U.S. health system has worst access for the poor among 11 wealthy nations, study finds

Even as Senate Republicans renew efforts to pass a bill expected to raise health-insurance premiums beyond the means of millions of Americans, new research released Friday shows that income inequality already limits the poor’s access to care more profoundly in the United States than it does in 10 other wealthy nations.

The New York-based Commonwealth Fund shared this finding and other information from its research Friday as part of a perspective piece in the New England Journal of Medicine. In the article, leaders of the 99-year-old nonprofit foundation, which studies how the U.S. can achieve a high-performing health care system, will examine how the U.S. can move from last to first among its high-income peers.

“As background, it is often said that the U.S. has the best health care in the world, but there is limited evidence to support that claim,” said Eric Schneider, senior vice president for policy and research at the fund and the study’s lead author. “The overall performance of the U.S. health care system ranks last among the 11 countries included in this study. This result is due to poorer performance in several areas, including access, administrative efficiency, equity and health outcomes.”

Yet Schneider said the United States spends far more on health care than other wealthy nations do, and that spending has grown more rapidly than any other country’s in the study. Since 1980, U.S. health care spending as a percentage of the nation’s gross domestic product has grown to 16.6 percent. Australia ranks lowest in this category at 9 percent. Spending grew to 10.9 percent in the Netherlands, 9.9 percent in the U.K., 10 percent in Canada and 11.1 percent in France.

Although health-care costs have grown at a much lower pace in the U.K., Sweden and the Netherlands, the Commonwealth Fund study found, their systems are marked by greater equity between rich and poor when it comes to access to safe, preventive care. Another key finding: Americans under age 75 are more likely than citizens from any of the other wealthy nations to die from causes considered preventable.

Debate continues around dismantling or replacing the Affordable Care Act, said Dr. David Blumenthal, president of the Commonwealth Fund, but the nation has seen gains in access under the law, also referred to as Obamacare.

“Roughly 20 million people have gained coverage, pushing our uninsured rates to the lowest in decades,” Blumenthal said, “and there have been a number of quality improvements, including a decline in health care-acquired infections in U.S. hospitals.”

Under the original Senate GOP proposal, California would lose $114 billion in federal funding for Medi-Cal by 2037. Low reimbursements already deter some doctors from taking patients covered by Medi-Cal, so advocates have said they fear cuts could make it impossible for impoverished state residents to access preventive care, even if they do have coverage.

The California Black Health Network has been conducting town halls all around the state, and Deputy Director Angelo Williams said they have heard participants express mild to intense panic as they discuss cuts proposed in the House and Senate bills. The bill’s supporters have stressed the need for individual responsibility for health care, but Blumenthal said countries with minimum or no medical cost-sharing perform better than the United States where cost-sharing levels are high.

“Far too many people in the U.S. can’t get the health care they need,” he said. “Far too many remain uninsured, especially compared to other wealthy nations. If we’re going to do better for patients, we should learn from what is working in other nations and continue the path to creating a health system that will provide high-quality care to everybody.”

Editor’s note: This story has been corrected to say that U.S. health care spending as a percentage of the nation’s gross domestic product has grown to 16.6 percent. That same figure has grown to 10.9 percent in the Netherlands, 9.9 percent in the U.K., 10 percent in Canada and 11.1 percent in France.

This story was originally published July 14, 2017 at 4:00 AM with the headline "U.S. health system has worst access for the poor among 11 wealthy nations, study finds."