Almost 4-in-10 U.S. adults did not see a doctor when sick or failed to fill prescriptions due to cost, compared to 5 percent in other nations, researchers say.
An 11-country survey by The Commonwealth Fund also found about 2-of-5 U.S. adults spent $1,000 or more out-of-pocket for medical care in the past year -- by far the highest rate of any country surveyed.
The survey of 20,045 adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States found the United States spent more on healthcare per capita than any other nation -- $8,508.
Norway had the next highest at $5,669 per capita and $5,643 per capita in Switzerland. New Zealand had the lowest per capita rate -- $3,182 -- per person, the report said.
The United States also spent the most on insurance administrative cost, $606 per person, compared to $277 in France and $266 in Switzerland, the next-highest countries. The report's authors noted the high administrative spending in the United States was a symptom of the country's complex, more fragmented health insurance system.
"The U.S. spends more on healthcare than any other country, but what we get for these significant resources falls short in terms of access to care, affordability, and quality," Dr. David Blumenthal, president of the Commonwealth Fund, said in a statement.
The study also found, U.S. adults either had serious problems paying medical bills or were unable to pay them, compared to fewer than 13 percent of adults in France, the next-highest country, and 6 percent or fewer in Britain, Sweden and Norway.
Uninsured adults in the United States were the most likely to struggle to afford healthcare of the 11 countries studied, but even U.S. adults insured all year long were more likely than adults in other countries to forgo care because of cost, to struggle with medical bills, and to face high out-of-pocket costs.
U.S. health insurance also had the higher deductibles and higher cost-sharing -- co-insurance -- and did not place limits on out-of-pocket costs.
This potentially explains why even U.S. adults with health insurance struggle to afford needed healthcare, the report said.
The vast majority -- 75 percent -- of U.S. adults said the health system needs to undergo fundamental changes or be rebuilt. Fifty-one percent of the Dutch, 54 percent of the Swiss and 63 percent in Britain said they had strong positive views of their country's healthcare system, saying it worked well and only needed minor changes.
Thirty-two percent of U.S. adults either spent a lot of time dealing with insurance paperwork, disputes or had their insurer deny a claim and/or pay less than anticipated compared with 25 percent in Switzerland, 19 percent in the Netherlands and 17 percent in Germany -- all countries with competitive health insurance markets -- which reported these problems.
U.S. adults with no health insurance often waited for primary care when they were sick, with fewer than half saying they were seen the same day or the next day, and 1-in-4 waiting six days or longer, the survey found.
Along with Canadian adults, U.S. adults were more likely to report long waits for primary care and high use of hospital emergency departments compared to other countries. German, Dutch and New Zealand adults were the most likely to be seen by a clinician rapidly, with two-thirds or more reporting they could get same- or next-day appointments for primary care, the report said.
The survey was conducted by Social Science Research Solutions and contractors in each country, from February to June. The final samples of adults included: Australia, 2,200; Canada, 5,412; France, 1,406; Germany, 1,125; Netherlands, 1,000; New Zealand, l,000; Norway, 1,000; Sweden, 2,400; Switzerland, 1,500; United Kingdom, 1,000; and United States, 2,002. The margin of error 2 percentage points for Canada; 3 percentage points for Australia, France, Germany, the Netherlands, Sweden, Switzerland and the United States and 4 percent for Norway, New Zealand and Britain.