Compared to patients in seven other countries, chronically ill adults in the United States are far more likely to forgo care because of costs, according to a new study from the Commonwealth Fund, a private foundation supporting independent research on health policy. The eight-country survey, published in the online edition of the journal Health Affairs, finds that U.S. adults also experience the highest rates of medical errors, coordination problems, and high out-of-pocket costs. Given that, it’s not surprising that U.S. patients are significantly more likely to call for fundamental change in their country’s healthcare system with a third saying it needs to be rebuilt completely. More than half (54 percent) of U.S. chronically ill patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared to 7 to 36 percent in other countries. About one-third of U.S. patients—a higher rate than in any other country—experienced medical errors or poorly coordinated care, including delays in access to medical records or duplicated tests. Reflecting cost-sharing as well as gaps in insurance coverage, 41 percent of U.S. patients spent more than $1,000 in the past year on out-of-pocket medical costs, compared with 4 percent in the U.K. and 8 percent in the Netherlands. Overall, Dutch patients often stand out for more positive experiences—they were the most likely to report timely, affordable access to care, experience low rates of medical errors or coordination gaps, and hold positive views about their health system. The study authors attribute the difference in experience between Dutch and U.S. patients to the Netherlands' universal coverage (accomplished through individual mandates and private health insurance), strong primary care foundation, and widespread use of electronic medical records.