Percentage of Women on Government Help Due to Lack of Funds to Care for the Baby

Women in the The states have long lagged behind their counterparts in other loftier-income countries in terms of access to wellness care and health status. This cursory compares U.South. women'southward health status, affordability of wellness plans, and ability to access and utilise care with women in 10 other high-income countries past using international data.

Highlights

• U.South. women report the least positive experiences among the 11 countries studied. They take the greatest burden of chronic illness, highest rates of skipping needed wellness care because of cost, difficulty affording their health intendance, and are least satisfied with their care.
• Women in the U.Southward. have the highest rate of maternal mortality because of complications from pregnancy or childbirth, every bit well as among the highest rates of caesarean sections. Women in Sweden and Norway have among the everyman rates of both.
• Women in Sweden and the U.S. report the highest rates of breast cancer screening among countries surveyed; women in Norway, Sweden, Australia, and the U.S. accept the lowest rates of chest cancer–related deaths.
• More than one-quarter of women in the U.S. and Switzerland report spending $2,000 or more out of pocket on medical costs for themselves or their family unit in the past year compared to 5 per centum or fewer in most of the other study countries.
• More than than one-3rd of women in the U.S. written report skipping needed medical intendance because of costs, a far college rate than the other countries included in the written report.
• U.S. women are less likely to charge per unit their quality of care as excellent or very skillful compared to women in all other countries studied.

Groundwork

Compared to women in other high-income countries — similar, for instance, Germany or Australia — American women accept long struggled to access the health care they need. The United States spends more on health care than other countries do, merely Americans report high rates of non seeking intendance because of costs, every bit well as loftier instances of chronic disease. Prior inquiry has found that poor access to primary care in the United States had led to inadequate direction and prevention of diagnoses and diseases.

With the Affordable Care Act (ACA) now in place, almost women in the U.S. have guaranteed access to health coverage (Appendix ii); more than seven million working-historic period women have gained insurance since the implementation of the law. Millions of others who had been insured now receive additional benefits and cost protections through the police's reforms. Merely recent changes by the Trump assistants and Congress may jeopardize this progress. These changes include repeal of the police's individual mandate penalization; expansion of plans that practise not accept to comply with the constabulary's consumer protections and benefit requirements, including the requirement to provide maternity intendance; threats to remove guaranteed coverage of preexisting conditions; and proposed changes to Title X funding. In the futurity, these changes may raise costs and limit access to health insurance and services for people who do not qualify for subsidized intendance, especially those with wellness issues. They could reduce the recent gains U.Due south. women take made and widen differences betwixt women in the U.Southward. and those in other countries.

Using information from the Republic Fund International Wellness Policy Survey (2016) and measures from the Organisation for Economic Co-operation and Development (OECD) and the United nations Children'due south Fund (UNICEF), this cursory compares U.S. women'south health condition, affordability of health plans, and power to access and utilize intendance with women in x other industrialized countries.

For an overview of each country'south wellness care arrangement, see Appendix one, and for further detailed information on each land's wellness arrangement, run into the Commonwealth Fund International Health Care System Profiles here.

Women in the U.S. reported a higher rate of having multiple chronic diseases compared to women in the 10 other countries, with German women reporting the lowest rates. I of 5 U.S. women reported having two or more chronic conditions, compared to one of 10 or less in Germany, holland, and Australia. Chronic diseases include a diagnosis of articulation pain or arthritis, asthma or chronic lung disease, diabetes, heart disease, or high claret pressure.

The relationship betwixt emotional distress and health is complex, just some research shows emotional distress can exacerbate concrete illness as well every bit lead to difficulties managing other aspects of life, such as the ability to work. One-quarter or more of women in Australia, Norway, New Zealand, Switzerland, Sweden, Canada, and the U.Southward. reported having experienced emotional distress — that is, anxiety or sadness that was difficult to cope with alone in the by ii years. Only 7 percent of women in Germany reported having emotional distress and only 11 percent of women in French republic.

Women in the U.S. had the highest rate of maternal mortality considering of complications from pregnancy or childbirth; women in Sweden and Norway had among the lowest rates. High rates of caesarean sections, lack of prenatal care, and increased rates of obesity, diabetes, and heart disease may be contributing factors to the loftier rate in the U.S.

Caesarean sections are generally non recommended for younger mothers with uncomplicated births and are frequently more than costly than vaginal births considering of the costs of the operating room and medical personnel, longer recovery, and hospital stays. Australia, Switzerland, and the U.S. accept the highest rates, while women in Kingdom of norway and the netherlands have the lowest rates — approximately one-half the charge per unit of the highest-ranking countries. The reasons behind the wide variation observed in caesarean department rates across developed countries warrants farther investigation; however, some researchers suggest it is a combination of a country's specific health system, md and patient preferences, cultural factors, population characteristics, and payment incentives.

