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Volume 12 Number 211 News: Quality ATLANTA--An international health survey set for release Nov. 1 by the Commonwealth Fund has found that U.S. patients are more likely to have medical errors, forgo care because of costs, and say the health care system needs to be rebuilt than patients in six other nations. In the survey, 12,000 patients in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States were contacted. Interviews were conducted by telephone. The survey, "Toward Higher-Performance Health Systems: Adults' Health Care Experiences in Seven Countries, 2007," is to be published online in the journal Health Affairs. The survey found wide country differences in access, after-hours care, and coordination, according to the study. All the nations surveyed, except the United States, have universal health insurance but vary in how health care is funded and delivered. The Netherlands' approach, for example, includes a large role for private insurance, and Germany has not-for-profit sickness funds, according to the study. One-Third Say Rebuild System The survey also found that U.S. patients have greater problems with access to care, the highest out-of-pocket costs, and the most problems paying medical bills compared to other countries. According to the survey, patients in the United States and Canada also are the least likely to get a same-day appointment with their physician when sick and instead seek care in an emergency room. The survey also found that one-third of U.S. patients interviewed said the U.S. health care system needs to be rebuilt, which was the highest percentage of the countries surveyed. Just one in six surveyed thought the U.S. health care system works well, the lowest rate in the survey. Lessons From Abroad U.S. patients also reported more fragmented and inefficient care, including medical record and test delays, perceptions of waste, and more time spent on paperwork than in other countries. "There are lessons to be learned from looking abroad. This survey shows that patients in the U.S. are frustrated by high costs and a complicated health care system," said Cathy Schoen, a senior vice president of the Commonwealth Fund and lead author of the study. In the area of patient safety, the survey found that U.S. adults reported the highest rates of lab test errors and among the highest rates of medication errors, with the highest rates of errors reported among patients seeing multiple doctors or with multiple chronic illnesses. One-third of U.S. patients with chronic conditions reported a medical, medication, or test error in the past two years, the survey said, again the highest in the survey. Those With 'Medical Home' Do Best Adults in all seven countries said that having a primary care doctor who coordinates their care, or a 'medical home,' results in "significantly more positive experiences," that included more time with their physician, more involvement in care decisions, and better coordination with specialists and hospitals. In Britain, the Netherlands, and New Zealand, the survey found that adults register with primary care clinics and general practitioner medical practices to coordinate care, while in Germany and the United States, patients generally can self-refer to specialized care. Except for the Netherlands, where everyone has a regular doctor, the survey found that only 45 percent to 60 percent of those questioned in the other six countries said they had a medical home. Waiting Times The survey found that German and U.S. patients reported the fastest access to health care, while Canadians and Britons had the longest waits for elective surgery. Eight percent of Canadians surveyed had to wait six months or longer for elective surgery, while 15 percent of Britons waited six months or more, the survey said. But waiting times varied considerably by type of care and country, Schoen said. Patients in Australia, Germany and New Zealand reported being able to get in quickly for elective surgery. Even with good access, one-fifth of U.S. patients said they had serious problems paying medical costs in the past year. In a teleconference with reporters, Karen Davis, president of the Commonwealth Fund, said the survey showed "that in the U.S. we pay a high price for having a fragmented system." The Commonwealth Fund is a private foundation that conducts independent research on health systems. The complete study will be available to "Health Affairs" subscribers.
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