Compared to patients in seven other countries, chronically-ill adults in the USA are far more likely to forgo care because of costs; they also experience the highest rates of medical errors, coordination problems and high out-of-pocket costs, says a new study.

The 2008 Commonwealth Fund survey, of 7,500 chronically-ill patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK and the USA, found that more than half (54%) of the US patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared to 7%- 36% in other countries. About a third of the US patients – more than in any other country - experienced medical errors or poorly-coordinated care, while 41% spent more than $1,000 in the past year on out-of-pocket medical costs, compared with 4% in the UK and 8% in the Netherlands.

In addition, chronically-ill patients in the USA often experienced long waits to see primary care physicians and difficulty getting care after hours, and frequently turned to emergency rooms for care, says the study, which is published in the journal Health Affairs. Canadians also reported such primary care access concerns - only 26% of US and Canadian patients reported same-day access to doctors when they were ill, and on quarter or more reported long waits. In contrast, about half or more of Dutch (60%), New Zealand (54%), and UK (48%) patients were able to get a same-day appointment.

Moreover, US patients were the most likely to find it very difficult to get after-hours care without going to an emergency room - 40% said it was very difficult, compared with only 15% in the Netherlands and Germany, the lowest rates of any country on this measure.

However, three-quarters of patients in the USA, as well as more than two-thirds in the Netherlands and Germany, were able to get an appointment with a specialist within a month. Waits for specialists were longest in Canada, New Zealand and the UK.

But one-third of US patients - more than in any other country - reported either being given the wrong medication or dosage, experiencing a medical error, receiving incorrect test results, or facing delays in hearing about abnormal test results. Patient reports of any error were lowest in the Netherlands (17%), France (18%) and Germany (19%). US error rates were particularly high for delays in patients getting abnormal test results, indicating inadequate tracking systems, say the researchers.

Overall, Dutch patients were the most likely to report timely and affordable access to care, to experience low rates of medical errors or coordination gaps and to hold positive views about their health system, say the authors. In contrast, US patients were significantly more likely that those in any of the other seven nations to call for fundamental change in their country's health care system, with a third saying the system needs to be rebuilt completely.

- Earlier this month, the annual Euro Health Consumer Index (EHCI) ranked the Dutch health care system as the best in Europe, while the UK’s was placed 13th in the 31-nation league table.