It is recommended that women have screenings for breast and cervical cancers. The U.S. fares well compared to other countries on these indicators. Older women in the U.Due south. and Sweden are screened for breast cancer more frequently than women in the other countries analyzed; women in Switzerland are screened at the lowest charge per unit.

Women in the U.S. had among the lowest rates of chest cancer–related deaths, subsequently Kingdom of norway, Sweden, and Commonwealth of australia. Women in kingdom of the netherlands and Germany had the highest rates.

High health care costs create meaning financial burdens on U.S. household budgets, even amid insured families. Over one-quarter of women in Switzerland and the U.Southward. reported spending $2,000 or more in out-of-pocket medical costs for themselves or their family unit in the past year. In comparing, no more than than ane of xx women reported such high costs in virtually other countries included in the report.

U.S. women nigh often reported problems paying or disputing medical bills or spending time on related paperwork. Nearly one-half (44%) of women in the U.S. faced such issues compared with only ii percent in the U.K. U.S. women had the highest rates of having payment denied by their insurers or receiving a smaller insurance payment than they expected, compared to women in other countries (Appendix 4).

Many women in the U.S. skip needed medical intendance because of costs, likely considering of high out-of-pocket costs and the fact that 11 1000000 women still accept no insurance coverage. 30-8 percent of women in the U.Southward. reported they went without recommended care, did not see a medico when sick, or failed to make full prescriptions because of costs in the past year. This is the highest rate amongst the 11 countries in our analysis (Appendix 5). Before the implementation of the ACA in the U.S., the charge per unit was even college, 43 per centum. In the U.K. and Deutschland, simply v percent and 7 percent of women, respectively, reported forgoing care because of cost.

Having a regular doctor or place of care, such as a primary intendance medico, is important for preventing disease, managing chronic weather condition, and coordinating specialist visits. Majorities of women in all 11 countries reported having a regular doc or place of intendance. Just somewhat fewer women in the U.S. and Switzerland reported having a regular doctor, compared to those in the other nine countries. In contrast, all women in the netherlands reported having a regular doctor or identify of intendance.

More than one of three women in Canada, the U.S., and Sweden reported emergency section (ED) visits in the past two years; rates were lower in other countries. Women in Germany had the lowest charge per unit of ED visits.

Women in the U.S., Switzerland, and holland had quicker admission to specialist care. Among women who needed to see a specialist in the by 2 years, only a quarter of women in these countries had to wait more 4 weeks for an appointment, compared to the bulk of women in Canada and Norway.

U.Southward. women were the least probable to rate their quality of care equally splendid or very expert compared to women in all other countries studied. More than 60 percent of women in the U.Yard. and Switzerland rated the quality of their health intendance as high, compared with i-quarter in the U.S. Farther analyses showed that women with multiple chronic atmospheric condition or emotional distress, and those who faced loftier out-of-pocket costs, medical pecker or cost-related access problems, long specialty look times, or had emergency department visits were significantly less likely to rate their quality of care every bit skilful (data not shown).

Conclusions and Policy Implications

Women in the United states of america continue to be disadvantaged by their relatively poorer health status and college costs of care, while benefiting from higher rates of preventive screenings and quicker access to specialty care. While this study did not investigate the reasons behind these findings, they might be viewed in the context of lower rates of health insurance coverage in the U.S., as well every bit differences in wellness care delivery systems and the level of social protection across countries.

Consequent with other enquiry, we find that U.S. women accept the highest rate of maternal mortality among high-income countries. What's more, this charge per unit has been steadily ascension in the past decades. Considerable racial, rural-urban, and other socioeconomic disparities also persist. U.S. maternal mortality is three times higher amongst African American mothers — with rates like to those found in developing countries — compared to white mothers.

Information technology is notable that U.S. women face up fewer barriers to accessing specialist care relative to women in virtually of the x other countries analyzed. The U.S. as well outperforms most countries in terms of breast cancer screenings. This, coupled with relatively low rate of breast cancer deaths, may exist associated with the high quality of cancer intendance delivered in the U.S., including all-encompassing screenings, treatments, and technology.

Despite the pregnant gains the United States has made in health insurance coverage since the implementation of the ACA, the U.Southward. remains the but land in this study without universal coverage. Uninsured adults about oft cite concerns nearly affordability equally the reason they practice not shop for coverage. Coverage is out of reach for people with depression incomes who live in states that take not expanded Medicaid and those who are undocumented and therefore ineligible for coverage. In addition, many people in the U.Due south. accept insurance plans with loftier levels of cost-sharing. More than ane-tertiary of women in the U.S. proceed to skip needed intendance because of costs. While the rates of going without needed intendance because of costs and problems paying medical bills have decreased since 2010, they are still the highest among all 11 countries included in the 2016 Commonwealth Fund International Health Policy Survey.

