The United States is the worst industrialized country when it comes to women’s health
Women in the United States have a life expectancy that is two years lower than women in other high-income countries. A new study by the Commonwealth Fund shows that women’s health lags behind internationally.
In fact, the United States fares worse than similarly developed countries in terms of life expectancy, health status, access to care and affordability of care for women, the report shows.
“Compared with women in other high-income countries, American women have long had poorer access to the health care they need,” the report’s authors said. “Although the United States spends more on health care than other countries, surveys consistently find that Americans avoid seeking health care because costs are highest, even as the United States continues to lead the world in the prevalence of chronic disease.”
All this has resulted in the living conditions of American women being significantly worse than those in other countries.
Using data from the Commonwealth Fund, CDC and Organisation for Economic Co-operation and Development (OECD) 2023 International Health Policy Survey, researchers found that women in the United States simply do not live as long as their peers.
While the average life expectancy at birth is 80 years in the United States, it is higher in other countries. In the United Kingdom, the country with the next lowest life expectancy for women, women can expect to live to 82 years. In South Korea and Japan, life expectancy for women is 87 years, in Switzerland and France it is 86 years, and in Sweden and Australia it is 85 years.
In this context, the preventable death rate among women in the United States is alarmingly high compared to other high-income countries: it is 279 preventable deaths per 100,000 women. In Chile, the country with the next highest preventable death rate, the number is 182 preventable deaths. In South Korea, the country with the lowest rate, there were only 81 preventable deaths per 100,000 women.
While US women are most likely to die from cardiovascular disease, their risk of dying from breast or cervical cancer is in the middle range.
Yet the health status of American women is below average, measured by factors such as taking multiple prescription medications, reporting mental health problems, and reporting health-related social problems.
Women in the United States were most likely to report taking multiple prescription medications to treat their illness. Black women in the United States were more likely to report taking multiple prescription medications than women of any other race or country.
White women from the US were most likely to report having mental health problems. Black and Hispanic women from the US were most likely to report that social factors were crucial to health problems, followed by women of all races from France and women of all races from the US
Limited coverage leads to poor access to health care
According to the data, these poor outcomes are due to the weaker health care system for women in the United States.
For one thing, the United States is the only country in the developed world where women have such a high rate of uninsured women (14% of American women are uninsured). In Australia, Germany, and the United Kingdom, most women are covered by public health insurance. In Canada, France, the Netherlands, and New Zealand, private health insurance is the main form of coverage.
The higher number of uninsured women in the United States means poorer access to health care. While 87% of women (83% of black women) in the United States reported having regular health care, the numbers are much higher in other developed countries.
In the Netherlands, every woman reported having a regular source of care, while in New Zealand and the United Kingdom, 98% reported having access to a general practitioner. In Switzerland (93%), Australia (95%), France (96%) and Germany (96%), over 90% also have access to a general practitioner.
This lack of standard care results in American women ending up in higher-intensity care facilities more often than their counterparts abroad.
About one-fifth of all women in the United States have visited the emergency room because they needed treatment that could have been provided by a primary care doctor or because they did not have a primary care doctor. Among Latino women in the United States, this percentage is 23% and among black women, 29%. In the Netherlands (5%) and Germany (8%), this is the case for less than one-tenth of women.
American healthcare costs pose hurdles
But it is not just the excessive use of emergency rooms that is a problem in the United States; American women also forgo treatment altogether, usually for cost reasons.
About half of women of all races in the United States said they had foregone health care because of cost; 56% of Hispanic women in the United States said this.
In comparable countries, this practice is much less common. In Australia, the country with the second highest cost barriers, 39 percent of women forego treatment. In the Netherlands (15 percent), Germany (18 percent) and Great Britain (18 percent), less than a fifth of women did so.
Similar trends emerged when focusing specifically on mental health care. More than a quarter (27%) of all American women reported foregoing mental health care due to cost. That represents 28% of white American women, 23% of Hispanic American women, and 21% of black American women.
While a similar proportion of women in Australia report cost-related barriers to mental health, this problem is less common in most comparable countries. In Germany and the Netherlands, foregoing mental health care due to cost is almost unheard of: only 4% and 5% of women, respectively, do so.
When American women seek health care, cost continues to be a concern. Women in the United States are most likely in the developed world to report having trouble paying their medical bills (53%). In Australia, the country with the second most problems paying their medical bills, 38% of women reported having trouble paying their medical bills.
The common denominator among the United States’ international partners is access to universal health insurance, explained researchers at the Commonwealth Fund.
“Other countries have made significant efforts to ensure that women receive necessary health care, which includes primary care, mental health care, maternity care, and social care,” they wrote. “The other countries in this analysis not only provide coverage for all, but also cap annual out-of-pocket costs for covered services, provide cost-sharing exemptions for primary care and certain other services, and provide additional safety nets based on income and health status.”
Some fixes to the Affordable Care Act (ACA), such as increasing market subsidies and providing coverage for people who fall into the Medicaid coverage gap, could be a good first step.
But under the weight of court decisions such as those in Braidwood Management vs. Becerracalling into question guarantees for prevention services or those adopted in 2022 Dobbs decision, the researchers concluded that improving women’s health could be an uphill battle.
Sara Heath has been covering patient engagement and health equity news since 2015.
