Reform Update: Healthcare in U.S. more pricey, less accessible, survey shows

Healthcare in the U.S. is more expensive and less accessible than in 10 other advanced nations where adults were less likely to report trouble with medical bills or avoiding a doctor to avoid the cost, according to a new report by Commonwealth Fund researchers based on a survey of more than 20,000 people in the 11 countries.

The results, though not surprising, are a starting point by which to measure the success of the 2014 health insurance expansion under the Patient Protection and Affordable Care Act. “One way to assess the impact of U.S. health reform is to track how the healthcare experiences of U.S. citizens compare over time to those of people in industrialized countries that implemented universal or near-universal coverage decades ago,” wrote authors Cathy Schoen, Robin Osborn, David Squires and Michelle Doty in the journal Health Affairs. Their findings were based on a telephone survey of adults in the 11 countries ages 18 and older conducted between February and June.

In the final months before the expansion begins to extend that coverage, the picture of U.S. healthcare painted by the report is bleak. Roughly one in three U.S. adults said cost stopped them from going to the doctor or getting needed care. About one in five U.S. adults did not fill prescriptions or take medicine as recommended, and about the same number reported serious problems paying medical bills.

Among other nations surveyed, cost was less of a factor in whether adults sought medical care. The Netherlands and New Zealand each reported that one in five adults did not visit doctors or receive needed care because of cost, a distant second to the 32% in the U.S. Germany ranked a distant second behind the U.S. in the percentage of adults who said they did not take prescribed medication, at 9%.

Thirteen percent of adults in France reported major difficulty with medical bills compared with 23% in the U.S. The U.S. figure soars to 43% when researchers looked exclusively at U.S. adults with chronic conditions.

The financial stress from healthcare among U.S. adults may be related to the growth of health plans that leave patients exposed to a larger share of medical costs, the researchers said. “Notably, roughly 40% of both insured and uninsured U.S. respondents had spent $1,000 or more during the past year on medical care, not counting premiums,” the authors wrote. “Those percentages point to often-high patient cost sharing or frequent benefit gaps.”

While the fierce political battles over Obamacare show a wide divide among Americans in how to overhaul U.S. healthcare, the Commonwealth Fund survey found there was broad agreement that major changes are needed. The survey found U.S. adults more convinced of the need for an overhaul of healthcare than adults in other countries. In the U.S., 75% of adults said the system needed to be scrapped and rebuilt or that fundamental changes were necessary.

The survey was conducted before the bumbled October launch of the Affordable Care Act's health insurance exchanges. It included respondents from the U.S., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and Switzerland, which adopted a system with some resemblance to Obamacare in the 1990s.

AtlantiCare in Egg Harbor Township, N.J., announced it selected Geisinger Health System, Danville, Pa., in its search for a deal to better position the New Jersey healthcare system for health reform. Under the proposed deal, Geisinger will acquire AtlantiCare. “We believe that the Affordable Care Act has signaled a fundamental change in how healthcare will be provide, consumed and paid for,” said David Tilton, AtlantiCare's president and CEO. Geisinger has the scale and experience with delivery reform that AtlantiCare sought in a potential partner, he said. The two systems signed a letter of intent and will begin due diligence. The partners hope to reach a definitive agreement in the first three months of next year, he said.

Melanie Evans