The connected efforts by Congress and the Trump administration to weaken the ACA, rather than improve the quality and affordability of health insurance, may increase the cost of insurance and go far more than difficult for some women to afford comprehensive health coverage. These actions include the administration'south support for catastrophe the ACA's guaranteed consequence and preexisting weather condition protections, which ensure every individual has access to insurance regardless of their wellness condition, and expanding the availability of plans which are not required to comply with the police force's consumer protections. A recent analysis of 24 short-term insurance policies found that none provided coverage for motherhood care.

The administration'southward recently proposed changes to the Title Ten programme — including cuts to funding for family unit planning services, counseling, and routine exams and cancer screenings — volition reduce access to health services among low-income women and minorities. The proposed regulations would cake federal funding to family unit planning providers that provide abortion services. About 4,000 health centers across the country receive such Title Ten funding, and over 4 million women, the vast majority of whom have incomes below 150 percent of the federal poverty level, annually receive services from these centers. Many women besides receive routine primary care and behavioral health services at women's wellness centers. Simply states can take steps toward prioritizing women's health. For example, California successfully reduced the charge per unit of maternal mortality by 55 percent in less than a decade, through the statewide Pregnancy-Associated Mortality Review (CA-PAMR) plan that introduced surveillance, public health, and quality comeback initiatives for maternal care.

Given the substantial maternal mortality gap between U.Southward. women and their counterparts in other countries, policymakers might as well expect at the arrangement of health systems of these countries. For instance, in many other countries compared in this brief, maternal care is complimentary at the point of delivery, including postpartum care (Appendix ane). Furthermore, most countries deliver maternal care in primary intendance or community-based settings past nurses or midwives, rather than in specialty or inpatient settings using obstetricians, as is often the case in the U.Due south. This not only makes care more expensive, merely likewise limits women's choices around childbirth. Midwives attend only 12 per centum of U.S. vaginal births. Other countries likewise provide greater social protection for women of reproductive historic period. The U.S. remains the only land in the developed world that does non guarantee paid motherhood leave, despite International Labor Organization standards recommending that new mothers should be provided at least two-thirds of previous earnings for a minimum of 14 weeks.

Finally, since research suggests that the differences in health spending betwixt the U.Due south. and the rest of the earth stem largely from college prices, payment and delivery organization reform must be at the top of the nation's policy agenda. For case, international data testify that the average costs of a normal commitment or a caesarean section are near twice as loftier in the U.S. equally in Australia and nearly xl per centum to lx percent higher than in Switzerland. Bringing wellness costs under control volition help improve admission to wellness insurance and health care.

How Nosotros Conducted This Study

This brief includes data from the 2016 Republic Fund International Health Policy Survey of Adults in eleven Countries, conducted by SSRS and country contractors in Australia, Canada, French republic, Frg, kingdom of the netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S. betwixt March and June 2016. The survey was administered past telephone (mobile and landline) using a common questionnaire that was translated and adjusted for country-specific wording. Response rates ranged from eleven per centum in Kingdom of norway to 47 percent in Switzerland. The analysis weighted terminal samples to reflect the distribution of the adult population in the country, adjusting for age, sex, region, education, and boosted variables consistent with country standards. This cursory restricts the analysis to 9,254 women ages eighteen to 64. Sample sizes for each state are included in Appendix 3. The U.S. sample includes women who reported being uninsured for some of part of the previous calendar year (12 months; 8.three%).

The Organization for Economic Co-functioning and Development (OECD) is an international organization representing 36 industrialized countries that share a delivery to democracy and a market economic system. The OECD produces reports and data on a wide range of economic and social bug, including the OECD Health Data series, an almanac release of information on various aspects of health and health intendance in the member countries. Working with statistical offices in each member country, the OECD produces the most authentic and comprehensive international health intendance data available on its member nations. Each yr, the OECD releases health data on a range of topics, including spending, hospitals, physicians, pharmaceuticals, prevention, mortality, quality, and condom.

Commonwealth Fund staff analyzed data from the Commonwealth Fund International Health Policy Survey of Adults in eleven Countries equally well as data extracted from the OECD on August six, 2018, and the UNICEF database (maternal mortality only) on June 6, 2018, for the 11 countries. As of December 5, 2018, the UNICEF and OECD data were unchanged.

Acknowledgments

The authors thank Yaphet Getachew, Corinne Lewis, and Arnav Shah of the Republic Fund for assistance with verifying information.

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Source: https://www.commonwealthfund.org/publications/issue-briefs/2018/dec/womens-health-us-compared-ten-other-countries