Healthcare in the United States is significantly less accessible than in other wealthy nations, with barriers spanning cost, geography, wait times, and workforce shortages. In a 2024 comparison of 10 high-income countries by the Commonwealth Fund, the U.S. ranked last overall, including last on four of five health outcome measures. About 27.2 million Americans had no health insurance at all in 2024, and millions more with insurance still struggle to get the care they need.
Cost Is the Biggest Barrier
More than a third of U.S. adults (36%) say they have skipped or postponed needed healthcare in the past year because of cost. That number climbs to three-quarters among people without insurance. But having coverage doesn’t solve the problem: roughly 37% of insured adults also report skipping care they needed because of what it would cost them out of pocket.
The financial exposure is steep even for people with marketplace plans under the Affordable Care Act, where the out-of-pocket maximum can reach $9,450 for an individual and $18,900 for a family. A 2023 international survey found that 41% of Americans spent $1,000 or more on healthcare out of pocket in the prior year. About 20 million adults carry medical debt, with more than half owing over $2,000 and 14% owing more than $10,000.
Where You Live Shapes What You Get
Roughly 75 million people live in areas the federal government designates as primary care shortage zones, meaning there simply aren’t enough doctors nearby. For dental care, 58 million people face the same problem. Mental health access is even worse: 122 million Americans live in a mental health shortage area.
Rural communities bear the heaviest burden. More than 100 rural hospitals have closed over the last decade, and at least 18 closed or stopped offering inpatient care in 2025 alone. Over 700 rural hospitals are currently at risk of closing, with 300 at immediate risk. When a rural hospital shuts down, the nearest emergency room may suddenly be 30, 45, or 60 minutes away, turning treatable emergencies into life-threatening ones.
Wait Times for New Patients
Even when you can find and afford a provider, getting an appointment takes time. The average wait for a new patient across five major specialties is 26 days. Dermatology has the longest waits at nearly 35 days, followed by obstetrics and gynecology at about 31 days and cardiology at close to 27 days. Family medicine averages around 21 days, and orthopedic surgery comes in at roughly 17 days. These figures come from major metropolitan areas, so waits in smaller cities and rural regions are often longer.
U.S. patients are also more likely than people in peer countries to report they don’t have a regular doctor or place of care. Options for getting treatment after regular office hours are more limited here than in most comparable nations.
Race, Income, and Unequal Access
Access barriers don’t hit everyone equally. Hispanic adults are nearly twice as likely as white adults to have trouble finding a provider that accepts their insurance (6.4% vs. 3.6%). Black and multiracial adults also report higher rates of this problem. American Indian and Alaska Native adults are roughly twice as likely as white adults to be unable to reach a provider during office hours.
Income creates even steeper divides. Among adults in the lowest income bracket, nearly 8% struggle to find a provider compatible with their insurance, compared to under 3% for higher-income adults. Travel time follows the same pattern: 4.7% of the lowest-income adults delay care because it takes too long to get to a provider, compared with 1.4% among those with higher incomes. The Commonwealth Fund rated the U.S. last on equity among the countries it studied, citing the widest income-related gaps in cost-related access problems and the most reported instances of unfair treatment based on race or ethnicity.
A Growing Physician Shortage
The supply of doctors is not keeping pace with demand. Federal projections estimate that by 2030, the U.S. will be short roughly 79,000 physicians in full-time equivalent terms. That gap spans both primary care and specialties, and it’s expected to widen through 2035. An aging population needing more care, combined with a wave of physician retirements, is driving the mismatch.
This shortage intensifies every other access problem. Fewer available doctors mean longer wait times, less time per appointment, and more communities left without local providers. Areas that already struggle to attract physicians, particularly rural and low-income regions, feel it first.
Telehealth Has Helped, With Limits
The rapid expansion of telehealth during and after the pandemic opened a new pathway for millions of patients. Virtual visits eliminate travel time, reduce costs, and allow people in shortage areas to connect with providers they couldn’t otherwise reach. For people with mobility limitations, caregiving responsibilities, or jobs that make daytime appointments difficult, telehealth removes real obstacles.
But telehealth requires reliable internet access, which many rural and low-income communities still lack. It also works better for some types of care than others. Follow-up visits, mental health counseling, and medication management translate well to video. Physical exams, imaging, lab work, and procedures still require an in-person visit. Telehealth narrows the gap but doesn’t close it.
How the U.S. Compares Globally
Among high-income countries, the U.S. spends far more per person on healthcare yet delivers worse results on access and outcomes. The Commonwealth Fund’s 2024 report placed the U.S. last among 10 nations overall, last on equity, and last on administrative efficiency. Americans are more likely than people in peer countries to face affordability problems, lack a regular source of care, and encounter bureaucratic hurdles like billing disputes and insurance denials.
The gap is not about the quality of treatment available at top hospitals. For patients who can afford and physically reach advanced care, outcomes can be excellent. The problem is that too many people cannot clear those hurdles, creating a system where access depends heavily on your income, your insurance, your zip code, and your race.