Who Has the Most Trouble Paying Medical Bills? The Sick.

Americans with chronic illnesses or serious health problems are more likely to have difficulties paying their medical bills or problems getting needed care than adults with similar problems in other high-income countries.  The poll found that Americans were most likely to have problems getting needed care because of the high cost, or as a direct result of medical debt, according to the Commonwealth Fund“Despite spending far more on healthcare than any other country, the United States practically stands alone when it comes to people with illness or chronic conditions having difficulty affording healthcare and paying medical bills,” Commonwealth Fund president Karen Davis said.  “This is a clear indication of the urgent need for Affordable Care Act (ACA) reforms geared toward improving coverage and controlling healthcare costs.”

According to the researchers, the results underscore some of the biggest flaws in the American healthcare system.  The Commonwealth Fund surveyed 18,000 “sicker adults” in the United States and 10 other nations – including Australia, Canada, France, Germany, Switzerland and the United Kingdom – and asked about healthcare costs, access to care, coordination of care and medical errors.  Forty-two percent of Americans said the high costs of healthcare prevent them from seeing doctors, getting prescribed medications and avoiding treatments, an appreciably higher percentage than in the 10 other countries.

“Our system is the most disjointed in the developed world, which is the cause of many of our problems,” said Robert Field, professor of health management and policy at the Drexel University School of Public Health in Philadelphia.  “Doctors often don’t communicate with each other, so we are more likely to get duplicate tests, multiple drugs with dangerous interactions, and lost lab results.”

According to the survey, 51 percent of American adults with health problems who were 65 or younger went without care because of costs, compared with 19 percent of adults 65 and older, who were covered by Medicare.  The study found extensive gaps in access to healthcare.  More than 70 percent of  patients in Britain, Switzerland, France, New Zealand and the Netherlands were able to get same- or next-day appointments when needed.  Just half of patients in Sweden and Canada reported such rapid access.

More than 33 percent of American patients questioned paid more than $1,000 in medical costs in 2010, compared with less than 10 percent in France, Sweden and Great Britain – the nations reporting the lowest rates.

One reason why is that industrialized nations are more successful in giving patients easy access to primary care and to “medical homes” that are essentially centers for care and complex treatment.  A medical home is a single, familiar location where people receive care from accessible providers who know the patient’s medical history and the knowledge to optimally coordinate care.  The Commonwealth Fund study credits medical homes with fewer errors, poor information, coordination gaps, and emergency room visits.

“To varying degrees, care is often poorly coordinated,” said Cathy Schoen, the Commonwealth Fund’s senior vice president for policy, research and evaluation.  But the results also indicate that the use of medical homes reduced that lack of coordination and helped in other ways, said Commonwealth Fund researchers.  “Having a medical home makes a difference; it makes a difference in every country,” Schoen said.

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