Compared to patients in seven other countries, chronically ill adults in the United States are far more likely to forgo care because of costs, according to a new survey conducted by the Commonwealth Fund.
Published Thursday in (italics) Health Affairs, (end italics) the 2008 survey of 7,500 chronically ill patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United States included adults who had a diagnosis of at least one of seven chronic conditions.
"The study highlights major problems in our broken healthcare system and the need to make major changes," said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article. "Patients are telling us about inefficient, unsafe and often wasteful care. Moreover, a lack of access as well as poor coordination of care is putting chronically ill patients at even higher health risk."
According to the survey, more than half (54 percent) of chronically ill patients in the United States did not get recommended care, fill prescriptions or see a doctor when sick because of costs, compared to 7 percent to 36 percent in other countries. In addition, about one-third of U.S. patients - a higher rate than in any other country - reported experiencing medical errors or poorly coordinated care, including delays in access to medical records or duplicated tests.
Reflecting cost sharing as well as gaps in insurance coverage, 41 percent of U.S. patients spent more than $1,000 in the past year on out-of-pocket medical costs, compared with 4 percent in the U.K. and 8 percent in the Netherlands.
In addition to access barriers due to costs, chronically ill patients in the United States often experienced long waits to see primary care physicians and difficulty getting care after hours, and often turned to emergency rooms for care. Canadians reported similar concerns with primary care access.
According to the survey, one-third of U.S. patients - more than in any other country - reported being given the wrong medication or dosage, experiencing a medical error, receiving incorrect test results or facing delays in hearing about abnormal test results.
"The U.S. is not only facing an economic crisis, we are facing a health system crisis," said Commonwealth Fund President Karen Davis. "With the U.S. outspending all other countries, we can't afford not to reform our health care system to secure a healthier future."