If I ever start to feel complacent about the state of the U.S. health care system, I need only turn to my husband, who's Australian, for a reminder of where we fall short. He readily admits that the Aussie system isn't perfect, but at least it provides care to all and, in his experience, doesn't have as many confusing restrictions (most recently he was perplexed that we had to give up our much-loved pediatrician because our insurance changed and our doctor wasn't on the new plan).

But his, and my own, frustrations with the health care system are minor compared with those of people needing a high degree of ongoing care. According to a new survey, the United States lags far behind other countries in providing affordable, accessible, and even safe care for people with chronic illnesses. Some of the findings:

• More than 50 percent of U.S. patients reported not filling prescriptions, seeing a doctor when sick, or getting recommended care because of costs. In other countries, only 7 percent to 36 percent reported skipping care.
• U.S. patients had the highest rate of medical errors, with one-third reporting problems such as being given the wrong medication or dosage, or receiving incorrect test results.
• When ill, only one-quarter of U.S. patients could get same-day appointments with doctors. This compares with around half or more of patients in the Netherlands, New Zealand, and the United Kingdom.
• U.S. patients were least likely to have a personal doctor or a long-term relationship with a care provider.
• U.S. patients were most likely to report poorly organized, duplicate, or wasteful care. For example, one-third said that their medical records or test results had been unavailable during appointments, or that they'd had duplicate tests.
• U.S. patients had the highest out-of-pocket medical costs, with more than 40 percent spending at least $1,000 a year.