How Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries

TLDR

The eleven countries studied have diverse health coverage systems, from fully public to mixed public–private models, with varying cost‑sharing arrangements. The study uses a 2010 cross‑national survey of adults in eleven countries to assess insurance‑related experiences. Insurance design creates marked disparities in access, cost burden, and administrative hassles: U.S.

Abstract

This 2010 survey examines the insurance-related experiences of adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United States, and the United Kingdom. The countries all have different systems of coverage, ranging from public systems to hybrid systems of public and private insurance, and with varying levels of cost sharing. Overall, the study found significant differences in access, cost burdens, and problems with health insurance that are associated with insurance design. US adults were the most likely to incur high medical expenses, even when insured, and to spend time on insurance paperwork and disputes or to have payments denied. Germans reported spending time on paperwork at rates similar to US rates but were well protected against out-of-pocket spending. Swiss out-of-pocket spending was high, yet few Swiss had access concerns or problems paying bills. For US adults, comprehensive health reforms could lead to improvements in many of these areas, including reducing differences by income observed in the study.