Americans more likely to delay care than adults in other nations

When adults in the United States get sick, they are far more likely to forgo health care because of cost than adults in many other countries -- even if they have health insurance.

A study comparing 11 nations -- Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the U.S. -- found that only 57% of American adults saw a doctor the same or next day when they were sick. This lags far behind the top three nations: 72% of Dutch adults saw a physician the next day, 78% of New Zealanders did and 93% of Swiss adults went to the doctor that quickly.

One big reason for the discrepancy, the study found, was that U.S. patients were the most likely to incur high medical expenses, even when insured. In the U.S., 35% of patients spent more than $1,000 out of pocket on health care in the past year. Switzerland was the next highest, with 25% of patients spending that much. Fewer than 1% of the U.K. patients surveyed reported out-of-pocket expenses of more than $1,000 for health care.

Researchers analyzed data from the 2010 Commonwealth Fund International Health Policy Survey, which queried more than 19,000 people 18 and older in phone interviews between March and June 2010. Health care systems ranged from public systems to hybrids of public and private insurance, with varying levels of cost-sharing. All countries in the study, published online Nov. 18 in Health Affairs Web First, allow some role for private insurance.

The survey found that 33% of U.S. adults went without recommended care, did not see a doctor when sick or failed to fill prescriptions because of costs. In comparison, as few as 5% of adults in the U.K., where coverage as well as much of the care is provided through the public National Health Service, made one of those decisions.

Patterns regarding affordability and cost-related access in the 11 countries varied according to insurance design. U.K. and Dutch adults, with comprehensive benefits and nominal cost sharing, were the most confident that they would be able to afford care. Among U.K. adults, 90% were confident; 81% of adults in the Netherlands were confident. Adults in those countries were the least likely to have gone without care because of costs, with the figure at 5% in the U.K. and 6% in the Netherlands.

Even if insured, U.S. patients were significantly less likely than adults in all other countries to have confidence in their ability to afford care. Only 58% said they were confident.

"We emerge as the only country in the study where having health insurance doesn't guarantee that you'll be covered for care when sick or you'll be protected well against high medical costs when seriously ill," Cathy Schoen, senior vice president of the Commonwealth Fund, said at a news conference. "We hope and we expect that reforms [in the Patient Protection and Affordable Care Act] will make a positive difference."