1. Section Editor(s): Pfeifer, Gail M. MA, RN

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Insurance access, cost, and complexity burden higher in the United States. U.S. adults are more likely to have had problems in these three health insurance-related areas than adults in 10 other high-income nations, according to the 2010 Commonwealth Fund International Health Policy Survey, published online in the December 2010 Health Affairs. Key findings from the survey showed that 20% of the U.S. adults surveyed had serious problems paying medical bills, compared with 9% or fewer in the other nations. And in the previous two years, 31% of U.S. adults had "spent a lot of time on paperwork or disputes," or had experienced denials of coverage or received less money than expected. The good news, according to the survey, is that U.S. adults reported more rapid access to specialists. The authors conclude that health care reform may address most of these issues, except perhaps those affecting low-income populations, who are covered in separate insurance programs. The survey is available at