearly a quarter (23%) of U.S. adults either had serious problems paying medical bills or were unable to pay them, compared to less than 13 percent of adults in France, the next-highest country, and 6 percent or fewer in the U.K., Sweden, and Norway. About two of five (41%) U.S. adults spent $1,000 or more out-of-pocket for care in the past year - by far the highest rate of any country surveyed.

Uninsured adults in the U.S. were the most likely to struggle to afford health care. However, even U.S. adults insured all year were more likely than adults in other countries to forgo care because of costs, to struggle with medical bills, and to face high out-of-pocket costs, with 42 percent paying $1,000 or more out-of-pocket for medical care. According to the study, U.S. health insurance has higher deductibles and higher cost-sharing, and does not place limits on out-of-pocket costs. This potentially explains why even people with health insurance in the U.S. struggle to afford needed health care.

The 2013 survey of 20,045 adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States focused on people's experiences with their country's health care system, particularly those related to accessing and affording care. The study's authors note that the findings could provide a baseline for how the U.S. health system is performing as the nation's health insurance system undergoes the most significant changes it has seen since Medicare and Medicaid were enacted in 1965.

"For more than 10 years now, The Commonwealth Fund has compared the U.S. health system to the systems of other industrialized nations, and the U.S. has always been an outlier when it comes to costs, access, and affordability. Far too many people go without care or can't afford to be sick, even when they have health insurance," said Cathy Schoen, Commonwealth Fund senior vice president and lead author of the article. "This study, which offers benchmarks to assess the progress of U.S. health reforms from an international perspective, clearly underscores the need to simplify our health insurance system and ensure that people can get and afford the care they need."