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Health care costs in the United States are infamously high, and a lack of insurance is often blamed. But even countries with universal coverage suffer from the high cost of health care, and those costs can get passed down to patients.

The Commonwealth Fund sought to understand how the United States—the only high-income country without universal health coverage—compares to nine of its peers. Munira Z. Gunja, lead author of a Fund survey on this question, spoke to Harvard Public Health.

Why study this topic?

We know health care affordability remains a huge problem in the United States. We really wanted to understand how the U.S. compares to other high-income countries in terms of affordability, and to look at disparities by income.

What did you find?

One surprising finding was that being high-income in the U.S. does not protect you from a health insurance system that is not adequate. You’d think that money buys us so many things in this country, but higher-income people still have higher rates [than their counterparts abroad] of skipping needed medical, dental, or mental health services, and of medical bill problems.

But affordability is a problem in several countries. In countries where everyone has access to insurance, coverage is only the first step. They still have to figure out how to make health services more affordable.

What would you like to see happen based on the study’s results?

We need to look at the role of insurance in affordability from a different lens: Where is all the money being spent? We have high costs for health services; our hospital system is very expensive. How can we use those dollars in a way that trickles down to the consumer so that they can afford care?

—Jina Moore Ngarambe

(Survey by the Commonwealth Fund, November 2023)

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