More Than Half of Chronically Ill U.S. Adults Skip Needed Care Due to Costs

A new Commonwealth Fund survey of chronically ill patients in eight industrialized nations finds that those in the U.S. are by far the most likely to forgo care because of the cost, as well as the most likely to experience medical errors, care coordination problems, and high out-of-pocket costs.


According to the survey, which also included Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom, U.S. patients are significantly more likely to call for fundamental change in their country's health care system, with one-third saying the system needs to be rebuilt completely. The journal Health Affairs published the findings today as a Web Exclusive.

Key Findings

  • 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 of U.S. patientsthe highest proportion in the surveyexperienced medical errors, including delays in learning about abnormal lab test results.
  • one-third of U.S. patients encountered poorly coordinated care, including medical records not available during an appointment or duplicated tests.
  • The U.S. stands out for patient costs, with 41 percent reporting they spent more than $1,000 on out-of-pocket costs in the past year. U.K. and Dutch patients were most protected against such 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.
  • In the past two years, 59 percent of U.S. patients visited an emergency room (ER); only Canada had a higher rate (64%). In both countries, one of five patients said they went to the ER for a condition that could have been treated by a regular doctor if one had been available.

(SOURCE: The Commonwealth Fund e-Alert,, November 13, 2008)