In the midst of the growing data boon in healthcare, the Commonwealth Fund has recently published chilling news about the state of health in America.

The Commonwealth Fund, a nonpartisan group, surveyed 26,863 adults from developed countries and found that 43% of low-income Americans decline to pay for healthcare. Additionally, the study discovered that Americans are generally sicker than their counterparts in other countries, with 28% possessing two or more chronic diseases. Though beaten out by Canada by 1%, Americans were also found to have the greatest levels of emotional distress.

Compared with other countries, the U.S. has lagged behind when it comes to providing affordable health care. Despite the assorted maladies afflicting Americans, which include high rates of diabetes, heart disease, arthritis, and asthma, many elect to not visit the doctor when experiencing symptoms because of prohibitively high pricing.

Sara Collins, the Commonwealth Fund’s vice president of healthcare coverage and access, stated that solving cost problems would greatly contribute to ending America’s health issues. She spoke briefly about Washington’s new administration, stating that it is “really too early to know” what impact it would have on America’s healthcare. She did, however, add that the common link between the other countries in the surveys was easier access to health insurance.

The study is notable not only because of America’s apparent lack of affordable healthcare, but because of the degree to which it lags behind other countries. While 33% of the adults surveyed in the United States reported skipping healthcare for financial reasons, the next highest measure is only 22% in Switzerland.

Though the numbers on the survey seem to have improved since the Commonwealth Fund’s 2013 study, with percentage of low-income adults unable to afford healthcare down 8%, it’s obvious that the country has gone awry when it comes to providing coverage for its citizens.

And all of this despite having the highest healthcare spending rate on the list.

“The U.S. spends more on health care than any other country, but what we get for these significant resources falls short in terms of access to care, affordability, and coordination,” stated Commonwealth Fund President Dr. David Blumenthal.

He went on to discuss that the U.S. has much to learn from its fellow countries, particularly when it comes to providing care to low-income or chronically ill patients.

However, if there is a silver lining to this study, particularly to anyone with an interest in good patient engagement, it is that America has the highest percentage of doctors that discuss diet and exercise with their patients, a good start to making citizens aware of ways that they can take their health into their own hands.