US adults are more likely to have poor health than those in 10 similar countries, survey finds

BMJ 2016; 355 doi: (Published 16 November 2016) Cite this as: BMJ 2016;355:i6174
  1. Michael McCarthy
  1. Seattle

US adults are more likely to skip care because of cost, to struggle to afford basic necessities, and to have poorer health than adults living in 10 other high income countries, a survey has found.1

The Commonwealth Fund conducted the survey, which was based on interviews with nearly 27 000 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The results were published on 16 November in the journal Health Affairs.1

The survey is the latest of a series of international surveys conducted by the fund since 1998 to gauge health related experiences of doctors and patients in different countries. For the first time the survey also looked at the relation between reported health and wellbeing and the prevalence of material hardship.

It found that, when compared with adults in the other countries, US adults reported poorer health: more than a quarter (28%) reported at least two chronic conditions such as arthritis, diabetes, or heart disease, and a similar proportion (26%) reported episodes of emotional distress in the past year that they said were difficult to cope with alone.

Only Canadians reported similar rates of poor health (22%) and emotional distress (27%) to US adults. Rates of reported poor health were lowest in the UK and the Netherlands (14%) and in Switzerland and Australia (15%). Rates of emotional distress were particularly low in France (12%) and Germany (7%).

US adults were also much more likely to report that they were “always” or “usually” worried about having enough money to buy nutritious meals or to pay their rent or mortgage: 22% reported such difficulties, compared with just 4% in Germany, 7% in France, and 8% in the UK.

US adults were also more likely to report financial barriers to healthcare, as 33% reported that they had not visited a doctor, had skipped a recommended treatment or test, or had either not filled a prescription or skipped a dose of a prescribed drug because of cost. Only 7-8% of adults in Germany, the Netherlands, Sweden, and the UK reported such cost related problems.

Cost barriers to care were even greater among low income adults in the US, where 43% reported cost related difficulties—the highest rate in any country. Rates in the other countries ranged from just 8% in the UK to 31% in Switzerland.

“The United Kingdom was the only country where low-income adults were not significantly more likely than the rest of the population to report cost-related problems,” the authors wrote. Low income was defined as having a household income lower than 50% of the country’s median.

The survey found that all nations surveyed had problems with patient engagement, chronic care management, and care coordination. Overall, the Netherlands, primarily because of its strong primary care system, was the best performer on most measures of access, engagement, and coordination.


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