Online-only: Study: Chronic illness, cost are barriers to necessary health care
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* Donya Currie

U.S. adults with health problems are more likely to go without care and have trouble paying bills than those in comparable countries, according to a Commonwealth Fund study that explored medical homes.

Released Nov. 9 and published online in Health Affairs, the study was based on a survey of patients’ experiences in the United States and 10 other high-income countries. Those chronically ill adults in the study who received care from a medical home — which is an accessible, primary care practice that helps coordinate care — were less likely to report medical errors, test duplication and other care coordination problems.

Yet sicker adults in the United States had the highest rates of reported problems paying medical bills and forgoing needed care because of cost. In the study, 42 percent of U.S. adults reported not visiting a doctor, not filling a prescription or skipping medication doses or not getting recommended care. That was a significantly higher proportion than in all the other countries studied and more than double the rates in Canada, France, the Netherlands, Norway, Sweden, Switzerland and the United Kingdom.

In addition to being most likely to face financial difficulty with care, U.S. patients also had among the highest rates of self-reported medication, lab or medical errors as well as gaps in care coordination.

“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,” said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the study. “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.”

The study found 27 percent of U.S. patients said they could not pay or had serious problems paying medical bills, compared to between 1 percent and 14 percent of adults in the other 10 countries. Thirty-six percent of U.S. patients spent more than $1,000 on medical costs, compared with fewer than 10 percent in France, Sweden and the United Kingdom. The study’s authors said that was a reflection of high cost-sharing and uninsured rates in the United States.

Cost-related access problems and medical bill burdens in the United States were concentrated among adults younger than 65. Compared to those 65 or older with Medicare coverage, those younger adults were far more likely to go without care because of cost or to struggle to pay medical bills. Fifty-one percent of U.S. adults younger than 65 went without care because of costs, compared to 19 percent of adults ages 5 or older. Regardless of their insurance status, sicker adults younger than 65 were at high risk for access problems, bill concerns or high out-of-pocket costs.

“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 Karen Davis, president of the Commonwealth Fund. “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.”

For more information, visit [www.commonwealthfund.org](http://www.commonwealthfund.org).

*   Copyright The Nation’s Health, American Public Health Association