As COVID-19 continues to ravage countries around the world, a new survey finds that Americans with lower incomes are sicker and more likely to struggle to afford health care compared with their counterparts in other wealthy countries.

Findings from the 2020 Commonwealth Fund International Health Policy Survey, published today by Health Affairs, show that U.S. income-related inequality and relatively worse access to primary care could threaten the nation’s recovery from the pandemic. The survey compared the health experiences of adults with lower incomes and income-related disparities across 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S.

Among the findings:

• On nearly every measure the study used, income-related disparities were greatest in the U.S.
• Half of U.S. adults with lower income don’t get needed care because it’s too costly. Even many with higher income skip care for cost reasons.
• Difficulty with paying medical bills is mostly a U.S. phenomenon: 36 percent of adults with lower income in the U.S. reported this problem, versus 7 percent to 16 percent in the other countries.