November 14, 2008
Compared to patients in seven other countries, chronically ill adults
in the U.S. are far more likely to skip 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, the United Kingdom, and the United States included adults who had a diagnosis of at least one of seven chronic conditions.
More than half (54 percent) of U.S. chronically ill patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared to 7 to 36 percent 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 access to medical records or duplicated tests. Reflecting cost-sharing as well as gaps in insurance coverage, 41 percent of U.S. patients spent more than $1,000 in the past year on out-of-pocket medical costs, compared with 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 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."
Experiences vary widely across countries
In addition to access barriers due to costs, U.S. 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 U.S. 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 U.K. patients were able to get a same-day appointment.
U.S. patients were the most likely to find it very difficult to get after-hours care without going to an emergency room: 40 percent said it was very difficult, compared with only 15 percent in the Netherlands and Germany, the lowest rates of any country on this measure.
In the past two years, 59 percent of U.S. 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, U.S. patients reported short waits for specialists. Three-quarters of patients in the U.S., 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 U.K.
Errors and perceptions of wasteful care
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, U.S. error rates were particularly high for delays in patients getting abnormal test results.
U.S. patient experiences indicate often poorly organized, duplicate, or wasteful care:
• One third of U.S. patients experienced a time when either test results or medical records were not available or tests were duplicated, significantly higher than all other countries and more than double the coordination gaps reported in the Netherlands
• Nearly half of U.S. patients reported their time had been wasted because of poorly organized care or they had received care of little or no value during the past two years. Such perceptions of waste or inefficient care were also high in France, Germany, and Canada. They were lowest in the Netherlands and the U.K.
