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Compared To Other Countries, U.S. Patients Have More Access To Specialists, Less To Primary Care

Nov 18, 2010

A new international survey finds that U.S. consumers report greater access to specialty health care but also have a tougher time seeing a doctor on the day they need help and in paying their medical bills than consumers in many other developed nations.

Americans visit doctors and specialists more readily than some other countries, such as Canada and France, according to the survey, which was conducted in 11 countries last spring for the Commonwealth Fund, a Washington-based health policy foundation. Eighty percent of Americans who needed to see a specialist were seen in less than four weeks, trailing the results in only Germany and Switzerland. In Canada, the number was 41 percent.

The survey, published online today in Health Affairs, also found that the United States fell behind seven other countries in both the percentage of adults who can see a doctor or nurse the same day they needed care – 57 percent of adults – and the percentage that had to wait six days or more to see a health care professional – 19 percent. Only Canada, Norway and Sweden did not score higher than the United States in those categories.

In addition, one in three American adults skipped a doctor visit, did not fill a prescription or get other care in the past year because it cost too much, according to the survey. More Americans skipped care because of cost than adults in any other of the countries surveyed.

Twenty percent of Americans said they had a serious problem paying their medical bills in the previous year, the highest percentage of any of the countries. Second was France, with 9 percent. A higher proportion of Americans also spent more than $1,000 out-of-pocket for health care and experienced problems with their health insurance, including disputes over bills.

The new health law will "go a long way" in reducing out-of-pocket and other health costs, Karen Davis, president of The Commonwealth Fund said in a conference call with reporters. "We'll have substantially reduced out-of-pocket costs as a result of the Affordable Care Act. There are subsidies for cost sharing, certainly for very low income families. But they'll still be high relative to what's happening in other countries."

The group has conducted other international surveys of health care.

But Robert Book, senior research fellow in health economics at the Heritage Foundation, cautioned against equating lower-cost coverage in countries outside the U.S. with better health. "If you have to wait for four weeks to get surgery, or four months to get surgery, that's not access. You can have coverage for everything but access to nothing," he said.

Book added that as the health law is implemented, patients could have more trouble getting care because of the influx of millions of newly insured people.

The telephone survey between March and June included more than 2,500 people in the United States and thousands of others in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. The results have a margin of error of plus or minus 2 to 3 points, depending on the country.

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