IN­SUR­ERS:

U.S. leads 10 other coun­tries in in­surance prob­lems: study

Modern Healthcare - - Front Page - Joe Carl­son

In its an­nual sur­vey of in­ter­na­tional con­sumer at­ti­tudes, the Com­mon­wealth Fund has found what study au­thors called “glar­ing gaps” in the health­care sys­tem in the U.S. in terms of cost, qual­ity, ac­cess and the rel­a­tive sim­plic­ity of in­surance plans.

“We emerge as the only coun­try in the study where in­surance cov­er­age does not guar­an­tee that you will re­ceive care when you are sick,” said Cathy Schoen, se­nior vice pres­i­dent for pol­icy, re­search, and eval­u­a­tion at the New York-based Com­mon­wealth Fund.

As greater num­bers of health­care con­sumers in the U.S. ex­pe­ri­ence fine-print in­surance caveats such as life­time max­i­mums, gaps in cov­er­age and in­ex­pli­ca­ble de­nials of pay­ment, they also have steadily lost faith in the sys­tem, ac­cord­ing to the re­sults of the study.

A re­port on the study was pub­lished last week in Health Af­fairs in the ar­ti­cle, “How Health In­surance De­sign Af­fects Ac­cess to Care and Costs, by In­come, in Eleven Coun­tries.” The study sur­veyed nearly 20,000 res­i­dents of 11 in­dus­tri­al­ized na­tions about their health plans.

Only 70% of those sur­veyed in the U.S. said they were con­fi­dent of re­ceiv­ing the most ef­fec­tive treat­ment, de­spite the fact that the Amer­i­can sys­tem’s per-capita costs are al­most dou­ble the next-most-ex­pen­sive sys­tem in the study: $7,538 per per­son in the U.S. and $4,627 in Switzer­land.

Asked about the pub­lic at­ti­tudes shown in the sur­vey, rep­re­sen­ta­tives for providers and in­sur­ers each es­sen­tially blamed the other side.

Caro­line Steinberg, vice pres­i­dent of trends anal­y­sis for the Amer­i­can Hos­pi­tal As­so­ci­a­tion, said com­plaints about the high out-of­pocket costs and lower lev­els of ac­cess were func­tions of the in­surance plans of­fered by the var­i­ous com­mer­cial and govern­ment pay­ers. “This study re­ally high­lights cov­er­age is­sues, and one of the huge is­sues for con­sumers is not hav­ing the cov­er­age you think you have,” Steinberg said. Con­sumers “are afraid they will face bar­ri­ers to ac­cess and they won’t be able to af­ford care.”

Robert Zirkel­bach, spokesman for Amer­ica’s Health In­surance Plans, said it was the providers—not the in­sur­ers—who have cre­ated the costly and com­plex health­care de­liv­ery sys­tem around which in­sur­ers struc­ture their plans.

“The prices that are charged for med­i­cal ser­vices in the U.S. far ex­ceed those charged in other places in the world,” Zirkel­bach said. “As the cost of health­care in­creases, the cost of cov­er­age in­creases.” As a re­sult, more con­sumers will choose cheaper, less-in­clu­sive cov­er­age.

In the U.S., 35% of re­spon­dents re­ported pay­ing more than $1,000 out-of-pocket, while in other coun­tries the fig­ures ranged from 1% to 25%.

Like­wise, 20% of Amer­i­cans re­ported hav­ing se­ri­ous prob­lems pay­ing their med­i­cal bills. In the other coun­tries in the sur­vey, the num­bers all were in the sin­gle dig­its, rang­ing from 2% to 9%.

Costs in the U.S. were so high, in fact, that 28% of peo­ple sur­veyed said high med­i­cal costs caused them not to see a doc­tor when they were sick in the past year—an­other cat­e­gory in which the U.S. scored high­est.

One area in which the U.S. scored bet­ter than other coun­tries on the list was wait times for spe­cial­ists. In the U.S., 80% of re­spon­dents re­ported be­ing able to see a spe­cial­ist in less than four weeks. In Canada’s state-run sys­tem, only about half as many peo­ple could say the same, while an­other 41% said they waited more than two months to see a spe­cial­ist.

Canada and the U.S. re­ported sim­i­lar pat­terns for elec­tive surgery wait times. In the U.S., 68% of re­spon­dents said they waited less than a month for elec­tive surgery, while only 7% waited more than four months. In Canada, only 35% could get in for an elec­tive pro­ce­dure in a month, and a quar­ter of the Cana­dian re­spon­dents waited bet­ter than four months to go un­der the knife.

Schoen: In­surance is no guar­an­tee of health­care in the U.S.

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