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Study: U.S. Patients More Likely to Call for Health Care Overhaul

By Joanna Anderson, CQ Staff

November 13, 2008 -- Medical patients in the United States are significantly more likely to call for an overhaul of their country's health care system than patients elsewhere in the world, according to findings released Thursday by the Commonwealth Fund.

Revamping the health care system is one of President-elect Barack Obama's top priorities. Commonwealth Fund President Karen Davis said the incoming administration and Congress would present a window of opportunity in 2009 to build a high performance care system.

Davis tied what she called a health care crisis in the United States to the current economic downturn, noting that increased unemployment will leave more Americans without access to care and tighter family budgets will hinder affordability of care. "We can't afford not to reform our care system," added Commonwealth's Senior Vice-President Cathy Schoen.

The 2008 survey of 7,500 chronically ill patients in eight countries found Americans far more likely to forgo care because of costs. More than half of the U.S. patients questioned did not get recommended care, fill prescriptions, or visit a physician when sick because of the associated costs. That figure ranged from 7 percent to 36 percent in the other countries.

The study also found that U.S. patients experienced the highest rates of medical errors, coordination problems, and high out-of-pocket costs. Roughly one-third of the Americans surveyed reported medical errors or poorly coordinated care, such as delays in access to records and duplicated tests. Meanwhile, 41 percent of U.S. patients spent more than $1,000 in the past year on out-of-pocket medical costs, compared with just 4 percent in the United Kingdom and 8 percent in the Netherlands. Schoen attributed those high out-of-pocket costs to the large number of uninsured Americans, as well as a substantial cost-sharing burden placed on those with insurance, she said.

The survey included adults diagnosed with at least one of seven chronic conditions in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.

The findings also show that chronically ill patients in the United States often experienced long waits to see primary care providers, had difficulty accessing care after hours, and frequently turned to emergency rooms for care. One of five of the U.S. patients surveyed said they had gone to an emergency room for a problem they thought could have been treated by a primary care physician had access been readily available, according to Schoen.

While the study revealed poorly organized, duplicate, or wasteful care experiences for U.S. patients, it showed notably more positive experiences for Dutch patients. The authors attributed the contrast to the Netherlands' universal coverage system, strong primary care, and widespread use of electronic medical records.

In addition, the authors identified a number of challenges shared by all countries studied: enhancing primary care, assuring quality transitional care when patients are discharged from hospitals, and improving information flow when patients see multiple clinicians.

Davis called Wednesday's introduction of a health care agenda by Senate Finance Committee Chairman Max Baucus, D-Mont., a step in the right direction. Baucus' plan would expand coverage to all Americans, emphasize increased quality and lower costs, trim waste in federal health programs, and rebalance their financing.

Democrats are expected to pass a large expansion of children's health insurance early next year.
Drew Armstrong contributed to this story.

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