Americans more likely to incur high medical costs, insurance snafus than global counterparts

Americans were the most likely among adults in 11 countries to incur high medical expenses, even when insured, and to spend time on insurance paperwork and disputes or to have payments denied, although they have better access to specialist services than many.

The Commonwealth Fund conducted its 13th annual health policy survey to learn how the insurance designs of various countries affect access, financial protection when sick, and the complexity of health insurance. The 11 countries included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

The survey consisted of computer-assisted telephone interviews using a common questionnaire that was translated as needed. Study populations ranged from 1,000 to 3,500 in each country. Results appeared online Nov. 18 at Health Affairs. Questions addressed topics such as affordability, access and ease-of-use.

In terms of affordability, 35% in the U.S. spent $1,000 or more out-of-pocket for health care, compared to 25% in Switzerland and 21% in Australia. Spending $1,000 or more was rarest in the United Kingdom (1%) and Sweden (2%). Also, the U.S. is the only country in which 20% of adults reported serious problems paying health care bills, compared to all other countries, which reported single-digit percentages.

The U.S. led in insurance disputes. Americans were the most likely (17%) of all 11 countries to report spending a lot of time on insurance paperwork or disputes, and 25% of U.S. adults reported that they were denied insurance reimbursement or were reimbursed less than they expected. Meanwhile, 31% of U.S. adults reported some type of insurance-related concern in the past two years. More than twice as many adults younger than 65 years old reported spending a lot of time on paperwork, disputes with insurers or insurance surprises than those covered by Medicare (35% vs. 16%, respectively).

In terms of access, countries varied in their capacity to provide 24/7 health care outside of hospital emergency departments. Far exceeding all other countries, 93% of the Swiss reported a same- or next-day appointment the last time they were sick, compared to 57% of Americans. About two-thirds of adults in Canada, France, Sweden, and the U.S. said it was difficult to get after-hours care without going to the emergency department, nearly twice the rate reported in the Netherlands, New Zealand, and the United Kingdom. Swiss adults, along with German and U.S. adults, were more likely than adults in the other countries to report quick access to specialists; more than 80% in each country saw a specialist within four weeks. They also had the best rates of less than four weeks' wait time for elective surgery.