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U.S. worst in developed world for women's health outcomes
Women's health in the U.S. trails similarly developed nations in terms of outcomes, care access and healthcare affordability.
Women in the United States can expect to live two years less than their peers in other high-income nations, with a new brief from the Commonwealth Fund showing women's health lagging internationally.
Indeed, the U.S. underperforms in life expectancy, health status, access to care and affordability of care for women compared to other similarly developed nations, the report showed.
"Compared to women in other high-income countries, American women have long had worse access to the health care they need," the report authors said. "While the U.S. spends more on health care than other countries do, surveys regularly find that Americans avoid seeking care because of costs at the highest rates, even as the U.S. continues to lead in the prevalence of chronic disease."
All of that has led to significantly poorer outcomes for American women compared to those in other nations.
Using data from the Commonwealth Fund's 2023 International Health Policy Survey, the CDC and the Organisation for Economic Co-Operation and Development (OECD), the researchers determined that women in the U.S. simply don't live as long as their counterparts.
While the average life expectancy at birth is age 80 in the U.S., it's higher in other countries. In the United Kingdom, the nation with the next-shortest life expectancy for women, women can expect to live until age 82. Women see a life expectancy of 87 years in South Korea and Japan, 86 years in Switzerland and France and 85 years in Sweden and Australia.
Relatedly, the avoidable death rate for women in the U.S. is staggeringly high compared to other high-income nations, coming in at 279 avoidable deaths per 100,000 women. That's compared to 182 avoidable deaths in Chile, the nation with the next-highest avoidable death rate. In South Korea, the nation with the lowest rate, there were only 81 avoidable deaths per 100,000 women.
American women were among the most likely to die from cardiovascular disease, but they were among the middle in terms of risk of death from breast or cervical cancer.
Still, health outcomes for American women are subpar, as measured by factors like taking multiple prescriptions, self-reported mental health needs and self-reported health-related social needs.
Women in the U.S. were the most likely to report taking multiple prescriptions for disease management. Black women in the U.S. were more likely than women of any race from any country to report taking multiple prescriptions.
Meanwhile, white women from the U.S. were the most likely to say they have mental health needs. Black and Hispanic women from the U.S. were the most likely to report social determinants of health needs, followed by women of any race from France and women of any race from the U.S.
Limited coverage yields poor healthcare access
These poor outcomes can be credited to a weaker women's healthcare system in the U.S., the data indicated.
For one thing, the U.S. is the only country in the developed world with an uninsured rate for women (14% of American women do not have insurance coverage). In Australia, Germany and the United Kingdom, most women are covered by public insurance. In Canada, France, the Netherlands and New Zealand, private health insurance is the primary form of coverage.
Higher uninsured rates among women in the U.S. translate to poorer access to care. While 87% of women (83% of Black women) in the U.S. said they have a usual source of care, the rates are much higher in other developed countries.
Every woman in the Netherlands said they have a usual source of care, while 98% in New Zealand and the United Kingdom have one. Primary care provider access is over 90% in Switzerland (93%), Australia (95%), France (96%) and Germany (96%), too.
That lack of usual source of care is landing American women in higher acuity care settings more often than their international counterparts.
Around a fifth of all women in the U.S. have used the emergency department (ED) for care that could have been provided by a regular doctor or because they didn't have a regular doctor. That rate was 23% for Hispanic women in the U.S. and 29% for Black women in the U.S. This happens for less than a tenth of women in the Netherlands (5%) and Germany (8%).
American healthcare costs pose barriers
But it's not just ED overutilization that's the problem in the U.S.; American women are also skipping out on care altogether, usually because of cost.
Around half of women of any race in the U.S. said they avoided seeking care due to cost, with 56% of Hispanic women in the U.S. saying as much.
This practice is significantly less common in peer nations. In Australia, the country with the next-highest rate of cost-related access barriers, 39% of women skipped treatment. Less than a fifth of women in the Netherlands (15%), Germany (18%) and the United Kingdom (18%) did the same.
Similar trends emerged when focusing specifically on mental healthcare. More than a quarter (27%) of all American women said they skipped mental healthcare due to cost. That shakes out to 28% of white American women, 23% of Hispanic American women and 21% of Black American women.
While similar proportions of women in Australia reported cost-related barriers to mental health, this issue is less common in most peer nations. In Germany and the Netherlands, skipping mental healthcare due to cost is nearly unheard of, with only 4% and 5% of women doing so, respectively.
When American women do access care, costs continue to be a problem. Women in the U.S. are the most likely in the developed world to say they have issues paying their medical bills, with 53% reporting as much. In Australia, the nation which has the next-most common affordability woes, 38% of women said they had issues paying their medical bills.
The common thread among the U.S.'s international counterparts is access to universal healthcare coverage, the Commonwealth Fund researchers explained.
"Other countries have made substantial efforts to ensure women are able to get needed health care, which includes primary, mental, maternal, and social care," they wrote. "In addition to ensuring coverage for all, the other nations in this analysis generally cap annual out-of-pocket costs for covered benefits, provide cost-sharing exemptions for primary care and certain other services, and offer additional safety nets based on income and health status."
Some fixes to the Affordable Care Act (ACA), such as enhancing marketplace subsidies and covering folks who fall into Medicaid's coverage gap, could be a good first step.
But under the weight of court decisions, like those pending in Braidwood Management v. Becerra, calling into question guarantees of preventive services or those decided in the 2022 Dobbs decision, the researchers concluded that improving women's health could be an uphill battle.
Sara Heath has covered news related to patient engagement and health equity since 2015.
