US lags behind other industrialized countries on insurance rates, access to care

More insured patients could make things worse

The United States continues to rank behind other industrialized countries on insurance rates and access to care, despite advancements made under the Affordable Care Act (ACA), Aaron Carroll writes for the New York Times' "The Upshot."  

Carroll cites data from the Organisation for Economic Co-Operation and Development—an intergovernmental organization with 35 member countries, including the United States—that show the United States has a higher uninsured rate than most other industrialized countries, even after accounting for coverage gains under the ACA.

Further, a Commonwealth Fund survey conducted in 2013 found that the United States consistently ranked low on health performance indicators when compared with 11 other countries with similar socioeconomic conditions.

For example, the study found that 52 percent of U.S. residents said they could not schedule a same-day or next-day appointment with their health care providers when they needed care or were sick. The United States ranked 10th out of 11 countries on that indictor.

In addition, the United States ranked eighth out of 11 countries when respondents were asked if it was "somewhat" or "very easy" to access care after regular working hours. According to "The Upshot," individuals who cannot access care outside of regular working hours are more likely to seek care at an ED.

Researchers also surveyed primary care physicians in 10 countries for the study. They found that the United States ranked ninth out of the 10 countries on whether the physicians reported feeling "well prepared" to manage care for patients with complex needs. The United States ranked last on whether physicians made home visits to patients and whether physician practices allowed patients to see doctors or nurses after hours without using an ED.

Reasons for the lag

One reason why the United States lags behind other industrialized countries on access to care is that it has fewer general practitioners per population than any of the other countries surveyed. For instance, the United States had about 50 percent fewer primary care physicians per 1,000 people than Sweden, and about 20 percent fewer than France or Germany.

Uninsured rate hits historic low, CDC says

Additionally, more U.S. residents have gained insurance since the ACA took effect, which may be further stressing a health system with too few primary care providers, according to "The Upshot." Also, the cost of accessing care in the United States is a barrier for some individuals. According to the Commonwealth Fund study, one-third of U.S. respondents said they did not fill a prescription, visit a physician, or obtain medical tests because of costs.

A need for reform

According to "The Upshot," U.S. residents agree the U.S. health care system needs reform but remain unsure of how to reform it. The Commonwealth Fund study found that in 2013, 75 percent of U.S. respondents said the health care system needed fundamental change or to be totally rebuilt. However, "it's hard to see how things will improve" because U.S. residents "can't seem to have a discussion" on how to solve access to care issues in the country, Carroll concludes (Carroll, "The Upshot," New York Times, 10/24).

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