Health costs, red tape causing Americans to skip care

High costs and a burdensome insurance system are keeping droves of Americans away from the medical care they need, according to a new analysis of data compiled by The Commonwealth Fund and published in the journal Health Affairs. The study, which piggybacks on the findings of another Commonwealth Fund study published earlier this year about quality of care, determined that out of 11  "industrialized" nations, the U.S. had the most problems with patients opting against getting care due to expenses. 

In all, one-third of American adults surveyed said they went without care because of cost; the next closest nation was Australia at 22 percent. The UK and the Netherlands had only 5 and 6 percent of respondents, respectively, who admitted to forgoing care. What's more, 20 percent of U.S. adults surveyed reported "major problems" with medical bills; no other country cracked 9 percent in that department. 

A total of 19,000 adults, ages 18 and older, were surveyed in 11 nations: the U.S., UK, Australia and the Netherlands, as well as Canada, France, Germany, New Zealand, Norway, Sweden and Switzerland. 

"The U.S. experience to date provides a cautionary tale of complexity, with high overhead costs and disparities by income," the study's authors wrote. "Similarly, the United States has the opportunity to learn as countries with insurance-based systems incorporate incentives for patients and providers, including reference pricing and value-based benefit designs, and as countries with competing insurers develop risk adjustment to focus competition on value."

The authors also note that despite the changes to insurance the new health reform law will bring about, complexities will remain because lower-income people still will be covered by a separate program. 

"In the other 10 countries in our survey, providers were typically paid the same amount regardless of patients' incomes, which is not currently the case in the United States," they wrote. "To the extent that provider networks...differ for those low-income insurance programs, continuity of care as well as insurance will remain at risk after reforms take effect." 

In a separate survey of 500 U.S. primary-care doctors conducted late last month, roughly 95 percent said that their patients had been either rationing or forgoing their medication altogether over the past six months because of financial and insurance coverage concerns. 

"I have many patients choosing between medication, paying bills, and buying food," one survey respondent said, according to a press release from MDLinx, the doctor portal responsible for the study. "My partners and I are spending much more time [largely not reimbursed] helping patients juggle these issues," the anonymous physician added. 

To learn more:
- read the full study at Health Affairs
- check out this synopsis from The Commonwealth Fund
- here's the MDLinx press release

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