Many Americans Dissatisfied With Their Medical Care

THURSDAY, Nov. 1 (HealthDay News) -- Although the United States spends more than twice as much on health care as other western countries, many Americans say they are forced to forgo care because of costs, experience more medical errors, and say the health-care system needs to be overhauled, a new survey finds.

U.S. patients also have the highest out-of-pocket costs and the most difficulty paying medical bills, according to the survey of seven countries conducted by The Commonwealth Fund.

And U.S. and Canadians are least likely to be able to get a same-day appointment with their doctors and are more likely to go to emergency rooms for immediate care, the survey found.

"It's easy to say that we have the best health system in the world, but it's really important to look at the evidence to see what the data show," Karen Davis, Commonwealth Fund president, said during a teleconference Wednesday.

"We are certainly the most expensive health-care system," Davis said. "What these surveys have shown year after year is that patients in the U.S. experience more problems with access to care because of costs," she said.

The report,Toward Higher Performance Health Systems: Adults' Views and Experiences With Primary Care, Care Coordination and Safety in Seven Countries, 2007, is published in the Nov. 1 online issue ofHealth Affairs.

For the survey, Commonwealth Fund researchers were led by Cathy Schoen, fund vice president and research director of its Commission on a High Performance Health System. They surveyed 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States about their health-care systems.

"Despite spending that leads the world, U.S. adults, for the most part, are likely to go without needed care because of costs, to report medical errors when sick, and to encounter high out-of-pocket costs and struggle to pay their medical bills," Schoen said during the teleconference.

Schoen's team found that one third of U.S. adults said the health-care system needed rebuilding, which was the highest rate in any country. In addition to costs, U.S. patients said they received more fragmented and inefficient care, including medical record and test delays, and more time wasted on paperwork, compared with patients in other countries. "Both low- and high-income patients expressed these views," Schoen said.

U.S. patients also said they had the highest rates of lab test errors and some of the highest rates of medical or medication errors. These errors were highest among patients seeing multiple doctors or with multiple chronic illnesses, Schoen said. In the United States, one-third of patients who had chronic conditions reported a medical, medication, or test error in the last two years.

Many U.S. adults also said they were likely to go without care because of costs. Thirty-seven percent of all U.S. adults and 42 percent of those with chronic conditions said cost had kept them from taking prescribed medications, seeing a doctor when sick, or receiving recommended care last year. These rates were far higher than all other countries, Schoen noted.

Patients in Canada, the Netherlands, and the United Kingdom rarely reported not getting needed medical care because of costs, the survey found.