US women face worse outcomes, higher costs than in other wealthy countries

The U.S. healthcare system regularly fails to meet the needs of women of reproductive age, according to a new Commonwealth Fund report. 

The study compared healthcare access and outcomes for women ages 18 to 49 in 11 high-income countries. It used data from a 2020 Commonwealth Fund survey and the Organisation for Economic Co-operation and Development. The U.S. remains the only wealthy country without universal healthcare, it noted.

“Other countries have made substantial efforts to ensure women are able to get needed primary care as well as maternal and mental health care,” the report authors said.

It found that compared to women in other wealthy countries, U.S. women have the highest rates of death from avoidable causes like pregnancy-related complications. Nearly 200 in 100,000 deaths could have been prevented. High rates of avoidable deaths can indicate shortcomings in public health and care delivery systems, the report said. Primary and preventive health services like cancer screenings and immunizations can reduce premature and unnecessary deaths. The maternal mortality rate is also highest in the U.S., more than three times the rate in the other countries studied, and disproportionately affects Black mothers.

U.S. women spend more out of pocket on healthcare than in other countries; more than a quarter reported annual family out-of-pocket costs of $2,000 or more, even those covered by insurance, compared to less than 5% of women in the U.K., France and Netherlands. High costs make U.S. women a lot more likely to skip or delay needed care. More than half said they had a problem paying a medical bill in the past year. By contrast, only 1 in 10 women in the U.K. reported such a problem.

U.S. women also have the highest rate of mental health needs and among the highest rates of multiple chronic conditions. One in 5 women has two or more chronic conditions, compared to fewer than 1 in 10 women in Switzerland, Germany, Sweden and France. Managing social drivers and good medical care are associated with better management of chronic conditions; the U.S. invests less in these areas compared to other countries.

Women in the U.S. are among the least likely to report having a regular doctor or place to go for care, along with women from Sweden and Canada. Having a regular doctor helps minimize disparities and limits healthcare costs, the report noted. Only a quarter of U.S. women ranked the country’s healthcare system highly, compared to most women in other countries.

U.S. policymakers could extend affordable primary care to all women by building on existing Affordable Care Act reforms, the report said. The government should also encourage states to extend Medicaid coverage to at least a year postpartum, unlike the current 60 days, and expand coverage of women’s preventive services without cost-sharing. Further, making mental health care more affordable is critical to serving women’s needs, for instance by requiring coverage of essential health benefits from large-group employer plans.

The report suggested one way to increase the waning supply of primary care physicians is by subsidizing medical education and increasing the number of federally supported Medicare residency positions. Expanding the maternal care workforce to include more nurses, midwives and doulas could also improve outcomes.