Personal Injury Law

Chronically Ill Most In Need Of Medical Reform

By Jane Akre

Those most in need of medical care are going without in the U.S.

That is the conclusion of a new international survey from The Commonwealth Fund, a private foundation that researches improvements in the delivery of health care.

Looking at eight industrialized countries the fund finds that half of chronically ill adults are forgoing needed care because of the cost.

Among the uninsured in the U.S. that number jumps to 82 percent.

The chronically ill are far more likely to experience medical mistakes, a lack of coordination of care and the highest out-of-pocket costs.

• 54 percent of Americans chose not to get recommended care, fill prescriptions or see a doctor because of cost, even among the insured.  In New Zealand, that number is seven percent, in Australia 36 percent.
• 34 percent of Americans had a problem coordinating their health care, compared to 14 percent in the Netherlands and 25 percent in Canada.
• And Americans experienced the most frequent lab errors of 34 percent compared to 17 percent in the Netherlands and 29 percent in Australia and Canada.

"Not surprisingly, U.S. patients hold the most negative system views, with a third calling for rebuilding the health-care system," Cathy Schoen, the Fund's senior vice president said to the Washington Post. 

"In short, U.S. patients are telling us about inefficient, unsafe and often wasteful care. The lack of access and poorly coordinated care is putting these patients at very high health risk and driving up costs of care."

Besides the U.S., the 7,500 participants came from Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom.

Patients with multiple chronic illness account for a disproportionate amount of health care spending because of the multiple clinics they must visit.

Because of their repeated exposure to health care, they were chosen to provide a unique perspective on the system. 

All of the participants had recently been hospitalized, had major surgery or a serious illness including hypertension, heart disease, diabetes, arthritis, lung problems, cancer or depression.

In the U.S. patient costs are highest with 41 percent spending more than $1,000 on out-of-pocket costs. The U.K. and Dutch patients are protected against such costs.

But don't Americans have more access to doctors when they need them?  The answer is no.  26 percent of U.S. and Canadian patients have access to same-day service. One quarter report long waits.  Need to get to see a doctor quickly - 60 percent of Dutch patients can see a doctor the same day while that number is 54 percent in New Zealand and 48 percent in the U.K.

The Dutch have a strong primary care infrastructure.

Those patients who wait until their condition worsens are costing the system more and patients with multiple chronic conditions are at a higher risk of death.

What does it all mean?                                       

The new administration has ambitious aims of putting children's health care, stem cell research and health care reform at the top of its agenda, though Obama did not campaign on a platform of universal health care, as the Commonwealth Fund concludes is needed.  

The Commonwealth Fund's president Karen Davis said during a teleconference, "This is a time of economic crisis around the world, but also a time of crisis in the U.S. health care system.  The survey findings provide a basis for action toward reforming our health care system."

Presently, 138 million Americans have chronic health conditions. The bulk of Medicare spending goes toward recipients who suffer five or more conditions.

The study is published in the journal Health Affairs. # 

Full post as published by InjuryBoard on November 14, 2008 (boomark / email).