A new Commonwealth Fund international survey finds that medical homes in the U.S. and abroad are showing positive results improving health outcomes. The report identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible and helps coordinate care received from other providers.

Sicker adults in the U.K. and Switzerland were most likely to have a medical home, with nearly three-quarters connected to practices that have characteristics of a medical home, compared to about 33 percent to 65 percent in the other nine countries. U.K. and Swiss patients also reported more positive healthcare experiences than sicker adults in the other countries. They were also more likely to be able to get a same- or next-day appointment when sick, to have easy access to after-hours care and were less likely to experience poorly coordinated care.

The poll found that sicker adults in the U.S. stood out for having the highest rates of problems paying medical bills and going without needed care because of the cost. Forty-two percent reported not visiting a doctor, not filling a prescription or skipping medication doses or not getting recommended care, a significantly higher proportion than in all the other countries and more than double the rates in Canada, France, the Netherlands, Norway, Sweden, Switzerland and the U.K. Moreover, U.S. patients had among the highest rates of self-reported medication, lab or medical errors, as well as gaps in coordination of care.

Across the diverse healthcare systems included in the study, patients who were connected to a medical home in general had more positive care experiences, including better support for managing chronic conditions, better communication and better care coordination. Patients with medical homes were also less likely to report medical mistakes and far more likely to rate their care highly.

The U.S. stood out as the most likely to have problems getting needed care because of the cost or to have medical bill or debt problems. More than two of five sicker adults in the U.S. (42 percent) went without care because of costs. More than one in four (27 percent) said they could not pay or had serious problems paying medical bills, compared with between 1 percent and 14 percent of adults in the other 10 countries. In addition, more than one-third (36 percent) spent more than $1,000 on medical costs, compared with fewer than 10 percent in France, Sweden, and the U.K., the countries with the lowest rates – a reflection, the authors say, of high cost-sharing and high uninsured rates in the U.S.

In the U.S., cost-related access problems and medical bill burdens reported in the survey were concentrated among adults under age 65. Compared to adults 65 or older with Medicare coverage, under-65 adults were far more likely to go without care because of costs, compared to 19 percent of adults age 65 or older; 35 percent of those under 65 had problems with medical bills, compared with only 6 percent of adults 65 or older. Whether insured all year or uninsured, under-65 sicker adults in the U.S. were at high risk for access problems, bill concerns or high out-of-pocket costs.