Chronically Ill U.S. Patients Often Skip Care Due to Costs

Nov. 13 -- THURSDAY, Nov. 13 (HealthDay News) -- Chronically ill patients in the United States spend more out-of-pocket money, skip needed care, and report more medical errors than patients in seven other industrialized countries, a new survey finds.

"This is a time of economic crisis around the world, but also a time of crisis in the U.S. health-care system," Karen Davis, president of the Commonwealth Fund, which conducted the survey, said during a teleconference Tuesday. "The survey findings provide a basis for action toward reforming our health-care system."

Noting that the U.S. spends more on health care than any other country, Davis said: "We cannot afford not to reform our health-care system. Investment in our health-care system will pay dividends in terms of a healthy workforce and economically secure families."

Results of the survey were published online Nov. 13 in the Commonwealth Fund journal Health Affairs.

For the survey, researchers interviewed 7,500 people who had at least one chronic condition. The countries in the survey were Australia, Canada, France, Germany, Great Britain, the Netherlands, New Zealand and the United States.

All of those surveyed had recently been hospitalized, had major surgery or a recent serious illness, Cathy Schoen, the Commonwealth Fund's senior vice president, said during the teleconference.

An estimated 138 million people in the United States suffer from chronic health conditions, Schoen said. "The 23 percent of Medicare recipients who suffer from five or more conditions account for 68 percent of all Medicare spending," she noted.

The survey found striking differences across the eight countries, Schoen said. "Overall, the United States stands out for chronically ill adults reporting the most negative experiences. They are far more likely to go without care because of cost, including not filling prescriptions, [or] following up on recommended care," she said.

Patients in the United States are also more likely to report poorly coordinated care that puts them at risk and wastes their time, Schoen said. And they're significantly more likely to report prescription and diagnostic test errors, she said.

"Not surprisingly, U.S. patients hold the most negative system views, with a third calling for rebuilding the health-care system," Schoen said. "In short, U.S. patients are telling us about inefficient, unsafe and often wasteful care. The lack of access and poorly coordinated care is putting these patients at very high health risk and driving up costs of care."

The uninsured face the most risk, Schoen said. "They have a high risk of errors, of poor coordination and not getting in because of cost," she said. "A startling 82 percent went without care because of cost."

Even U.S. patients with insurance have higher costs than patients in other countries, Schoen noted. Uninsured and insured U.S. patients experience the same level of poorly coordinated care, she added.

Dutch patients reported the most positive health-care experiences, Schoen said. "Dutch patients stand out with few access concerns, rapid access when sick and after hours, low exposure to high costs and comparatively more positive coordination experiences," she said.

Among the survey's highlights:

  • More than 50 percent of U.S. patients went without care because of cost. Dutch and British patients rarely go without care due to costs.
  • One third of U.S. patients encountered poorly coordinated care -- significantly higher than all other countries.
  • One third of U.S. patients reported medical errors, double that of the Netherlands.
  • U.S. patients have higher out-of-pocket costs than other countries. Forty-one percent of American patients spent more than $1,000 a year on out-of-pocket expenses. Such costs were much rarer in Britain, France and the Netherlands.
  • U.S. and Canadian patients reported difficulty getting same-day access to doctors when sick. More than half of Dutch, New Zealand and nearly half of British patients get same-day appointments.
  • Fifty-nine percent of U.S. patients were seen in emergency rooms.
  • Many U.S. patients reported difficulty getting "after-hours" care. Dutch patients said it was easy to get such care.
  • U.S., Dutch and German patients get to see specialists quickly. British, Canadian and New Zealand patients have longer waits for specialists.
  • Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program, thinks this survey provides more evidence of the need for universal health care in the United States.

    "For Americans with serious chronic illness, access to medical care is quite bad, both absolutely and in comparison to other developed nations," she said.

    It's hardly surprising that costs prevented 82 percent of uninsured American patients from getting needed drugs, treatments or doctor visits, Woolhandler said. "What is surprising is that nearly half (43 percent) of insured patients also reported access problems, a higher rate than in any of the other seven countries, all of which spend less than we do and have universal national health insurance."

    More information

    For more on U.S. health care, visit the Commonwealth Fund.

    SOURCES: Steffie Woolhandler, M.D., associate professor, medicine, Harvard Medical School, Boston, and co-founder, Physicians for a National Health Program; Nov. 12, 2008, teleconference with Karen Davis, president, and Cathy Schoen, senior vice president, The Commonwealth Fund, New York City; Nov. 13, 2008, Health Affairs, online