In its annual survey of international consumer attitudes, the Commonwealth Fund has found what study authors called “glaring gaps” in the healthcare system in the U.S. in terms of cost, quality, access and the relative simplicity of insurance plans.
Costs and red tape cause Americans to skip healthcare: study
“We emerge as the only country in the study where insurance coverage does not guarantee that you will receive care when you are sick,” said Cathy Schoen, senior vice president for policy, research, and evaluation at the New York-based Commonwealth Fund.
As greater numbers of healthcare consumers in the U.S. experience fine-print insurance caveats such as lifetime maximums, gaps in coverage and inexplicable denials of payment, they also have steadily lost faith in the system, according to the results of the study.
A report on the study was published last week in Health Affairs in the article, “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries.” The study surveyed nearly 20,000 residents of 11 industrialized nations about their health plans.
Only 70% of those surveyed in the U.S. said they were confident of receiving the most effective treatment, despite the fact that the American system’s per-capita costs are almost double the next-most-expensive system in the study: $7,538 per person in the U.S. and $4,627 in Switzerland.
Asked about the public attitudes shown in the survey, representatives for providers and insurers each essentially blamed the other side.
Caroline Steinberg, vice president of trends analysis for the American Hospital Association, said complaints about the high out-of-pocket costs and lower levels of access were functions of the insurance plans offered by the various commercial and government payers. “This study really highlights coverage issues, and one of the huge issues for consumers is not having the coverage you think you have,” Steinberg said. Consumers “are afraid they will face barriers to access and they won’t be able to afford care.”
Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said it was the providers—not the insurers—who have created the costly and complex healthcare delivery system around which insurers structure their plans.
“The prices that are charged for medical services in the U.S. far exceed those charged in other places in the world,” Zirkelbach said. “As the cost of healthcare increases, the cost of coverage increases.” As a result, more consumers will choose cheaper, less-inclusive coverage.
In the U.S., 35% of respondents reported paying more than $1,000 out-of-pocket, while in other countries the figures ranged from 1% to 25%.
Likewise, 20% of Americans reported having serious problems paying their medical bills. In the other countries in the survey, the numbers all were in the single digits, ranging from 2% to 9%.
Costs in the U.S. were so high, in fact, that 28% of people surveyed said high medical costs caused them not to see a doctor when they were sick in the past year—another category in which the U.S. scored highest.
One area in which the U.S. scored better than other countries on the list was wait times for specialists. In the U.S., 80% of respondents reported being able to see a specialist in less than four weeks. In Canada’s state-run system, only about half as many people could say the same, while another 41% said they waited more than two months to see a specialist.
Canada and the U.S. reported similar patterns for elective surgery wait times. In the U.S., 68% of respondents said they waited less than a month for elective surgery, while only 7% waited more than four months. In Canada, only 35% could get in for an elective procedure in a month, and a quarter of the Canadian respondents waited better than four months to go under the knife.
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