A new survey from The Commonwealth Fund finds that adults in the United States are far more likely than those in 10 other industrialized nations to go without health care because of cost, have trouble paying their medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover insurance wouldn’t pay as they expected.

"We spend far more on health care than any of these countries, but this study highlights pervasive gaps in U.S. health insurance that put families’ health and budgets at risk," said Commonwealth Fund senior vice president Cathy Schoen, lead author of the article. "In fact, the U.S. is the only country in the study where having health insurance doesn’t guarantee you access to health care or financial protection when you’re sick."

Uninsured and insured U.S. adults reported equally high rates of out-of-pocket costs, with one-third paying $1,000 or more out-of-pocket in the past year for medical bills, significantly higher than in all the other countries.

Key Findings:

• 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 U.S. adults had major problems paying medical bills, compared with 9 percent or less in all other countries.
• Thirty-one percent of U.S. adults reported spending a lot of time dealing with insurance paperwork, disputes, having a claim denied by their insurer, or receiving less payment than expected. Only 13 percent of adults in Switzerland, 20 percent in the Netherlands, and 23 percent in Germany—all countries with competitive insurance markets that allow consumers a choice of health plan—reported these concerns.
• The study found persistent and wide disparities by income within the U.S.—even for those with insurance coverage. Nearly half (46%) of working-age U.S. adults with below-average incomes who were insured all year went without needed care, double the rate reported by above-average-income U.S. adults with insurance.
• The U.S. lags behind many countries in access to primary care when sick. Only 57 percent of adults in the U.S. saw their doctor the same or next day when they were sick, compared with 70 percent of U.K. adults, 72 percent of Dutch adults, 78 percent of New Zealand adults, and 93 percent of Swiss adults.
• U.S., German, and Swiss adults reported the most rapid access to specialists. Eighty percent of U.S. adults, 83 percent of German adults, and 82 percent of Swiss adults waited less than four weeks for a specialist appointment. U.K. (72%) and Dutch (70%) adults also reported prompt specialist access.