Chronically ill patients in the U.S. are far more likely to go without healthcare because of costs than patients from seven other countries, according to a new study from the Commonwealth Fund and published as a Web exclusive in Health Affairs. In a survey of 7,500 chronically ill patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the U.S., patients in the U.S. also fared worst in their experience with medical errors, coordination problems and high out-of-pocket costs. By comparison, the study found that the Dutch had “notably positive access and coordination experiences,” which researchers attributed to a strong primary-care infrastructure.
More than half (54%) of chronically ill patients in the U.S. reported at least one cost-related access problem, such as not filling prescriptions, skipping doses, not visiting a physician when sick, or not getting recommended care. Also, the study said both insured and uninsured patients in the U.S. are at high risk for access, coordination and safety problems, as 43% of those chronically ill patients went without care because of costs. The percentage of uninsured patients who skipped care or did not fill prescriptions was nearly double that amount at 82%.
Researchers gave examples of what countries could do to integrate care over time and promote health for the chronically ill, such as using incentives and more “bundled” payments; spreading the use of registries and electronic information systems; and engaging patients and communities to focus on prevention and health. -- by Jessica Zigmond