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Healthcare Affordability Woes Affect High- and Low-Income Patients Alike

For some metrics, healthcare affordability is more challenging for high-income Americans than low-income folks in similarly developed nations.

It’s long been understood that healthcare in the United States is unaffordable for the nation’s poorest patients, but a new analysis from the Commonwealth Fund shows that healthcare affordability is a big problem for high-income people in the US, too.

The report, based on findings from the Commonwealth Fund’s 2023 International Health Policy Survey, showed that healthcare affordability is more problematic in the US than in other similarly developed nations. Overall, nearly a quarter of the US population is covered by a health plan that doesn’t ensure affordable access to care, and that lack of affordability presents itself in care access problems for all patients, regardless of income.

These findings come as experts continue to examine healthcare costs in the US and how they do and do not differ across income brackets. This latest data shows that there is, indeed, a disparity in healthcare affordability in the US, but high-income earners also face steep cost challenges.

For example, 46 percent of low- and middle-income people in the US skip needed medical care due to cost, compared to 29 percent of high-income Americans who did the same. The US isn’t the only industrialized nation with this disparity (in New Zealand, 34 percent of low-income people skip healthcare compared to 16 percent of high-income earners), but both numbers dwarf those of other similarly developed nations.

These findings are similar when looking at patient access to dental care and access to mental healthcare. Low- and middle-income adults are more likely to skip both dental and mental healthcare than their high-income counterparts in nearly every country, but it’s more pronounced in the US than in its peer nations.

These findings about low-income adults are certainly upsetting, but they are far from shocking. Previous data, including past Commonwealth Fund reports, have noted that low-income adults in the US face greater healthcare affordability issues than adults in similarly developed nations.

But this latest Commonwealth Fund report shows that it’s not just low- and middle-income people struggling with American healthcare costs; US adults with high incomes are also more likely to have healthcare affordability woes, including having to skip needed care due to costs and challenges paying medical bills, than their counterparts in other nations.

In fact, the richest Americans have more healthcare affordability problems than even some poor adults in other similar nations, the report showed.

For example, 29 percent of high-income Americans said they skip or delay getting needed medical care due to cost. That’s, of course, more than any other high-income earner in any other developed nation, but it’s also more than the number of low- and middle-income folks who struggle with cost-related access barriers in other countries. Only 16 percent of low- and middle-income earners in the UK, the Netherlands, Germany, and France skip or delay care due to cost.

Said otherwise, healthcare is more unaffordable for rich Americans than it is for some poor Europeans.

Moreover, adults in the US are more likely to have medical bill problems, regardless of income, with 44 percent of low-, middle-, and high-income people reporting as much. Again, more high-income people in the US report medical bill problems than low-income folks in any other nation.

In addition to healthcare affordability, the Commonwealth Fund report looked into social determinants of health, finding that reporting of at least one social service need is common in all industrialized nations studied. Save for Germany, the Netherlands, and Switzerland, a third or more of low- and middle-income people had a social service need. SDOH needs are most common in the US, with 38 percent of low- and middle-income people reporting as much.

Notably, high-income people in the US are among the least likely to report a social service need, with only 14 percent reporting as much. That’s less than in the UK, Canada, France, New Zealand, and Switzerland.

The US is likely an outlier in healthcare affordability because of its unique healthcare coverage system, the researchers suggested, pointing out that it’s the only nation in the analysis without universal healthcare coverage. The US also spends less on social services than other similarly developed nations.

“Still, the notable income disparities we found in several other countries suggest that ensuring affordability is a challenge there as well,” the researchers pointed out. “Having health coverage is important, but that coverage must be both affordable and comprehensive.”

Germany and the Netherlands, which have fewer income-based affordability disparities, may point to a path toward more comprehensive healthcare coverage, the researchers said. These nations require insurance coverage, implement cost-sharing caps, and determine the cost of coverage by an individual’s income.

“Affordability of care is key to equitable health outcomes,” the Commonwealth Fund researchers concluded. “National health systems should consider policies and approaches to strengthen benefit design and reduce costs for all.”

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