title: How health insurance design affects access to care and costs, by income, in eleven countries.
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.
authors.affiliation: Commonwealth Fund, New York City, NY, USA. cs@cmwf.org
authors.forename: Cathy
authors.initials: C
authors.lastname: Schoen
authors.forename: Robin
authors.initials: R
authors.lastname: Osborn
authors.forename: David
authors.initials: D
authors.lastname: Squires
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Doty
authors.forename: Roz
authors.initials: R
authors.lastname: Pierson
authors.forename: Sandra
authors.initials: S
authors.lastname: Applebaum
mesh_terms: D000328:Adult; D003625:Data Collection; D019049:Developed Countries; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000458:organization & administration*; D007407:Interviews as Topic; D008875:Middle Aged; D055815:Young Adult