Americans tend to pay more for healthcare, according to a recent survey. But half of the respondents said they didn't seek help when sick, didn't fill a prescription or didn't get recommended treatment.

But the other countries surveyed -- Canada, the United Kingdom, Australia, New Zealand and Germany -- also exhibit some disturbing trends when it comes to patient safety and quality of care, the surveyors found, with no one emerging as a clear winner or loser.

"We have areas of shared concern across countries, but we also saw wide variations between top-performing countries and those at the bottom in particular measures," said Robin Osborn, vice president of Commonwealth Fund and co-author of the new report.

The survey of health care in six countries was released by the Commonwealth Fund and the journal Health Affairs at a conference in Washington, DC, attended by health officials from each of the countries involved.

Communication and Coordination Problems

Researchers interviewed more than 2,000 adults with a high incidence of chronic illness, an area where health spending tends to be concentrated. Germany is the only country that had not been included in previous surveys.

"Sicker adults are very dependent on medical care, they are the most intense users of the healthcare system and are most vulnerable. They are our canaries in the coal mine, signaling weak links and failures, and giving us real-time feedback," Osborn said.

More US respondents (34 percent) reported having experienced at least one of four types of errors: medication errors, incorrect test results, delays in receiving test results or a mistake in treatment or care. In Canada, 30 percent of respondents reported at least one of these errors, as did 27 percent of Australian respondents, 25 percent of those in New Zealand, 23 percent of those in Germany, and 22 percent of those in the UK.

"The distinct majority (60 percent) said errors had occurred outside the hospital," said Cathy Schoen, also a co-author of the report and senior vice president of the Commonwealth Fund. "In all countries, mistakes were more likely in patients who said they saw four or more physicians, signaling a failure to communicate across sites of care."

Communication and coordination problems emerged as a major issue, with at least one-fifth of the respondents reporting such problems and one-sixth saying they would like to be more involved in their care.

"The US is typically recognized as having the most fragmented system with the greatest challenges in continuity of care and coordination," Osborn said. "Sicker adults in the US are least likely to have regular doctors and long-term relations with the doctor when they have one."

But coordination of care problems, such as duplication of tests and unavailable medical records, were seen in all the nations surveyed.

Transitional Care

In a similar vein, transitional care (referring to the move from hospital to home) was lacking across the board. As many as one quarter of respondents said they did not receive information on what symptoms to watch for, instruction on follow-up care or who to call. Germany was the worst, with 60 percent of respondents reporting failures to coordinate care.

Even Canada, which fared relatively well on these measures, acknowledged room for improvement. "For Canada, the integration of the system across a wide range of settings and professions is the major take-away lesson from this survey, as it has been in previous years," said Ian Shugart, assistant deputy minister of health policy for Health Canada in Ottowa.

"It's a question of striking a balance between choice as a good thing and lack of continuity, which certainly seems to be causing a problem for some of the patients here," added Philip Davies, deputy secretary for the Australian government's Department of Health and Ageing. "Our physicians, particularly in the ambulatory sector, are focusing back on the traditional curing role and maybe having less time to devote to other issues of explaining and devoting time to managing the patient's journey."

Americans tended to have to pay more for their care, spending more than $1,000 out-of-pocket in the past year. Half of the adults surveyed said they didn't seek help when sick, didn't fill a prescription or didn't get recommended treatment. By contrast, 13 percent of adults in the UK reported foregoing care because of costs, and two-thirds said they had no out-of-pocket costs.

"The US is an outlier," Schoen said.

Same-Day Access

In Canada and the United States, patients were significantly less likely to get same-day access to healthcare.

In the other countries, 45 percent to 58 percent reported being able to get same-day appointments. Waiting times for elective surgery or specialists were shortest in Germany and the United States.

"The lack of waiting time in Germany was notable because they spend a lower percentage of their gross domestic product on healthcare than we do," Schoen said.

The take-home message, Osborn said, is that "greater attention needs to be paid to medical errors in settings outside of the hospital, [with] better strategies to improve communication and hand off for those seeing multiple doctors."

More information: Visit the Commonwealth Fund for full access to the report.