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Posted: December 02, 2008

More Than Half of Chronically Ill Scrimp on Health Care: Survey

Compared to patients in seven other countries, chronically ill adults in the United States are far more likely to skip medical care because of costs. They also experience the highest rates of medical errors, coordination problems, and high out-of-pocket costs, according to a new study from The Commonwealth Fund.

The 2008 survey of 7,500 chronically ill patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, United Kingdom, and the United States included adults who had a diagnosis of at least one of seven chronic conditions.


More than half (54%) of US chronically ill patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared to between 7% and 36% in other countries.


About one-third of U.S. patients -- a higher rate than in any other country -- experienced medical errors or poorly coordinated care, including delays in gaining access to medical records or experiencing duplicated tests. Reflecting cost-sharing as well as gaps in insurance coverage, 41% of U.S. patients spent more than $1,000 in the past year on out-of-pocket medical costs, compared with 4% in the UK and 8% 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 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."


In addition to access barriers due to costs, US chronically ill patients often experienced long waits to see primary care physicians, difficulty getting care after hours, and often turned to emergency rooms for care. Canadians also reported such primary care access concerns.


Only one-quarter of US and Canadian patients reported same-day access to doctors when they were sick -- and one-fourth or more reported long waits. In contrast, about half or more of Dutch, New Zealand (54%), and UK patients were able to get a same-day appointment.


US patients were most likely to find it very difficult to get after-hours care without going to an emergency room: 40% said it was very difficult, compared with only 15% in the Netherlands and Germany, the lowest rates of any country on this measure.


In the past two years, 59% of US patients visited an emergency room; only Canada had higher rates. In both countries, one in five said they went to the ER for a condition that could have been cared for by a regular doctor if one had been available.


In contrast to long waits for primary care, US patients reported short waits for specialists. Three-quarters of patients in the US, as well as more than two-thirds in the Netherlands and Germany, were able to get an appointment with a specialist within a month. Waits for specialists were longest in Canada, New Zealand, and the UK.


One-third of U.S. patients -- more than in any other country -- reported either being given the wrong medication or dosage, experiencing a medical error, receiving incorrect test results, or facing delays in hearing about abnormal test results. Patient reports of any error were lowest in the Netherlands, France, and Germany.


Indicating inadequate tracking systems, US error rates were particularly high for delays in patients getting abnormal test results.


US patient experiences indicate often poorly organized, duplicate, or wasteful care: 

(Article courtesy of

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