Sicker US Adults Have More Financial Problems Than In Other Countries

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Main Category: Public Health
Also Included In: Health Insurance / Medical Insurance;  Seniors / Aging
Article Date: 09 Nov 2011 - 19:00 PST

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Chronically and seriously ill American adults have the highest rate of difficulties in paying their medical bills and doing without medical care because of cost, compared to their counterparts in the UK, Canada, Australia, France, the Netherlands, New Zealand, Norway, Sweden, Switzerland and Germany, a Commonwealth Fund International Survey reported today. The authors found that those who receive care from an accessible primary care practice (GP practice) that helps coordinate care - known as A Medical Home - had a lower risk of experiencing medical errors, test duplication and other failures resulting from poor coordination.

The survey is published in this week's issue of Health Affairs. The survey involved 18,000 sicker adults from 11 highly developed nations. The authors also found that those who were under the care of a Medical Home tended to rate their care more highly and enjoyed better relationships with their physicians, compared to patients with no access to a Medical Home.

The survey, carried out in 2011, included over 18,000 sicker adults who said were either in fair or poor health, had undergone surgery, had been admitted to hospital at some time during the previous 24 months, or had received treatment and care for a chronic or serious injury, disability or illness during the preceding 12 months. Those who had a regular source of care that knew about their medical history, was accessible, and helped coordinate their care with other providers were identified as having a Medical Home.

Having a Medical Home was found to be more likely among patients in Switzerland and the UK. Nearly three-quarters of the British and Swiss respondents had a Medical Home, compared to between 33% and 65% in the remaining nine nations. When sick, the British and the Swiss were the most likely to get a same-day or next-day appointment and to receive after-hours care. Citizens of the two nations were also at the lowest risk of experiencing poorly coordinated care.

As far as the US respondents were concerned:

• They had the most problems paying for the medical bills
• They were the most likely ones to do without medical care because they could not afford it
• 42% said they did not see a doctor, not to fill a prescription, skip a medication, or not receive recommended care. This percentage was considerably higher than in all the other nations, over double the percentage in the UK, Canada, France, the Netherlands, Norway, Sweden or Switzerland.
• They had the highest percentage of reported medical, lab or medication errors
• They had the highest percentage of people reporting gaps in coordination of care

The authors reported that patients connected to a Medical Home (compared to those who were not connected) had:

• more positive opinions about the care they received
• more positive opinions about the support they received for managing chronic conditions
• better opinions regarding care coordination
• overall, better ratings for their care and fewer medical mistakes

Source: Commonwealth Fund


Lead author, Cathy Schoen, Commonwealth Fund senior vice president, said:

"We found that to varying degrees in all countries, chronically ill or sicker patients encounter failures of providers to communicate with each other or coordinate care. Yet in each country, patients with primary care practices that help them navigate the care system and provide easy access are far less likely to encounter duplication, delays, and failures to share important information."

Schoen added that a 'high-performing health system' is the foundation for good patient-centered primary care.

Commonwealth Fund president, Karen Davis, said:

"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.

This is a clear indication of the urgent need for Affordable Care Act reforms geared toward improving coverage and controlling health care costs. It is crucial that as reforms are implemented, we control costs in ways that ensure those facing serious and chronic illness have affordable access to the health care they need and that preserve the gains made by Medicare."

The authors found that all 11 countries are facing similar challenges in making sure there is provision of effective treatment for sicker adults. Gaps in several aspects of care, including communication between specialists and GPs, failure to review medications, coordination, etc. were detected in all the countries to varying degrees.

The authors commented:

"All the other study countries already spend far less than the United States, yet provide more comprehensive, protective benefits. Comparative research finds the higher costs in the United States are largely due to paying higher prices and not related to the generosity of insurance."

In an Abstract in the journal, they concluded:

"The United States in particular has opportunities to learn from diverse payment innovations and care redesign efforts under way in the other study countries."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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