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Americans Struggle with Costs and Access

The U.S. trails other countries in making health care accessible and affordable. (Volume 9, Issue 34)

Since 1998, the Commonwealth Fund has surveyed several health care metrics in eleven countries across North America, Europe, and Australia. Recent surveys have shown the United States lagging in indicators relating to access and perceptions of costs. Understanding the measures in which the United States either lags or leads the international community provides guidance as reformers look for alternatives to the patchwork of public and private resources that comprise the U.S. health care system.

Source: Kevin M. Gill (CC)

Data showed the United States as lagging behind several Western industrialized nations in reports of personal concerns about financial barriers to health care, access to primary care, and treating chronic diseases. These findings were magnified amongst lower-income populations in all countries, including the U.S.  However, the U.S. faces several systemic handicaps when being compared to counterparts across the world. Approximately of the U.S. continue to lack insurance and there is no infrastructure to supply comprehensive care for the estimated 11 million in the U.S. Though the Affordable Care Act does provided protections against increasing costs and offers quality assurances through the Obamacare exchanges, other countries provide additional protections that U.S. citizens do not enjoy.

There are several reforms that would immediately improve health care for all Americans. We could find ways to provide coverage to uninsured adults and immigrants. Many lessons from our international counterparts show viable solutions to this issue. Additionally, strengthening the social safety net is imperative to improve the general health and mental well-being of patients in the United States.

Healthcare reform now inhabits a precarious position.  Republicans control the legislative and executive branches. They have the power necessary to address the deficits in U.S. health care, yet value costs and personal independence over access and quality. Innovation is needed for the reinvention of the U.S. health care system, but we only need to look towards our international partners for templates on how to provide affordable, comprehensive health care. Healthcare reform will not necessarily require development of novel health care systems, but will require Americans to adjust how they view health care and its implications in our every day lives.

commentary by Orlando Sola


Surveys of patients’ experiences with health care services can reveal how well a country’s health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination.

PMID: 27856648  Osborn, R, et al. Health Affairs 2016; 35 (12): 2327-2336.

Orlando Sola, MD, MPH
About Orlando Sola, MD, MPH

Orlando Sola is an assistant clinical professor in the Department of Family Medicine at SUNY-Downstate Medical Center. He trained at the Institute for Family Health/Mount Sinai Hospital. He obtained his medical degree from Columbia University’s College of Physicians and Surgeons and completed his Masters in Public Health at Johns Hopkins Bloomberg School of Public Health. Contact: Website | Facebook | Twitter | More Posts