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From Health Affairs:


Eleven-Country Survey Finds US Insurance Most Complex


Bethesda, MD -- A new survey of eleven different countries' health care, released today as a Web First by Health Affairs, found that US adults were significantly more likely than their counterparts in other countries to forgo care because of cost, to have difficulty paying for care even when insured, and to encounter time-consuming insurance complexity. The study surveyed the general populations of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. For more than ten years, the authors have conducted similar comparisons of the US health system with other industrialized nations.


Access, Affordability, And Insurance Complexity Are Often Worse In The United States Compared To Ten Other Countries


By Cathy Schoen, Robin Osborn, David Squires, and Michelle M. Doty


The authors are all affiliated with The Commonwealth Fund, which supported this research. This study will also appear in the December issue of Health Affairs.


A few key study findings:


  • During the past year, 32 percent of all US adults did not seek medical care or receive recommended care because of cost. Nearly one in four (23 percent) had serious problems or were unable to pay medical bills. US rates were far higher than those for any other country.

  • Adults in the US and Canada were less likely to be seen the same or the next day for primary care when sick compared with other countries.

  • One third (32 percent) of US adults spent a lot of time on medical bill paperwork or disputes, or had been denied insurance payments -- much higher rates than in any other country.

  • According to the most recent OECD data, in 2011 the US spent an average of $606 per person on health insurance administration, more than twice as much as any other country did. The 2011 US per capita health spending averaged $8,508, nearly $3,000 more than the next highest country in the study.

  • While some adults in every country surveyed cited the need for reforms, US adults were the most likely (75 percent) to support major reforms of their health care system.

"Although the level of health care costs in the United States is particularly high, all of the countries face health care spending growth rates that exceed the general growth rate of the economy," concluded the authors. "Holding the line will require creative responses and vigilance regarding insurance design to achieve the joint goals of safeguarding access, improving health outcomes, and meeting public expectations of high quality."

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.