Poor Sick People: U.S. Offers Raw Deal for the Unhealthy

If you're very sick and not very wealthy in America, your best move may be to just flee the country. Otherwise, expect to pay through the nose and possibly wind up deep in debt. That's the takeaway of newly released research from The Commonwealth Fund, a private foundation that seeks to improve poor people's access to quality health care.

Seeking to learn more about the experiences of sicker adults around the world, the group surveyed more than 18,000 adults who were in fair or poor health, had recently been hospitalized, and had had major surgery or a serious illness in the past year. The group looked at adults in 11 high-income countries where patients with complex care needs typically account for a disproportionate share of national health spending.

The findings: U.S. patients with complex care needs were much more likely than those in 10 other high-income countries to forgo needed treatment because of costs, according to the survey. Americans are also more likely to struggle with medical debt.

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In fact, 27% of the Americans surveyed were unable to pay or encountered serious problems paying medical bills in the past year, compared with between 1% and 14% of adults elsewhere. In the U.S., 42% reported not visiting a doctor, filling a prescription, or getting recommended care because of cost issues -- at least twice the rate of every other country but Australia, New Zealand, and Germany.

"Given how much the U.S. spends on health care, one would expect better performance," says Michelle McEvoy Doty, Ph.D, vice president of Survey Research and Evaluation with The Commonwealth Fund.

Indeed, Americans spend more on healthcare than any other country: $7,960 per person in 2009, the latest figure available. Norway came in a distant second at $5,352, according to data cited by The Commonwealth Fund.

A big problem is the number of uninsured -- 50 million. Those folks typically get their health care in emergency rooms, which drives up costs for themselves, as well as for the hospitals and doctors that ultimately care for them.

"There is an unevenness in health care in the U.S., compared to other countries, says Elise Gould, director of health policy research with the Economic Policy Institute, a nonprofit, nonpartisan think tank. "We have the best care in the world, but it really depends on who you are."