US outpaces other wealthy nations in cost-related care deferment, with wide gaps between income levels

Another international survey has painted Americans’ access to care in a poor light when compared to those living in other wealthy countries, particularly when looking at disparities in residents’ income levels.

Published Thursday by the Commonwealth Fund, the summer poll of adults living in nine countries found broad gulfs in healthcare utilization between residents with higher incomes and those with low or average incomes.

The U.S., however, consistently topped its peers for the highest portion of respondents who said they skipped medical care due to costs and was among the countries with the widest disparity in income level disparities, according to the foundation’s poll.

Specifically, 46% of surveyed U.S. adults with average or lower incomes said they had a cost-related reason for skipping medical care during the prior 12 months, well above the next-highest 34% of New Zealand or the 16% reported in the U.K., Netherlands, Germany and France. Twenty-nine percent of Americans with incomes above average reported the same, outpacing the second place Australia’s 25% rate and the lowest 6% among the French and the Dutch.

The Commonwealth Fund found similar income level gaps when looking at decisions to pass on dental and mental healthcare due to costs. Forty-six percent of low or average-income Americans versus 24% of higher earners reported skipping the former, while 21% versus 14% said they skipped the latter.

The U.S. had the second-highest rate of skipping responses for dental care (just behind New Zealand’s 47% and 42%), the highest for low- and average-income respondents skipping mental health care and the second-highest for high-income respondents skipping mental health care (behind Australia’s 15%), according to the survey.

Regardless of income, the survey found that 44% of U.S. residents reporting having a problem paying or handling a medical bill within the prior 12 months. This handily surpassed the next highest country, Australia (36% for low/average, 24% for high) and eclipsed the U.K.’s lows (9% low/average, 6% high).

“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 fund wrote in its report. “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.”

The group acknowledged that the income disparities seen across the other countries “suggest that ensuring affordability is a challenge there as well. Having health coverage is important, but that coverage must be both affordable and comprehensive.”

The Commonwealth Fund’s annual survey queried a representative sample of nine countries’ residents aged 18 and older. Final samples for each country ranged from 750 to 4,820 participants, with survey research firm SSRS contracted to field the poll in the U.S. and six other countries. Household income levels were self-reported.

The latest data furthers a string of international health survey data from Commonwealth and others that suggest Americans have the poorest healthcare system among other high-income nations. It also lands just weeks after another report from the foundation that found 51% of working-age Americans struggle to afford healthcare and almost a third have medical debt. These difficulties, and resulting decisions to skip care, were prevalent among respondents with employer coverage, individual plans or government insurance, the Commonwealth Fund found.