Schoen et al
Insurance Design and Access to Care
Overview
2010 study on insurance experiences in 11 countries:
Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK, USA.
Examines how insurance design impacts access to healthcare, cost burdens, and patient experiences.
Found significant variances in access, costs, and insurance problems across countries.
Key Findings
US adults face the highest medical expenses, even when insured.
Major issues include extensive paperwork, payment denials, and disputes.
German adults spend similar time on paperwork but are better protected from out-of-pocket spending.
Swiss citizens report high out-of-pocket costs yet few access issues.
Comprehensive health reforms in the US could address income disparities.
Insurance Structures
Coverage Types
Varied from public to mixed public-private systems:
UK: Public National Health Service provides coverage.
US: Mixed coverage (private, Medicare, Medicaid).
Germany: Universal coverage with private options for higher incomes.
Switzerland and Netherlands: Mandatory comprehensive insurance with private insurers.
Benefits and Cost Sharing
Diverse structures of insurance coverage and cost-sharing levels:
UK: Minimal cost-sharing; comprehensive benefits including dental and drugs.
Canada: No cost for primary care; limited drug coverage by province.
New Zealand: Historically high cost-sharing, but reforms have reduced it.
France: Significant cost-sharing covered by private insurance for most.
Cost Sharing Specifics
US, Switzerland, and Netherlands have deductibles on core benefits.
UK excelling in protecting citizens from excessive out-of-pocket spending.
Access and Affordability Insights
Experiences by Income Level
Low-income adults experience higher barriers to accessing care and insurance complexities.
Higher healthcare costs lead to care avoidance for low-income populations in several countries.
In the US, low-income adults report the greatest levels of uninsurance and care access issues.
Waiting Times
Wide variances in wait times for medical appointments:
Switzerland: Quick access to care; 93% receive same-day appointments.
Canada, Sweden, and Norway: Significant waits for doctors or specialists.
Insurance Complexity
Higher rates of time spent on paperwork among US adults (17%) compared to other countries.
Issues in navigating insurance lead to dissatisfaction and inefficiency in care.
Conclusions and Recommendations
There are international lessons to learn regarding insurance design:
Compliance with patient needs and clear access can reduce costs and enhance care.
Monitoring the United States' healthcare reform outcomes will illuminate paths to improved coverage and access for vulnerable populations.