The Commonwealth Fund Blog

International Survey: U.S. Leads in Insurance Paperwork, Disputes

November 18, 2010

Tags: international health policy health insurance access to care

new 11-country survey by the Commonwealth Fund focusing on health care access, cost, and insurance coverage 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. The survey included more than 19,000 adults, ages 18 and older, in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Key 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, compared with as few as 5 percent of adults in the United Kingdom and 6 percent in the Netherlands.
  • One-fifth (20%) 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—all countries with competitive insurance markets that allow consumers a choice of health plan—reported these concerns. 
  • The study found persistent and wide disparities by income within the U.S.—even for those with insurance coverage. Nearly half (46%) 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.

"What we are hearing directly from adults around the world, and what we hear regularly at home, is that there is substantial room for improvement in the U.S. health insurance system," said Commonwealth Fund President Karen Davis. "The good news is that there are opportunities to learn from other countries, and Affordable Care Act reforms will provide affordable insurance options for the uninsured, make sure insurance pays for essential care, and provide financial security for millions."

The survey findings were published today in Health Affairs.



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James Jordan of The Growth Source says:
November 28, 2010

The statistical data representing uninsured and underinsured individuals in America is truly shocking! The challenges we face in reforming the heath insurance and benefits sector of our health system—merely part of the larger picture—on the surface appears to be virtually insurmountable. With an ambitious beginning in the "Affordable Care Act", and subsequent bills, time will inform us of what is to be the practical, near term impact on the group insurance market.