Chronically ill Americans are more likely than peers in seven other countries to forgo care because of cost and suffer errors and inefficient, poorly organized care, the nonprofit Commonwealth Fund concluded in a report.

The 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults interviewed 7,500 patients in the U.S., Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom about access to care, safety, and efficiency. Each had at least one chronic condition: hypertension, heart disease, diabetes, arthritis, lung problems, cancer, or depression.

"Chronically ill adults in the U.S. were the most negative; one-third said the healthcare system needs a complete overhaul," the Commonwealth Fund said.

Fifty-four percent of U.S. patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs. The figure ranged from 7% to 36% in the other countries.

At about one in three, U.S. patients had the highest rate of medical errors, including delays in learning about abnormal lab tests. One-third also encountered poorly coordinated care, including medical records not available during an appointment or duplicated tests.

Only one-fourth of U.S. and Canadian patients said they could see a doctor on a same-day appointment. In both countries, one in five said they went to an ED for a condition that could have been treated by a nonemergency physician. More than 60% of Dutch, 54% of New Zealanders, and 48% of Britons were able to get same-day appointments.

Americans also led in out-of-pocket costs, with 41% personally spending more than $1,000 in the last year. Britons and Dutch were most insulated against such costs, the report said.

On the positive side, the U.S. did comparatively well on some measures of hospital discharge instructions and patient-centered care, even though chronically ill Americans often cannot afford to follow recommended care.