Americans are more likely to have no health care cover, forego treatment because of costs, struggle to pay medical bills, be confronted with very high medical charges even when they are insured, have insurance companies not pay them, and have disputes with insurance companies than 10 other countries in a survey carried out by the Commonwealth Fund. This is despite the fact that the USA spends far more of its Gross Domestic Product on health care than any of the other 10 countries.

The survey consisted of data gathered from 19,000 adults from Australia, The USA, The UK, France, Canada, The Netherlands, Sweden, Switzerland, Norway, France and New Zealand. Information was collected by telephone from March to June 2010.

Health coverage systems in the 11 countries vary widely, from a wholly public system in Canada, a mainly public system with some private health insurance companies and private health care providers in the UK, to countries with mainly private health insurance companies as in Switzerland and the USA.

The researchers wanted to find out what impact a country’s style of health care cover has on access to care, protection against high financial costs and medical debt, and the complexity of the insurance.

They found that:

  • Going without – 33% of American adults forego treatment, do not visit a physician when ill, or do not go and get their prescription – all because of costs. This compares to 6% in The Netherlands and 5% in the UK.
  • Struggling with bills – Up to 9% of ten countries’ adults had serious problems meeting the costs of their medical bills, compared to 20% in the USA. 9% was the highest among the other ten countries.
  • Complexity of insurance systems – Switzerland, The Netherlands and Germany have competitive insurance markets in which consumers choose a plan, like in the USA. However, 31% of Americans said they spent a great deal of time sorting out the insurance paperwork, compared to 23% in Germany and 20% in the other two countries.
  • Wealth disparity – 46% of insured Americans of working age with below-average incomes had to forego needed care. This is twice as many as among above-average income Americans with insurance. This wealth disparity linked to health care was far less in the other ten countries.
  • Access to primary care (general practitioner, GP) – 57% of Americans said they saw their physician that day or the following day when they were ill, compared to 70% in the UK, 72% in The Netherlands, 78% in New Zealand and 93% in Switzerland.
  • Seeing a specialist – 80% of American, 83% of German and 82% of Swiss adults said they waited less than four weeks to be seen by a specialist, compared to 72% of British and 70% of Dutch adults.

The authors concluded that:

    “..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.

Health Care Expenditure as percentage of Gross Domestic Product: (OECD 2007)

  • USA – 16%
  • France – 11%
  • Germany – 10.4%
  • Sweden – 9.2%
  • Norway – 9%
  • Australia – 8.7%
  • UK – 8.4%
  • Japan – 8.1%
  • Canada – 10.1%

Source: Commonwealth Fund

Written by Christian Nordqvist