According to a new study published in the journal Health Affairs, one-third of Americans say they’ve gone without medical care or avoided filling a prescription because of cost. This number is much higher than in the Netherlands, for example, where it stands at 5 per cent. What’s more, 20 per cent of American adults have major problems paying medical bills, compared to 2 per cent in Britain and 9 in France, the next most expensive country. The results come from the Commonwealth Fund, which advocates for U.S. health care reform. It commissioned a poll from Harris Interactive, of almost 20,000 people in 11 countries, conducted between March and June. About 60 per cent of Americans under 65 get health insurance through an employer, and 45 million 65 and older have coverge though the nation’s Medicare program, which covers the elderly and disabled. That leaves 47 million without any health insurance.