Results of a new international survey of 11 high-income countries show U.S. adults remain far more likely to go without needed healthcare — such as doctor visits, medical tests, treatments, or medications — because of cost. Shortfalls in patient engagement and Chronic Care Management were also reported.
The 2016 Commonwealth Fund International Health Policy Survey revealed several ways in which the U.S. healthcare system is not meeting patients’ needs.
Americans Struggle More With Access and Affordability
Adults age 18 or older in 11 countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) were asked about their patient experiences.
The survey found:
- U.S. adults were more likely to report having poor health, experiencing emotional distress, and worrying about having enough money for basic necessities, such as housing and nutritious food.
- Although cost-related access problems in the U.S. have dropped from 37 percent in 2013, the percentage of adults who faced cost-related barriers to care in 2016 was highest in the U.S. at 33 percent. These cost-related barriers were defined as being sick, but not visiting a doctor; skipping a medical test, treatment, or follow-up the doctor had recommended; and skipping doses of medication to save money or not filling prescriptions at all. By comparison, as few as 7 percent of respondents in the U.K. and Germany and 8 percent in the Netherlands and Sweden reported experiencing issues with affordability of care.
- The U.S. had the highest number of adults who reported having multiple chronic conditions (in this case, joint pain or arthritis, asthma or chronic lung disease, diabetes, heart disease, or hypertension).
- Adults in the U.S. (19 percent) and France (24 percent) were more likely to experience having their medical records or test results unavailable at the time of an appointment, or having had duplicate tests ordered in the past two years.
- 14 percent of chronically ill U.S. adults said they did not get the support they needed from healthcare providers to manage their conditions.
It should be noted that every country surveyed, except the U.S., provides universal insurance coverage in one form or another, and that the cost for U.S. healthcare services for things like physician visits and prescription drugs tends to be significantly higher than in other countries. These factors likely have an impact on the results.
Areas Where the U.S. Healthcare System Did Better
On the positive side, the U.S. healthcare system “performed comparatively well” in the areas of:
- Timely access to specialist care
- Discussions with a physician about how they could lead a healthy life
- Coordinated hospital discharge planning
Performances With Regard to Coordinated Care
Using data from the survey, Health Affairs, the leading journal of health policy thought and research, reported, “The United States trailed other countries in making healthcare affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination.”