WASHINGTON, D.C.—A new five-nation survey of public attitudes toward health care reveals that the U.S. has the highest share of residents facing access problems, driven in large part by the difficulty many face in paying for care. At least one in five Americans reported problems paying their medical bills, filling prescriptions, getting medical care when they had a problem, or getting a physician-recommended test. Americans with below average incomes reported more access to care problems than did their counterparts in the other four countries, according to the findings, which appear in the May/June international issue of the journal Health Affairs.
The 2001 survey, conducted by researchers at the Harvard School of Public Health and the Commonwealth Fund, examined citizens' views of and experiences with health care systems in Australia, Canada, New Zealand, the United Kingdom and the United States. All of these countries, except the U.S., have universal health care systems with varying roles for the private insurance market.
The International Health Policy Survey is the fourth in a series supported by the New York-based Commonwealth Fund to gauge global attitudes toward health care. This telephone survey was conducted between April-May 2001.
U.S. System Gets Poor Marks
In general, the survey found that the U.S. generally ranks at the bottom among the five countries on most indicators of patient views and experiences. Although inequities exist in all countries, the survey found that these are "the sharpest and most pervasive" in the U.S., which has the highest proportion of the public reporting problems paying their medical bills. "The findings make clear that the while the U.S. health system has some great strengths, it also has some serious inequities," says survey co-author Robert Blendon, a professor at the Harvard School of Public Health. "When it comes to health care in the U.S., the experiences of lower income people differ markedly from those with higher incomes on most measures of access, quality, and financial burden," adds co-author Cathy Schoen, vice president for health policy, research, and evaluation at the Commonwealth Fund. "The U.S. was the only country in which adults with below average incomes rated their relationships with doctors lower than those with higher incomes." Every Country Has Problems
Each country has its own special set of problems, however. Citizens in the United Kingdom report long queues for non-emergency hospital care and elective procedures, while Canadians say they have difficulty accessing medical specialists. A "substantial minority" of New Zealanders report problems getting care they need because of costs; and Australians have problems affording the cost of prescription drugs. Over the past 14 years, public attitudes toward health care systems in the five nations appear to have converged. In 1988, there was a clear distinction in attitudes between countries. Then, Canada's health system won the highest rating from its citizens while the U.S. system got the lowest. The 2001 survey finds that the majority of citizens in all five countries are dissatisfied with their health systems and favored substantial changes in them. Despite these high rates of dissatisfaction, the majority of citizens in each country did not report problems on the quality of care they received. Poor Access for Low Income Citizens
Not surprisingly, adults with lower incomes tended to have more general access problems regardless of where they lived. For example, 20 to 28 percent of citizens with below average incomes reported that their access to medical care had gotten worse compared to 1999. Accessing specialty care is a problem in all the countries but it's particularly bad in the U.S. for low-income citizens. Fourteen to 30 percent of low-income citizens in all five countries had problems seeing a specialist. Americans with below average incomes are much more likely than their foreign counterparts to report that it was "extremely or very difficult" to see a specialist. In Canada, New Zealand, and the U.S., citizens with below average incomes were also significantly more likely than those with above average incomes to report going without a needed prescription. In the U.S., a third of citizens with below average incomes said that they did not fill a prescription, did not get recommended tests or treatment, and did not visit a doctor when they had a medical problem because of cost barriers. Access to dental care is a problem in all five countries for citizens with below-average incomes. But the problem is particularly severe in the U.S., where slightly more than half of low-income adults surveyed said they needed dental care but did not see a dentist in the past year due to the cost of treatment. Other survey highlights:
- A majority of citizens in each country rated their care as excellent or very good. In 2001, between 53 percent and 67 percent gave their care this rating.
- Adults in the U.S. are the least likely to report long waiting times for elective or non-emergency surgery. Sixty three percent of Americans reported waiting less than a month, compared to 37 percent of Canadians.
- U.S. citizens are most likely to report problems paying medical bills (21%). However, one in 10 adults in Australia and New Zealand reports problems paying medical bills, as did 3 percent of Britons and 7 percent of Canadians.