On quality, the U.S. stood out "particularly with symptoms of more fragmented, poorly coordinated care," Schoen said. In 2008, for instance, 14% of American adults with a chronic condition reported receiving the wrong medicine or the wrong drug dose in the past two years. "This was twice the rate of the lowest rate countries, Germany and the Netherlands," she said.
Also, 14% adults in the U.S. reported delays in being notified about abnormal test results or given the wrong results during the past two years. These rates were more than twice the rates as those countries with the lowest rates, Germany (7%) and the Netherlands (6%). "As a result, we rank last on safety, and do poorly on several dimensions of quality," Schoen said.
The U.S. scored the highest regarding cost-associated access problems. Over half (54%) of chronically ill surveyed in 2008 reported going without care because of costs in the past two years, compared with 7% in the Netherlands and 13% in the U.K. These problems included not filling a prescription or skipping doses; not getting recommended tests, treatments, or recommended follow-up; or not visiting a doctor when sick, Schoen said.
But looking at the insured in the surveys, "we also see very high rates of going without care because of costs and very high rates of spending $1,000 or more," Schoen said. "Our insurance benefits have been declining as premiums have gone up, exposing more to being underinsured."
Other findings are: