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

By Steven Reinberg
HealthDay Reporter
Thursday, November 13, 2008; 12:00 AM

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.

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