If you become chronically ill, will you be able to afford the care you need?

The Commonwealth Fund conducted a survey of chronically ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. The results, released on November 13, 2008, show U.S. patients at particularly high risk of forgoing care because of costs and experiencing errors or inefficient, poorly organized care.

The survey found that, “While the U.S. did comparatively well on some measures of hospital discharge instructions and patient-centered care, chronically ill Americans often cannot afford to follow recommended care. Gaps in coverage and cost-sharing are undermining access and adherence.”

The survey found that:

• More than half (54%) of U.S. patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, versus 7 percent to 36 percent in the other countries.


• About one-third (33%) of U.S. patients--the highest proportion in the survey--experienced medical errors, including delays in learning about abnormal lab test results.


• One-third (33%) of U.S. patients encountered poorly coordinated care, including medical records not available during an appointment or duplicated tests.


• Nearly half (41%) of U.S. patients reported spending more than $1,000 on out-of-pocket costs in the past year--U.K. and Dutch patients were most protected against high out-of-pocket costs.


• Only one-quarter (26%) of U.S. and Canadian patients reported same-day access to doctors when sick, and one-fourth or more reported long waits. About half or more of Dutch (60%), New Zealand, (54%), and U.K. (48%) patients were able to get same-day appointments.


• Chronically ill adults in the U.S. were the most negative about their health care system: one-third (33%) of respondents said the health care system needs a complete overhaul.

Read the full report.