We Don't Get What We Pay for When It Comes to Health Care

Do we have the best health care system that money can buy? That is true for a small minority of Americans but it certainly not the case overall in you examine the results of a recent Commonwealth Fund survey. The survey compared the United States to 10 other industrialized countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

While we do have centers of excellent health care, the fact is that the U.S. too often falls far behind these other industrialized nations on many measures of access, quality, efficiency and health outcomes -- despite spending more than twice what other countries spend on average, or more than $7,500 per person in 2008.

Examples:

• One-third of U.S. adults did not see a doctor when they were sick or skipped recommended medications or follow-up care because of costs -- by far the highest rate compared with the other countries and in stark contrast to low rates in the Netherlands and the United Kingdom.
• U.S. adults were more likely than those in the 10 other countries to have gone without care because of costs in the past year; to report serious problems paying medical bills; and to spend $1,000 or more out of pocket for medical care, even when insured, and to spend a lot of time on paperwork and disputes with insurers or to be surprised that their insurance did not pay as expected.
• One-fifth of U.S. adults reported serious problems paying their medical bills -- more than double the next highest country. More than a third of U.S. adults said they spent $1,000 or more in the past year on medical costs --the highest rate in the survey. Notably, it was similarly high among those insured all year.
• Only 58 percent of U.S. adults were confident they would be able to afford the care they needed -- the lowest rate in the survey. U.K., Swiss and Dutch adults were the most confident they would be able to afford needed care. This finding reflects stresses families face in the current recession, fear that they will lose their insurance if they lose their job, as well as often inadequate health insurance.

The 11 countries in the survey represent a diverse mix of insurance and coverage systems. With the exception of the United States, all of these countries achieve universal or near universal coverage of their populations with diverse systems that range from mainly public, to public supplemented by private insurance, to competition among insurers.