Comparing U.S. Health Care Experiences to 10 Other Countries

A survey of 11 countries found that American adults are far more likely to forgo care because of cost and they were more likely to have difficulty paying for care even when they had insurance.

The study by Cathy Schoen, Robin Osborn, David Squires and Michelle M. Doty was published in the November issue of Health Affairs. The survey looked at the general populations of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

Adults in America and Canada reported long waits to be seen in primary care and a high use of hospital emergency departments.

“Perhaps not surprisingly, U.S. adults were the most likely to endorse major reforms: Three out of four called for fundamental change or rebuilding,” the authors wrote. They added that America can assess the impact of its health reforms by tracking the experiences of its citizens over time and comparing them to experiences in industrialized countries that already have universal or near-universal coverage.

Out of the countries in the study, America spends by far the most on health care — almost $3,000 more per person compared to Norway, which comes in second. The U.S., the Netherlands and Switzerland were the only countries that employ deductibles as part of the core insurance design.

“The U.S. market reforms scheduled to be implemented in 2014 will for the first time set standards on private insurance that limit out-of-pocket exposure,” the authors wrote. “The reforms will also provide income-related public subsidies for premiums and reduce cost sharing for people whose incomes fall below certain thresholds. These efforts will be similar in concept to provisions in Switzerland, the Netherlands, and France that seek to limit financial exposure for people who are in poor health or have low incomes.”

American respondents in the survey were most likely to report high out-of-pocket costs and more than 40% spent $1,000 or more in the past year. They also reported problems paying medical bills and forgoing care because of the cost. Access and affordability issues were far higher among the uninsured with nearly two-thirds of uninsured respondents admitting that costs made them skip care.

“As the United States proceeds to implement insurance expansions and market reforms, this study underscores the vulnerability of the uninsured and the importance of successfully expanding coverage,” according to the researchers. “At the same time, the variable experiences across countries with universal coverage indicate that having insurance is important but not sufficient to ensure timely or affordable access.”

Meanwhile, in Sweden, the United Kingdom, France, the Netherlands and New Zealand fewer than 10% of respondents reported high out-of-pocket costs.

However, things are not perfect in these other countries. In the Netherlands, 22% of respondents reported forgoing care because of cost, which is a substantial increase from just 6% in a 2010 survey.

In Australia, Canada, Switzerland and the U.S., chronically ill patients reported that costs played a role in deterring care and causing financial stress.

Access to care also varied greatly in the 11 countries represented in the study. In Germany and New Zealand, roughly 70% of respondents said they can get a same- or next-day appointment when they were sick. However, the same is true for fewer than half of adults in Canada and the U.S. Even worse, at least one in four adults in Canada, Norway and the U.S. actually waited six days or more to see a doctor or nurse when sick.

“Polls in the United States show mixed public support and lack of knowledge about the provisions of the Affordable Care Act,” the authors wrote. “Yet in the survey most U.S. adults called for major change, with a minority preferring the status quo.”