Abstract
Background
Over the past four decades, health spending by governments and individuals has steadily increased as a share of the global economy, driven in part by advances in medical technology and growing demand for services. Rising costs often translate into higher out-of-pocket expenses, including premiums, deductibles, copayments, and taxes. These financial pressures may lead people to forgo needed care, potentially worsening health outcomes.
Methods
We conducted cross-national comparisons using primary data from the 2023 Commonwealth Fund International Health Policy Survey, which surveyed adults age 18 and older in 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S.
Results
Less than 10% of higher-income adults in Germany and the Netherlands reported problems accessing care due to costs, compared to 29% of higher-income adults, and 46% of lower-income adults, in the U.S. In 7 of the 9 countries, adults with lower or average incomes were more likely to skip dental care than those with higher incomes. In 6 of the 9 countries, about one-third of adults with lower or average incomes reported at least one social service need. 44% of adults in the U.S. reported having medical bill problems compared to less than 10% of adults in the U.K.
Conclusions
Financial barriers to accessing care can negatively affect health behaviors and outcomes. Our findings reveal substantial cross-country differences in health care affordability. All countries in the study, except the U.S., provide universal coverage and typically cap out-of-pocket costs for covered services. However, affordability challenges persist in several of these systems, indicating that coverage alone is not sufficient. Ensuring that care is both affordable and comprehensive remains critical. Experiences in Germany and the Netherlands, where affordability concerns are less prevalent, may offer insights for improving health system design.