Americans are more likely to avoid seeking healthcare because of cost, access and insurance issues than residents of 10 other countries, according to a study published online Nov. 13 in Health Affairs.

Researchers led by Cathy Schoen, MS, of the Commonwealth Fund, an independent research foundation in New York, conducted surveys in 11 countries that asked about respondents’ interactions with their respective healthcare systems, focusing on affordability and access.

Of the 20,045 adults surveyed in the U.S., U.K., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland, 37 percent of American respondents did not seek out recommended care, did not seek medical care when they were sick or did not obtain prescribed medications because they could not afford them. In contrast, only 4 to 6 percent of people surveyed in the U.K. and Sweden reported having similar experiences.

Additionally, 23 percent of the Americans surveyed had a “serious problem” paying their medical bills (compared with France at 13 percent, the next highest) and 41 percent had more than $1,000 in medical expenses (compared with Australia, the next highest with 25 percent).

More Americans also reported that they had not seen a dentist compared with people living in the other countries (33 percent vs. 6 percent in the U.K., where the rate was lowest).

Americans were also more likely to experience difficulty when dealing with their insurance companies. More than 30 percent of Americans said they either “spent a lot of time on paperwork or disputes” or had their claims flatly denied or reimbursed for less than expected. Only 4 percent of survey respondents in both the U.K. and Sweden reported similar problems.

Three-quarters of Americans also said they believe the healthcare system needs an overhaul, while more than half of participants in the Netherlands, Switzerland and the U.K. said they believe the systems in their countries work well.

Despite the negative views many Americans surveyed had, the U.S. spends significantly more on healthcare per capita ($8,508) than any of the other 10 countries.

“Looking forward, the study indicates likely public support in the United States for reforms if they succeed in improving access and affordability, strengthening primary care, and reducing insurance complexity,” the authors concluded.