When it comes to health care, it’s generally the case that the care in wealthy countries is better than in impoverished ones.

But a country’s GDP only goes so far in predicting how things will go, as a survey of the some of best-off countries finds.

Take a guess which rich country’s health system provides the worst experience for patients?

Yep, it’s the United States, according work released today by the Commonwealth Fund. Not only do Americans avoid doctors when ill for fear of being slapped with big bills, but they also shell out far more when they do go, even if they have insurance.

The findings, published in the journal Health Affairs, looked at 11 developed countries and compared the experience of patients — from costs, to paying medical bills, to dealing with insurance companies.

The U.S. came out at the bottom on almost every count, sometimes with shocking gaps between it and the next country.

Here’s a rundown of the various ways the U.S. is falling behind Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom:

• Only 58 percent of U.S. adults said they thought they could afford the care they needed
• A solid 20 percent of U.S. adults had major problems paying medical bills, compared to 9 percent in France, with the next highest figure
• 31 percent of U.S. adults reported getting caught in insurance problems: either dealing with mountains of paperwork, having their insurer deny a claim, or receiving a lesser payment than expected
• Americans are coughing up more from their own wallets: one-third of U.S. adults paid $1,000 or more out-of-pocket in the past year for medical bills, much higher than all of the other countries.
• Among the worst-off are uninsured Americans: nearly half of them went without needed care and one third had problem with bills

But some of this should change with the passage of the health care overhaul, which will make sure the 32 million Americans without coverage get it. According to Commonwealth Fund President Karen Davis, the bill will make new insurance options for the uninsured affordable, ensure insurance pays for essential care, and improve financial security for millions of Americans.

Even amid the gloom of survey, there was one bright spot for beleaguered Americans: we do seem to have pretty good access to specialists. Outscored only by Germany and Switzerland, 80 percent of U.S. patients who need a specialist see one in less than four weeks.

A year ago, an analysis by the Organization for Economic Cooperation and Development reached some similar conclusions. America got good marks for cancer care and not-so-hot grades for primary care. Copyright 2010 National Public Radio. To see more, visit http://www.npr.org/.