Chronically ill Americans suffer far worse care than their counterparts in seven other industrial nations, according to a new study by the Commonwealth Fund, a New York-based foundation that has pioneered in international comparisons. It is the latest telling evidence that the dysfunctional American health care system badly needs reform.

    The results of the study, published by the respected journal Health Affairs, belie the notion held by many American politicians that health care in this country is the best in the world. That may be true at a handful of pre-eminent medical centers, but it is hardly true for the care provided to a huge portion of the population.

    The Commonwealth Fund's survey of 7,500 patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, Britain and the United States focused on patients who suffered from at least one of seven chronic conditions: hypertension, heart disease, diabetes, arthritis, lung problems, cancer or depression.

    The care they received in this country - or more often did not receive - ought to be a cause for shame. More than half of the American patients went without care because of high out-of-pocket costs. They did not visit a doctor when sick, skipped a recommended test or treatment or failed to fill a prescription. The uninsured suffered most, but even 43 percent of those who had insurance all year skipped care because of costs.

    Americans also were most likely to report wasting time because their care was so poorly organized. About a third reported that medical records and test results were not available when needed or that tests were duplicated unnecessarily. A third experienced a medical error, such as being given the wrong medication or test results. Some 40 percent found it very difficult to get after-hours care without going to an emergency room.

    The United States did comparatively well in some areas, such as providing relatively prompt access to specialists and clear instructions to patients leaving the hospital. But the nation's overall performance was abysmal.

    By contrast, Dutch patients reported far more favorable experiences with their health care system, largely because the Netherlands provides universal coverage (through individual mandates and private health insurance), a strong primary care system and widespread use of electronic medical records. It should be possible to achieve the same level of performance here.