Differences by Income

• In all countries except the U.K., adults with incomes below the national average were more likely than those with higher than average income to report trouble with medical bills and problems with access to care because of costs. However, income gaps were widest in the U.S., with a spread of as much as 19 percentage points between low- and high-income adults.

• Regarding access to primary care and waiting times, the U.K was notable for having few differences by income, and Switzerland and Germany stood out for rapid access to primary and specialist care for below-average income as well as above-average income adults. The U.S. stood out for significant income gaps in primary care access, after hours, and specialists, even for those who were insured all year.

Insurance Design Matters

The study included countries with diverse insurance arrangements, including three countries Germany, the Netherlands, and Switzerlandthat have achieved near-universal coverage with competitive health insurance markets, a requirement that all residents have insurance, and provisions to assure that insurance and care are affordable. As the article describes, each of these countries has developed insurance system rules that ensure people with health insurance are protected. Countries that require people to pay for some portion of their health care costs out-of-pocket, such as France, Germany, and Switzerland have limited out-of-pocket costs to patients. Germany limits out-of-pocket costs based on income, and
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