THURSDAY, Nov. 1 (HealthDay News) -- Although the United States spends more than twice as much on health care as other western countries, many Americans say they are forced to forgo care because of costs, experience more medical errors, and say the health-care system needs to be overhauled, a new survey finds.

U.S. patients also have the highest out-of-pocket costs and the most difficulty paying medical bills, according to the survey of seven countries conducted by The Commonwealth Fund.

And U.S. and Canadians are least likely to be able to get a same-day appointment with their doctors and are more likely to go to emergency rooms for immediate care, the survey found.

"It's easy to say that we have the best health system in the world, but it's really important to look at the evidence to see what the data show," Karen Davis, Commonwealth Fund president, said during a teleconference Wednesday.

"We are certainly the most expensive health-care system," Davis said. "What these surveys have shown year after year is that patients in the U.S. experience more problems with access to care because of costs," she said.

The report, Toward Higher Performance Health Systems: Adults' Views and Experiences With Primary Care, Care Coordination and Safety in Seven Countries, 2007, is published in the Nov. 1 online issue of Health Affairs.

For the survey, Commonwealth Fund researchers were led by Cathy Schoen, fund vice president and research director of its Commission on a High Performance Health System. They surveyed 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States about their health-care systems.

"Despite spending that leads the world, U.S. adults, for the most part, are likely to go without needed care because of costs, to report medical errors when sick, and to encounter high out-of-pocket costs and struggle to pay their medical bills," Schoen said during the teleconference.

Schoen's team found that one third of U.S. adults said the health-care system needed rebuilding, which was the highest rate in any country. In addition to costs, U.S. patients said they received more fragmented and inefficient care, including medical record and test delays, and more time wasted on paperwork, compared with patients in other countries. "Both low- and high-income patients expressed these views," Schoen said.

U.S. patients also said they had the highest rates of lab test errors and some of the highest rates of medical or medication errors. These errors were highest among patients seeing multiple doctors or with multiple chronic illnesses, Schoen said. In the United States, one-third of patients who had chronic conditions reported a medical, medication, or test error in the last two years.

Many U.S. adults also said they were likely to go without care because of costs. Thirty-seven percent of all U.S. adults and 42 percent of those with chronic conditions said cost had kept them from taking prescribed medications, seeing a doctor when sick, or receiving recommended care last year. These rates were far higher than all other countries, Schoen noted.

Patients in Canada, the Netherlands, and the United Kingdom rarely reported not getting needed medical care because of costs, the survey found.

"The Netherlands stands out for strong positive endorsement of their health-care system -- confidence in care, quality and safety, and access to the latest technology," Schoen said. "The Netherlands also stands out with low concern with access due to cost, as do Canada and the U.K.," she added.

Moreover, one-fifth of patients in the United States said they had serious problems paying medical bills. That was more than double the rate in the next highest country. In addition, 30 percent of American patients spent more than $1,000 in the last year on out-of-pocket medical expenses.

The survey also found that patients gave the highest grades to health-care systems in which people had one doctor in charge of their medical care. But, across all the countries surveyed, only 45 percent to 61 percent of adults said they had a primary source of care, sometimes called a "medical home." In the United States, only 26 percent of uninsured patients had a medical home, compared with 53 percent of insured adults under 65, the researchers found.

One expert said the survey revealed -- once again -- the shortcomings of the U.S. health-care system.

"Comparing the U.S. health-care system to other industrialized countries is not for the faint of heart. The deficiencies in the U.S. system are painfully evident in every such study, and this one is no exception," said Dr. David Katz, director of Yale University School of Medicine's Prevention Research Center. "We manage to spend more on less efficient health care than any country in the world."

The real message from this survey is not about countries or health-care systems, but people, Katz said.

"What seems to predict better care, better outcomes, and more patient satisfaction is the most fundamental aspect of care there is -- a caring relationship. Patients with a health-care provider they know and trust and can rely on and call their own have a better health-care experience," he said.

More information

For more on improving health care, visit The Commonwealth Fund.

SOURCES: Oct. 31, 2007, teleconference with Karen Davis, president, The Commonwealth Fund, and Cathy Schoen, vice president and research director, Commission on a High Performance Health System, The Commonwealth Fund, New York City; David Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Nov. 1, 2007, Health Affairs, online

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