Americans are sicker, skip care more than citizens of other high-income nations

Despite major coverage expansions under the Affordable Care Act, Americans are sicker and have more trouble affording care than 10 other high-income countries, a new survey shows.

Moreover, almost half of the poorest U.S. adults can't get the care they need, and many resort to the emergency room for treatment, according to the Commonwealth Fund study.

The non-partisan group surveyed almost 27,000 adults across 11 high-income countries about their health and experience with their country's healthcare system. The nations surveyed included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

The U.S. is the only country studied without universal healthcare coverage, though the uninsured rate in the U.S. has dropped to a record low.

It's the first international survey by the foundation conducted after some of the major coverage expansions under the ACA.

And yet, “Americans still struggle to afford care and face greater financial barriers to care than adults in the 10 other countries,” Robin Osborn, the study's lead author and the Commonwealth Fund's director of the international program in health policy and practice innovations, said during a press conference this week. “They also have a relatively hard time getting into primary care when they need it, and gaps in coordination of care are problems in all countries, with the U.S. at the top of the range.”

The survey found that Americans are much sicker than people in other high-income countries. The highest rate of all 11 countries, 28% of American adults said they have two or more chronic illnesses, such as a joint pain or arthritis, asthma, chronic lung disease, diabetes, heart disease, hypertension or high blood pressure. And 26% said they experienced emotional distress they couldn't cope with alone.

Canada reported the second-highest rate of chronic conditions at 22%, but the highest rate of emotional distress at 27%. In each country surveyed, at least 14% of adults reported having multiple chronic conditions.

Though Americans are in poorer health, they're also more likely than others to go without recommended healthcare, fail to fill a prescription or avoid the doctor when sick because of costs.

About a third of U.S. adults said they skipped needed healthcare because they couldn't afford it, down from 37% in the last 2013 survey. While that's an improvement, adults in the U.S. still report greater financial barriers to accessing care than the 10 other countries surveyed.

Switzerland reported the second-highest percentage of adults avoiding care because of cost at 22%, followed by New Zealand at 18% and France at 17%. On the other end of the spectrum, just 7% of U.K.-based adults avoided care because of costs.

The U.S. was also among the countries reporting the greatest difficulty seeing a doctor or nurse when sick. Forty-two percent of Americans said they did not see a doctor or nurse on the same or next day the last time they needed care, and 51% said it was hard to get after-hours care.

Similarly, 44% of adults in France, 43% in Switzerland and 41% in the U.K. didn't see a doctor or nurse on the same or next day when they last needed care. Nearly all countries reported high rates of patients who had a hard time finding after-hours care.

However, most adults in the U.S. were able to see a specialist fairly quickly. Just 6% of Americans said they waited longer than two months for a specialist appointment. Adults in France, Germany and the Netherlands reported similar low rates, but at least 19% of adults in Canada, New Zealand, Norway, Sweden, and the U.K. had to wait at least two months to see a specialist.

The U.S. healthcare system appears to have failed the low-income population, or those who earned less than half of the country's median income. In the U.S., 43% of low-income adults didn't get healthcare because they couldn't afford it—by far the highest rate reported. That's down from 51% in the 2013 survey. By comparison, in the U.K., just 8% of low-income adults said they didn't get care because of costs.

Low-income Americans had trouble getting in to see a doctor when sick, and more than a third said they waited six days or more to see one. Half of low-income Americans used the emergency department in the past two years, also the highest of any other country.

“This survey underscores that we can do better for our sickest and poorest patients, and that should be a high priority in efforts to improve our current system,” said Osborn.

With the election of Donald Trump as the next U.S. president, the nation's healthcare system is likely to undergo vast changes. During his campaign, Trump vowed to repeal and replace the Affordable Care Act, though in recent days he said he would consider keeping some provisions that prohibit insurers from denying people coverage based on pre-existing conditions, and allow young people to stay on their parents' plans until age 26.

Though it's too early to know how the Trump presidency will affect access to care, “If the law were changed in a way that either flattened or increased the number of people without insurance coverage, we would certainly see a movement back to a widening of a gap between the U.S. and other countries,” Sara Collins, the Commonwealth Fund's vice president of healthcare coverage and access, said during the press conference.