U.S. patients find it harder to pay for care


Compared to other countries, U.S. patients are more likely to forgo care because of cost

More than half (58%) of U.S. physicians told researchers at the Commonwealth Fund that their patients often have difficulty paying for medications and other healthcare services. By contrast, between 5% and 37% of physicians from the other 10 countries surveyed said the cost of care was often a problem for their patients.

The physician survey reinforces what patients have been saying for years, according to Commonwealth Fund Vice President Cathy Schoen, one of the authors of the report.

The problem is less severe in other advanced industrialized nations. Countries with nationalized care models tend to emphasize primary and preventive care and design benefit structures to alleviate cost burdens. For example, France's insurance model places the most efficacious drugs-regardless of price-in the lowest formulary tier. France and Germany waive patient cost sharing when out-of-pocket spending reaches a certain threshold.


The current recession, although a global phenomenon, has exacerbated the problem, according to Lori Heim, MD, president of the American Academy of Family Physicians (AAFP).

"Other countries have been hit by the recession, but if you lose your job in another country, you don't lose your health insurance," Dr. Heim says.

In a May poll conducted by AAFP, nearly 90% of the family physicians surveyed said their patients "have expressed concerns recently over their ability to pay for their healthcare needs." Physicians surveyed said more patients were canceling appointments, coming in without insurance and exhibiting health problems caused by lack of preventive care.

"We just never see this problem of cost in other country surveys," Schoen says.

Physicians in Italy were the second most likely group to say patients often have trouble paying for medications and other healthcare costs, with 37% indicating the problem. Physicians in Norway and Sweden were the least likely to see cost as a problem with only 5% and 6%, respectively, saying it was a concern to patients.

For physicians in the United States, unfortunately, cost is a constant and unignorable factor undermining care. Unaffordable preventive treatment is especially concerning. When a mother must forgo a flu vaccination because she can't not afford to vaccinate herself and her children, cost undermines basic health.

"People shouldn't have to make these kinds of choices," Schoen says.

-Shelly ReeseCommentary is independent of source data.

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