The outlook is bleak for people suffering from chronic disease, according to a recently-released survey. More and more people suffer from chronic illnesses, and they are not getting the care they need. And it's not getting any better in a recession.

About three-fourths of our nation's health care spending is on chronic diseases. Learning how to better manage chronic diseases lilke diabetes and congestive heart is a work in progress; we should learn from both the programs that are working as well as those that are not. One goal of health reform is to develop a health care system that is less fragmented, more able to provide the coordinated care needed to control chronic diseases. That will mean changing how we deliver health care, and how we pay health care providers.

The need for these changes was underscored in the survey, Re-Forming Health Care: Americans Speak Out about Chronic Conditions and the Pursuit of Healthier Lives. Commissioned by the National Council on Aging and supported by The Atlantic Philanthropies and the California HealthCare Foundation, the survey found that approximately 68 percent of Americans over 44 years of age have two or more chronic conditions. Another 20 percent have four or more. Over the past 10 years or so, these numbers have risen consistently.

The lagging economy places a strain on everyone, but for chronic disease sufferers, it can mean they are holding off on getting necessary treatment because of money. The NCOA survey found that one in four people suffering from chronic disease had delayed seeking health care treatment or failed to fill an important prescription because they were worried about cost, even though a substantial majority reported they were in pain, stressed, or depressed over the past year. About one in three reported that they did not have enough money to do things that would improve their health. The problem was reported more frequently by minorities.

Additionally, many chronic disease sufferers feel underserved by their health care providers. Slightly under half of respondents said they rarely or never receive referrals to outside resources such as classes or counselors, and 57 percent said that their health care providers had not asked them if they had help to manage their problems.

The NCOA has recommended that the government, health care providers, and those suffering from chronic disease all work together to fix the problems inherent to chronic disease management. The federal government should increase investments that encourage care coordination, providers should connect with their patients to encourage self and community-based care, and chronic disease sufferers should develop the skills they need to be self-advocates and secure the support they need.