Before Obamacare, America’s Health Care System Ranked Last Among Developed Nations

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When it comes to affordability and patient access, the United States ranks last among industrialized nations, according to a survey conducted by the Commonwealth Fund. Researchers said the data, collected before the full rollout of the Affordable Care Act, can help officials measure the improvements made since then.

According to the survey, a host of European countries — including Canada, Australia, France, Germany, and Switzerland — ranked the highest in access to health care. In the United States, however, researchers found that the financial burden of health care presents barriers for low-income Americans.

Two Johns Hopkins University researchers included the survey in a perspective analysis that appeared in the Oct. 23 issue of the New England Journal of Medicine.

“I would say that we found two things that really seem to drive the higher barriers to health care in the U.S.,” David Squires, a senior researcher with the Commonwealth Fund in New York City, told

“The first is that we have a huge uninsured population, which at least at the time of the survey was about 50 million people. And, the second is that we have millions more who have some kind of insurance, but the coverage isn’t really good enough to protect them fully if they actually become ill.”

A previous Commonwealth Fund survey found that Americans spend an average of $3,000 more in health care costs than some of their European counterparts. The survey also found that the price of medication discouraged nearly 40 percent of Americans from filling out prescriptions. Experts point to the host of services that European hospitals provide free of charge, especially to expectant mothers, as part of the reason for the cost disparity.

The incentives that doctors receive to perform as many procedures as possible can also influence the cost of healthcare in the United States. This especially true for health services like C-sections and joint replacement, designated by the American Academy of Family Physicians as two of the 40 most unnecessary medical procedures. Prices of these procedures also skyrocket as the technology used to perform them evolves, even if those improvements don’t pose many health benefits.

Experts also point to the variation in pricing for procedures across different geographic areas as a concern for patients trying to navigate the health care system. While Medicare has made some progress in attempting to match payments to the actual costs of services, people covered by private insurers may be confronted with large bills that don’t reflect the quality of care they received.

A 2013 Centers for Medicare and Medicaid Services (CMS) study showed that the uninsured and the privately insured often suffer the most from what researchers call “price gouging” — the act of charging for use of supplies that can raise a hospital bill by tens of thousands of dollars, depending on the facility. Patients, and even doctors, often don’t know about the costs of treatment until long after they’ve finished the procedure. The situation has worsened in recent years with the consolidation of hospital systems and medical supply firms, which has allowed them to set their own prices without as much government oversight.

Other analyses have highlighted a relationship between physicians and pharmaceutical companies that influences the type of medication for which patients receive prescriptions. Surveys have shown that the financial relationship between doctors, insurance companies, and Big Pharma hasn’t only driven up health care costs, but has also increased American skepticism of the health care industry.

That’s why supporters of the Affordable Care Act tout it as a step in the right direction for the reduction of health care costs. Rules set in place require insurance companies to spend up at least 85 percent of the premiums they receive on patient care or reimburse that money to customers. Insurance policies also cover preventative care as a way of reducing long-term health care costs and cutting down hospital readmissions. CMS also announced restrictions on how medical facilities could bill Medicare patients depending on the services they could provide.

Recently, a mechanism of the Affordable Care Act has also allowed consumers to search and compare the prices of common services, which a recent study said generated costs savings of hundreds of dollars for some patients. But critics who look to European health care systems as an example say that might not be enough to drive down health care costs as long as hospitals and private insurers are allowed to set prices of medical treatment.

“These issues don’t really exist in any of the other countries we looked at,” Squires said. “They all have universal health insurance. So everyone has access and the insurance they have is generally much more protective. It covers more costs and either has no co-pays or relatively modest co-pays. And there’s a ceiling on what a patient would have to pay in any one year, if anything,”