One limitation of the study is that just 23 percent of people invited to complete the survey agreed to do so, the authors note. Researchers also lacked country-specific data to help examine the reasons some nations had better care coordination than others.

In the U.S., it’s likely that a lack of insurance or the cost of treatment contributes to poor care coordination, said Dr. Asaf Bitton, a researcher at Brigham and Women’s Hospital and Harvard Medical School, both in Boston, who wasn’t involved in the study.

“Care coordination assumes that a person has some sort of minimal access to affordable health care,” Dr. Bitton said by email. “When a person is uninsured or underinsured, they will avoid often necessary care.”

The study results for U.S. patients aren’t surprising, said Dr. Kurt Stange, a researcher at Case Western Reserve University in Cleveland, Ohio, who wasn’t involved in the study. “What is surprising is that we keep investing in the fragmented parts of care – delivery of individual commodities of disease-specific health care – and then expect the whole – the integrated care and health of people and families – to get better,” Dr. Stange said by email.

Better care coordination in other countries suggests that supporting doctor-patient relationships matters, Dr. Stange added. “Investment in relationships is a vital resource that enables care to be coordinated,” he noted. “Investment in relationships has many other pay-offs as well.