In a new report based on a survey of 11 high-income countries, the U.S. was shown to have the highest rate of people reporting problems paying their medicals bills or going without health care due to cost.
According to the Commonwealth Fund study published today, chronically ill Americans also were the least likely among those surveyed internationally to have an ongoing relationship with a primary care provider, which means they lacked what is commonly referred to as a "health home."
The survey showed that 42 percent of U.S. respondents reported skipping medication or not filling a prescription, not seeing a doctor or not getting recommended care because they couldn't afford it.
That was more than double the rates in Canada, France, the Netherlands, Norway, Sweden, Switzerland and the United Kingdom.
“Despite spending far more on health care than any other country, the United States practically stands alone when it comes to people with illness or chronic conditions having difficulty affording health care and paying medical bills,” said Commonwealth Fund President Karen Davis.
Patients in Switzerland and the U.K. were the most likely to get a same- or next-day appointment when sick and have access to after-hours care. They also were less likely to receive poorly coordinated care, according to the report.
Experts say that people with health homes are less likely to report medical errors, duplicated tests and other failures of coordination that are thought to add significantly to U.S. health care costs.
According to the Commonwealth Fund, 89 percent of total U.S. health spending is concentrated among the sickest 30 percent of the population.
"These patients typically see multiple clinicians at different locations, making care coordination imperative," Commonwealth Fund officials said.
The administration of Gov. Sam Brownback on Tuesday announced plans to reform the Kansas Medicaid program. One element of the plan would require that managed-care contractors provide a "health home" for chronically ill Medicaid patients.
The Commonwealth Fund study was based on a survey of more than 18,000 sick adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. It included people who reported they were in fair or poor health, had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury or disability in the past year.
It identified patients as having a medical home if they reported having a care provider who knew their medical history, was accessible and helped coordinate care received from other providers.