If anyone still wonders why health care reform is a top priority for many in Washington, the most recent Commonwealth Fund survey comparing the experiences of patients in the U.S. with those in other leading industrialized nations should be especially illuminating. The study, published in Health Affairs, asked chronically ill adults about the health care they received in the past two years, and found that those in the U.S. are by far the most likely to forgo care because of cost, and are the most likely to experience medical errors, care coordination problems, and high out-of-pocket costs.
According to the survey, which also included Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom, more than half (54%) of chronically ill patients in the U.S. did not get recommended care, did not fill prescriptions, or did not see a doctor when they were sick because of the cost, compared with 7 percent to 36 percent in the other countries. About one-third of U.S. patients—again, the highest proportion among the eight countries—experienced medical, medication, or lab/diagnostic test errors, with a similar share encountering poorly coordinated care, including duplication of tests or medical records that were unavailable at the time of an appointment.
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 U.K. and 8 percent in the Netherlands.
"The study highlights major problems in our broken health care system and the need to make major changes," said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the Health Affairs 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."
How Chronically Ill in U.S. Fare Compared with Other Nations | ||||||||
| Percent of adults with any chronic condition who in past two years reported: | AUS | CAN | FR | GER | NETH | NZ | UK | US |
| Access problem because of cost* | 36 | 25 | 23 | 26 | 7 | 31 | 13 | 54 |
| Coordination problem** | 23 | 25 | 22 | 26 | 14 | 21 | 20 | 34 |
| Medical, medication, or lab error*** | 29 | 29 | 18 | 19 | 17 | 25 | 20 | 34 |
*Because of cost, respondent did NOT: fill Rx or skipped doses, visit a doctor when had a medical problem, and/or get recommended test, treatment, or follow-up. Source: 2008 Commonwealth fund International Health Policy Survey of Sicker Adults. |
In addition to cost-related barriers to health care, chronically ill patients in the U.S. often experienced long waits to see primary care physicians and had difficulty getting care after regular office hours. Many turned to hospital emergency rooms for their care. In fact, 59 percent of U.S. patients responding to the survey said they had visited an emergency room in the past two years. Only Canadian patients reported a higher rate of ER use (64%).
Not surprisingly, U.S. respondents were significantly more likely to call for fundamental change in the health care system, with one-third saying the nation's health system needs to be rebuilt completely.
In the study, more than half of patients had two or more chronic conditions. The authors note that such "patients account for a disproportionate share of national spending, placing them at the center of efforts to improve health system performance."
"The U.S. is not only facing an economic crisis, we are facing a health system crisis," said Commonwealth Fund president Karen Davis. "Our leaders need to come together to develop reforms which will make lasting improvements for patients, to assure universal coverage and high- quality, efficient care. With the U.S. outspending all other countries, we can't afford not to reform our health care system to secure a healthier future."