A new 11-country survey from The Commonwealth Fund finds that adults in the United States are far more likely than those in 10 other industrialized nations to go without health care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover insurance wouldn’t pay as they expected.

The U.S. stands out for the most negative insurance-related experiences.

One third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared to as few as 5 percent to 6 percent in the Netherlands and the U.K., according to the study.

One-fifth of U.S. adults had major problems paying medical bills, compared to 9 percent in France, the next highest country, 2 percent in the U.K., 3 percent in Germany, and 4 percent in the Netherlands.

Uninsured and insured U.S. adults reported equally high rates of out-of-pocket costs, with one-third (35%) of U.S. adults paying $1,000 or more out-of-pocket in the past year for medical bills, significantly higher than all of the other countries.

The study analyzes findings from the Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries, focusing on insurance and access to health care experiences reported by 19,700 adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

The study reveals widespread disparities by income within the United States. Lower income U.S. adults were far more likely than those with above average incomes to report difficulty with medical bills and timely access to health care.

“We spend far more on health care than any of these countries, but this study highlights pervasive gaps in U.S. health insurance that put families’ health and budgets at risk,” said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article. “In fact,
the U.S. is the only country in the study where having health insurance doesn’t guarantee you access to health care or financial protection when you’re sick. This is avoidable – other countries have designed their insurance systems to value access and limit out-of-pocket costs.”

The U.S. also stood out for its complex insurance system, the study found.

Thirty-one percent of U.S. adults either spent a lot of time dealing with insurance paperwork, had their insurer deny a claim, or had their insurer pay less than they anticipated. In contrast, only 13 percent of adults in Switzerland, 20 percent of adults in the Netherlands, and 23 percent of adults in Germany – all countries with competitive health insurance markets – reported these problems.

U.S. adults under 65 were the most likely to experience problems dealing with their health insurance providers – the 65 and older Medicare population was much less likely to report these issues.

According to the study, the U.S. stood alone among the countries for its persistent and wide disparities among income groups – even for those with insurance.

Although the uninsured were at highest risk for skipping needed care, working-age U.S. adults with below-average incomes who were insured all year were significantly more likely than those with above-average incomes to go without needed care because of costs and have serious problems paying medical bills – nearly half (46%) went without needed care and one third had one bill problem, double the rates reported by above-average income insured adults.

“What we are hearing directly from adults around the world, and what we hear regularly at home, is that there is substantial room for improvement in the U.S. health insurance system,” said Commonwealth Fund President Karen Davis. “The good news is that there are opportunities to learn from other countries, and Affordable Care Act reforms will provide affordable insurance options for the uninsured, make sure insurance pays for essential care, and provide financial security for millions.”