Chronic Illness Care: US Falls Short--November 2008

November 20, 2008
Eileen Koutnik-Fotopoulos

Survey reveals that more than half of US chronically ill adults skip care. Respondents cite cost and medical errors.

A 2008 international survey of 7500 chronically ill patients in 8 countries found that Americans are more likely to forgo care because of costs or experience medical errors, coordination problems, and high out-of-pocket costs.

Health Affairs

The study, by The Commonwealth Fund and published online November 13, 2008, in , surveyed chronically ill patients in the United States, Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom. The study participants had a diagnosis of at least 1 of 7 chronic conditions: hypertension, heart disease, diabetes, arthritis, lung problems, cancer, or depression.

The findings showed that 54% of US chronically ill patients did not get recommended care, fill prescriptions, or visit a doctor when sick due to costs, compared with 7% to 36% in other countries. About one third of US patients—higher than 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. The Netherlands, France, and Germany had the lowest reports of any errors. In addition, 41% of US patients spent >$1000 in the past year on out-of-pocket medical costs, compared with 4% in the United Kingdom and 8% 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.”

Commonwealth Fund President Karen Davis said the United States is not only facing an economic crisis, but a health system crisis. “Our leaders need to come together to develop reforms which will make lasting improvements for patients, to assure universal coverage, and high-quality, efficient care,” she said. “With the United States outspending all other countries, we cannot afford not to reform our health care system to secure a healthier future.”

For other articles in this issue, see:

The Power of Statins

Using Today’s Great American Smokeout to Help Patients Quit

New Yorkers Will Receive Rx Translations