We hear all the time how terrible our health system is compared to those of other developed countries. So since it is so bad, it would be logical to think that Americans are more dissatisfied with our system than citizens of other nations are with their health system. But research carried in health affairs suggests it is not quite that simple. (HA Article) The study was based on the International Social Survey Program during 2011 to 2013 in 18 developed countries. The questions and data collection model were standardized to the greatest extent possible across nations. The questions covered in the research were pretty limited, two each in three categories: barriers to access; access to most-preferred care and satisfaction with recent health care experiences. A little over 50% of Americans said they were at least fairly satisfied with the overall health system. The only countries with lower satisfaction were Japan, Portugal and the Slovak Republic. The highest satisfaction came from Belgium and Switzerland.
However, when asked about satisfaction with their most recent doctor visit, 57% of Americans were very or completely satisfied; and 60% were with their most recent hospital experience. The US was in the top three in satisfaction on both questions. 63% were confident they would get the doctor of their choice if they were seriously ill, a higher percent than in most countries, and 60% said they would get the best treatment in that situation, about average. And while 11% of Americans said they did not get treatment because of cost in the last year, which is high among comparator countries, if you include only the insured, that rate drops to close to average. Highly negative responses among uninsured Americans is largely responsible for the differences with the other countries. When insured Americans responses are compared, they are generally much more satisfied with aspects of our system that other nations’ citizens are with theirs. And only 2% of Americans could not get treatment because of long waiting times, way below the average of 8% in other countries. So quick access to address health needs is actually much better in the US.
While these authors give an ideologically driven explanation for the results, focussing on supposed economic insecurity in the US and a general higher level of quality in other countries that makes access to preferred providers less important, the more logical rationale is that overall satisfaction appears low in the US because there is such negative press about our system and because cost is high, but people tend to be very satisfied with their actual health experiences. At this point no one in the US doesn’t have insurance because of cost concerns; if you are low-income, you are eligible for Medicaid, which costs nothing or next to nothing, or for subsidies on the exchanges. (although the exchanges weren’t up and running during the study period) And if you aren’t low enough on the income scale to qualify for Medicaid or subsidies, you can afford health insurance. So those who are uninsured and dissatisfied likely have no one but themselves to blame. And citizens in other countries don’t get care that on generally accepted quality measures is any better than that in the US, in fact it is often worse. They accept that they have no choice but to endure long waits at times, which is a way of rationing care, but they aren’t happy about it. The real lesson of this survey is that Americans are actually probably among the most satisfied with their health care.