Health Costs Negatively Affecting Those Who Need It Most

If report cards were issued to countries for their health care system—the U.S. would not be on the principal’s “A” list. Compared with other industrialized nations, the U.S. comes in last when it comes to preventing deaths through appropriate medical care, despite spending more than twice as much on each person. The increase in premature births throughout the country recently earned the U.S. a “D” rating  in the first annual Premature Birth Report Card from the March of Dimes. And millions of Americans with chronic conditions such as high blood pressure or diabetes aren’t getting the care they need because they lack health insurance, putting them at high risk for complications. But a recent study by the Commonwealth Fund really puts things into perspective.

For the survey, researchers polled 7,500 patients from the U.S. and seven other countries, including Australia, Canada, Britain, France, Germany, the Netherlands and New Zealand. All of those surveyed had at least one of seven chronic conditions: high blood pressure, heart disease, lung disease, diabetes, cancer, arthritis and depression. Compared with the other nations, not only do chronically ill patients in the U.S. spend more out-of-pocket money and go without much needed healthcare because of the high costs, they also have the worst experience with medical errors and coordination problems.

More than 50 percent of U.S. patients reported having to forgo care because of cost, either by not filling prescriptions, skipping doses, or not visiting their physicians for recommended care; a problem rarely experienced by Dutch and British patients. Forty-one percent of U.S. patients reported spending more than $1,000 a year on out-of-pocket expenses, compared to lows of 4 percent in Britain and 5 percent in France.

Poorly coordinated care was reported by at least half of U.S. patients—significantly higher than the other countries. Patients in the U.S. and Canada reported difficulty getting same-day care when sick, compared to almost half of British and over half of Dutch and New Zealand patients who get same-day appointments. Many U.S. patients reported difficulty getting after-hours care, with 59 percent being seen in emergency rooms. Dutch patients had no problem getting such care.

One-third of U.S. patients reported medical errors; receiving the wrong medication or dosage, receiving incorrect test results or facing delays in getting their test results, more than any of the other countries.

On the positive side, U.S. patients were less likely to report a long wait to see specialists. For example, only 10 percent of American respondents said they had to wait two months or more for an appointment for a specialist, compared with 42 percent in Canada and 33 percent in both Britain and New Zealand. In addition, U.S. patient satisfaction with their care after discharge from a hospital was relatively high. Only 38 percent identified gaps in care or communication after discharge, lower than any other nation in the survey. And just 9 percent of Americans who had been hospitalized said they did not receive a written care plan at discharge, compared with 31 to 43 percent of the respondents in the other countries. “The United States did comparatively well on measures of transitional care during hospital discharge, and responses were more positive on some items related to patient-centered care (for example, setting goals and priorities),” the researchers added. “Yet U.S. patients often cannot afford to follow recommended care.”

Overall, Dutch patients reported the most positive health-care experiences, while “the United States stands out for chronically ill adults reporting the most negative experiences,” the Commonwealth Fund’s Cathy Shoen, who worked on the study, said. “In short, the U.S. patients are telling us about inefficient, unsafe and often wasteful care. The lack of access, combined with 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. A startling 82 percent went without care because of cost.” According to the U.S. Census Bureau, 15 percent of Americans, 45.7 million people, had no public or private health insurance last year. However, even U.S. patients with insurance experience higher costs than do patients in other countries, and both the uninsured and insured in the U.S. deal with the same level of poorly coordinated care, Shoen noted.

“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, said during a teleconference. “The survey findings provide a basis for action toward reforming our health-care system.” Pointing out that the U.S. spends more on health care than any other country, David 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.”

Dr. Steffie Woolhandler, associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program, thinks this survey provides strong evidence for the need to adopt 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. What is surprising is that nearly half 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.”

The survey findings were published online in the November 13 issue of the Commonwealth Fund journal Health Affairs.