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

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