Cathy Schoen, Robin Osborn, David Squires, Michelle M. Doty, Roz Pierson, Ph.D., and Sandra Applebaum
C. Schoen, R. Osborn, D. Squires, M. M. Doty, R. Pierson, and S. Applebaum, "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," Health Affairs Web First, Nov. 18, 2010.
An 11-country survey 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 health insurance systems of the 11 countries included in the latest Commonwealth Fund International Health Policy Survey vary widely. They range from wholly public systems to hybrid systems of public and private insurance, with varying levels of cost-sharing. In analyzing the survey findings, the researchers examined how the design of insurance coverage can affect access to care, financial protection against high costs and medical debt, and insurance complexity.
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
Thirty-one percent of
The study found persistent and wide disparities by income within the
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. They note that the U.S. has the opportunity to learn from insurance innovations in other countries, including value-based benefit design.
The authors based their analysis on a survey of 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. Interviews were conducted by telephone between March and June 2010.
Compared with the residents of 10 other industrialized countries, U.S. adults are the most likely to report health care problems related to access, cost, and insurance complexity. Comprehensive health reform could lead to improvements in many of these areas.