A new Commonwealth Fund study of chronically ill patients in eight industrialized nations finds that those in the U.S. are by far the most likely to forgo care because of the cost, as well as the most likely to experience medical errors, care coordination problems, and high out-of-pocket costs.

According to the study, which also included Australia, Canada, France, Germany, the Netherlands, New Zealand, and the United Kingdom, U.S. patients are significantly more likely to call for fundamental change in their country’s health care system, with one-third saying the system needs to be rebuilt completely. The journal Health Affairs published the findings recently as a Web Exclusive.

“The study highlights major problems in our broken health care system and the need to make major changes,” said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the Health Affairs article. “Patients are telling us about inefficient, unsafe, and often wasteful care. Moreover, a lack of access as well as poor coordination of care is putting chronically ill patients at even higher health risk.”

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