he U.S. health care system has significantly more access problems due to affordability than seen by other wealthy countries, according to a new study from Commonwealth Fund.
The report, “The Cost of Not Getting Care: Income Disparities in the Affordability of Health Services Across High-Income Countries” looked at how people in 9 different countries at different income levels are managing their health care costs.
The researchers found that the U.S. does particularly poorly for lower-income citizens. Nearly half (46%) of lower-income Americans said they delayed or skipped health care treatments or visits because of affordability issues. Even among higher-income Americans, more than one-quarter of respondents (29%) said they were likely to skip or delay health care because of the cost.
That’s about twice the rate, for both income groups, for those in Canada with health care cost issues, and almost three times as often when compared with the United Kingdom. Next-closest to the U.S. in health care cost issues was Australia, where 33% of low- or average-income adults had cost issues, and 25% of higher-income adults had cost issues with health care. New Zealand was similar, the data showed in that country, 34% of adults with lower or average income had health care cost issues, and 16% of those with higher income reported those issues.
These findings are not new; other studies have found the U.S. lags behind other countries in access and affordability. Research from the Kaiser Family Foundation from 2022 showed that about 40% of U.S. adults said they delayed or went without medical care due to cost issues.
“The U.S. spends more on health care than any nation in the world, yet Americans across all income levels find it more difficult to afford care than do people in other countries,” said Joseph Betancourt, M.D., Commonwealth Fund president. “As a primary care doctor, I have witnessed the dire consequences of people delaying or going without health care due to challenges with affordability—or having to weigh spending money on basic needs as food and utilities against spending money on needed health care and medicine. This is frustrating and unacceptable. Given how much we invest, everyone in the country should have meaningful access to affordable health care.”
Problems with medical bills, and medical debt In addition, the report found that 44% of Americans—in both low income and high-income groups—say they have some degree of trouble with medical bills. The country with the next-highest rate of self-report billing problems is Australia, with 36% of low-income people reporting problems with medical bills, and 24% of higher-income people reporting problems. The lowest rate of reported billing problems was the U.K., at 9% for low-income respondents, and 6% for higher-income respondents.
An earlier study by Commonwealth Fund outlined some of the problems with medical debt in the U.S. In that report, researchers found that having health insurance did not prevent people from incurring medical debt. That study found that 30% of adults with employer coverage were paying off debt from medical or dental care, as were 33% of those in the Affordable Health Act marketplace or individual-market plans, 21% with Medicaid health plans, and 33% with Medicare coverage. Among uninsured individuals, 41% reported having medical debt.
The effect on other types of health care At a time when access to mental health services has been in demand from consumers, the report found that poorer adults in the U.S. were more likely to skip getting mental health care because of cost: 21% compared to 14% for higher-income Americans.
The report noted again that the U.S. had the highest rate of access issues due to cost in this area: “Even Americans with high incomes were more likely (14%) than their counterparts in all other countries except Australia (15%) and Canada (12%) to avoid mental health care because of cost,” the report said.
And the U.S. ranked second among all countries in adults with lower or average incomes who were more likely to skip dental care; 46%, just below 47% for those in New Zealand.
U.S. ranks low in social services In addition, lower-income people in the U.S. had the highest rate when it came to having at least one social service need, such as food affordability, being able to make payments, and having a stable income. In the U.S., 38% of adults with lower or average incomes reported a social service need. By comparison, 35% of lower or average income adults in the U.K. report social service needs, 34% of adults had social service needs in Australia, Canada, and France.
The report noted that income disparities create challenges for health care access around the world and pointed to Germany and the Netherlands as two countries that seemed to have the most balanced approach to providing health care.
“In both countries, every person is required to have health insurance; there are cost-sharing caps limiting the amount patients have to spend out of pocket; and the cost of coverage is determined by an individual’s income, meaning that those with lower incomes receive more generous government support,” the Commonwealth Report said. “In addition, both countries include mental health care in the benefits provided by public health plans, and nearly everyone in Germany, along with most residents of the Netherlands, has dental coverage.”
The more market-driven system in the U.S. continues to lag behind other countries in providing comprehensive coverage to all regardless of income. “Our findings show vast income-related disparities in health care affordability in the United States — the only country in this analysis without universal health coverage and broad limits on out-of-pocket health spending,” the report concluded. “In addition to ensuring coverage for all, the other eight nations generally cap annual out-of-pocket costs for covered benefits, provide cost-sharing exemptions for primary care and certain other services, and offer additional safety nets for people with lower or average incomes and chronic conditions. Moreover, compared to other high-income countries, the U.S. spends proportionately less on social services relative to overall health spending, another likely contributor to Americans’ poorer health status and greater need for medical care.”
“The more market-driven system in the U.S. continues to lag behind other countries in providing comprehensive coverage to all regardless of income.”
Design by Chris Nicholls
T
44%
U.K.
36%
9%
Experiences trouble with medical bills (low-income groups)
U.S.
Australia
