Care is Often Poorly Coordinated

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Sicker adults need better coordination of care, especially in the United States, where almost half of those under the age of 65 will go without care because of costs.

This article published with permission from The Burrill Report.

Adults with serious illnesses or chronic conditions in the United States are far more likely to go without care because of the cost than people with similar ailments in other high-income countries, a new study finds.

The report, published in Health Affairs, found that 42% of sicker adults in the United States forgo care because of costs, triple the percentage of Switzerland, the next closest country. The study was based on finding from a 2011 Commonwealth Fund International Policy Survey.

Though half of U.S. adults under 65 went without care because of costs, only 19% of adults aged over 65 skipped care. The authors say that suggests that Medicare has a significant effect on minimizing cost as a barrier to care.

In administering the survey, the Commonwealth Fund aimed to better understand the needs of adult patients with complex care needs, especially in a climate where many high-income countries are seeing a disproportionate share of national health spending going towards the sicker adult demographic.

A total of 18,000 sick adults participated in the Commonwealth survey in Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States. The people reported they were in fair or poor health, had surgery or had been hospitalized in the past two years, or had received care for a serious of chronic illness, injury or disability in the past year.

The study found that across all countries, coordination gaps, lapses in communication between providers, and missed opportunities for engaging patients in management of their own care presented challenges in providing care to sicker adults.

Having a primary care doctor who coordinates care received from other providers and knows the patient’s medical history mitigated many of these challenges.

To address the problems laid out in their analysis, the authors of the study suggested that countries try to learn from one another and find ways to redesign primary care, develop care teams accountable across multiple sites of care, and manage transitions and medications better.

“Chronically ill patients encounter failures of providers to communicate with each other or coordinate care,” says Cathy Schoen, Commonwealth Fund senior vice president. “Yet in each country, patients with primary care practices that help them navigate the care system and provide easy access are far less likely to encounter delays and failures to share important information.”