Despite all the sophisticated medical technology and advanced procedures available in the United States, Americans with low incomes have a hard time getting health care and often receive low-quality care. The wealthy, on the other hand, enjoy ready access to high-quality care and insurance to help defray the cost.

A common assumption is that access to care is more equitably distributed among income groups in countries that provide universal, publicly funded health insurance than in countries that do not. But does universal health coverage really eliminate disparities among income groups? Findings from The Commonwealth Fund 1998 International Health Policy Survey suggest that countries with universal coverage that require patient user fees and allow a substantial role for private insurance also experience inequities in access to care.