A survey reports what many Americans already know: our health care system is a mess.

A report of 11 developed countries found that the United States spent the most on health care, even though almost one-third of Americans forgo treatment because they can't afford it.

A survey conducted by the Commonwealth Fund and published online in Health Affairs examined health insurance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United States, and the United Kingdom.

Among many significant national differences, the survey found that Americans were the most likely to incur high out-of-pocket medical expenses, spent the most time on paperwork and were mostly likely to have claims denied.

And while the Swiss had high out-of-pocket costs, few had problems paying the bills. And though Germans spent nearly as much time as Americans bogged down with paperwork, they were protected from out-of-pocket spending, the survey said.

One-fifth of U.S. adults had trouble paying medical bills in the previous year, and more than one-third of American adults had to spend more than $1,000 in out-of-pocket care, the highest of any country surveyed.

The Swiss had the promptest access to care -- around 93 percent said they saw a doctor or nurse the same or next day. Only 57 percent of Americans did, though wait times were longer for Canadians, Norwegians and Swedes, according to Health Affairs.

The U.S. had the widest gap by income of the countries surveyed - something the study authors hope could be changed by health reform.

"For US adults, comprehensive health reforms could lead to improvements in many of these areas, including reducing differences by income observed in the study," wrote the authors, led by Commonwealth Fund senior vice president Cathy Schoen.

The survey was conducted between March and June 2010 and was answered by 19,000 adults.

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