Chronically Ill Adults in U.S. Worse Off than in Other Countries

PHOTO: Registered nurse Susan Eager, left, checks the breathing of Jane Awise, who suffers from severe diabetes, while performing a home health care visit.
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Americans who are chronically ill are much less able to pay their medical bills and have to forego medical care because of the cost more often than their counterparts in other countries, according to a new survey by The Commonwealth Fund, an independent foundation that supports health care research.

The results, the researchers say, highlight some of the biggest flaws in the U.S. health care system.

The study data, reported in this week's Health Affairs journal, also found adults in the U.S. who suffer from chronic illnesses reported the highest rate of medical errors and most often said their medical care isn't well-coordinated between their doctors compared with adults in other countries.

Researchers at The Commonwealth Fund surveyed 18,000 "sicker adults" in the U.S. and 10 other countries – including Australia, Canada, France, Germany, Switzerland and the United Kingdom – and asked questions related to health care costs, access to care, coordination of care and medical errors.

Forty-two percent of Americans said the high costs of health care kept them from seeing doctors, getting medications and avoiding recommended treatments, a significantly higher percentage than in the 10 other countries.

"The number one finding is that the U.S. spends more on health care than other countries, but it doesn't get the most out of the health care system," said Karen Davis, president of The Commonwealth Fund. "The U.S. performs the most poorly on access to care and the financial burden that comes with chronic illness."

The study also found that people who have a "medical home" – a primary care physician or practice that coordinates treatment across specialties – felt better about their care and were less likely to report medical errors.

Chronically ill adults from United Kingdom and Switzerland reported the most positive health care experiences, and were also more likely to have a medical home.

The data, said the researchers, suggest that all 11 countries need to step up their efforts to provide more organized primary care and can learn lessons from each other. In addition to focusing on developing medical homes, the U.S. can look to other nations for guidance on providing more affordable care.

"Our system is the most disjointed in the developed world, which is the cause of many of our problems," said Robert Field, professor of health management and policy at the Drexel University School of Public Health in Philadelphia. "Doctors often don't communicate with each other, so we are more likely to get duplicate tests, multiple drugs with dangerous interactions, and lost lab results."

"The U.S. is starting to adopt the concept of the patient-centered medical home, but that's certainly an area where it's lacking," she added.

The survey also found that American patients were the most satisfied with how doctors interact with them and help manage their care. Americans, Field said, also believe the U.S. has the best health care system in the world.

Making health care in the U.S. more affordable and coordinated will require implementing changes such as better coordination of care and expanding insurance coverage, the experts said, and there are no easy answers. But despite the fact that the U.S. offers some of the best care in the world, the system must change in order for the majority of Americans to reap the benefits.

"We have great high-end care and lots of nice amenities. But we seem to have more fundamental problems that most," he said. "No country's system is perfect, but many of the others are well ahead of us in important ways."

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