(AP Photo/Charles Dharapak)

For U.S. patients with serious health problems, out-of-pocket care costs may be a more serious threat than problems with coordination.

A team of researchers led by Cathy Schoen of the Commonwealth Fund, New York, has published a paper comparing the experiences of patients in the United States and 10 other countries in the latest edition of Health Affairs, a health care finance and delivery journal.

The 19,000 patients included all had serious chronic conditions, and they had made extensive use of their countries’ health care systems. They are the sorts of patients who are at high risk of suffering a short-term or long-term disability.

Some policymakers have suggested that major problems with the U.S. health care system include poor coordination of care.

U.S. patients gave their care providers reasonably high marks on many care coordination indicators.

The U.S. patients were more likely than patients from any other country to say test results were often not available when they arrived at a doctor’s office, but the U.S. patients seemed to think their specialists and primary care providers were doing a better job of sharing information than doctors in countries such as France, Germany and Sweden, and they were less likely than patients in most of the other countries to say their regular doctors seemed unaware of their recent surgeries or hospital stays.

Similarly, the U.S. patients were less likely than the patients in any of the countries studied to say they felt they had experienced gaps in hospital discharge planning.

But 42% of the U.S. patients said they had had trouble getting care in the past year because of cost, and they were far more likely to report cost-related care access problems than patients in the other countries were. In Australia, the country with the second worst performance on the access indicator, only 30% of the patients reported having cost-related access problems.

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