1. Zolot, Joan PA


Breast cancer care and access to specialists are bright spots.


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Compared with women in 10 Western European and Scandinavian countries, U.S. women reported the worst physical health: 20% live with two or more chronic illnesses, compared with 7% (the lowest rate) in Germany. U.S. maternal health also scored poorly, with 14 maternal deaths per 100,000 live births, compared with rates ranging from four to 11 maternal deaths per 100,000 live births in the other countries.

Figure. Maternal mor... - Click to enlarge in new window Maternal mortality rate (maternal deaths/100,000 live births) among women ages 15 to 49. Reprinted from Gunja MZ, et al.

The study, by researchers at the Commonwealth Fund, compared the status of women's health and health care in 11 similarly high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Data came from telephone surveys conducted during 2016 and from data banks and analyses of the Organisation for Economic Co-operation and Development and the United Nations Children's Fund. AJN has previously reported on the alarmingly high U.S. maternal mortality rate (see In the News, December 2018 and January 2019).


Responding to the Commonwealth Fund report, Kathleen Simpson, editor-in-chief of MCN: The American Journal of Maternal/Child Nursing, commented that the U.S. health care system "is not designed in the best interest of mothers and babies. Everything is driven by cost." A researcher, Simpson noted that U.S. health status data are also significantly influenced by racial and rural/urban differences in access to and quality of care.


The affordability of health care stands out as a major challenge for women in the United States compared to women in most of the other countries, all of which have some form of national coverage and payment. Besides U.S. women, Swiss women also reported struggling with out-of-pocket medical costs; more than 25% said they paid $2,000 or more annually for themselves or their families. In seven of the other countries, 5% or fewer spent this much. High out-of-pocket costs were cited as a reason for skipping treatment or medication by significant numbers of respondents in the United States (38%), New Zealand (27%), and Switzerland (26%) compared with only 5% of respondents in the United Kingdom.


On the positive side, the United States and Sweden had the highest rates of breast cancer screening within the previous two-year period and posted the lowest breast cancer mortality rates along with Norway and Australia. Timely access to medical specialists was also a plus. Only 26% of U.S. women reported waiting more than four weeks to see a specialist compared with a high of 61% in Norway and Canada.


Seven million U.S. women have gained health insurance coverage since the Affordable Care Act became law in 2010, resulting in more women having access to affordable treatment. But recent actions by Congress and pending Trump administration proposals could jeopardize this progress, the researchers noted, thereby exacerbating disparities between the United States and comparable countries.


"This study shows consistency with other alarming data on the health status of women in the United States," said Simpson. "Our health care system is not designed to cover all people. There are people on the edges, people who are marginalized. That's a problem."-Joan Zolot, PA