New Survey Compares Healthcare in Seven Most Developed Nations, Finds US Healthcare Lags Behind

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http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=568237

A new Commonwealth Fund survey finds that, compared with adults in six

other countries, U.S. adults are most likely to go without health care

because of the cost and more likely to say that the health care system

needs to be rebuilt completely. In addition to cost concerns, the

survey analysis, by Fund Senior Vice President Schoen and

colleagues, finds the U.S. has multiple symptoms of less-efficient

care.

" Toward Higher-Performance Health Systems: Adults' Health Care

Experiences in Seven Countries, 2007 "

(Health Affairs Web Exclusive, Oct. 31, 2007), highlights the critical

role of having a " medical home " that is accessible and coordinates

care. In each of the countries surveyed, patients who had such a

medical home reported more positive care experiences than those

lacking one.

The survey included approximately 12,000 adults in Australia, Canada,

Germany, the Netherlands, New Zealand, the United Kingdom, and the

United States.

Highest Medical Error Rate in U.S.

Among adults in the seven countries, U.S. adults reported the highest

overall error rates, including lab and medication errors. One-third of

U.S. patients (32%) with chronic conditions reported a medical,

medication, or lab test error in the past two years, compared with 28

percent of patients in Canada, 26 percent in Australia, and fewer

patients in the other countries. Patient-reported errors were highest

in every country for those seeing multiple doctors or with multiple

chronic illnesses.

Skipping Care Because of Costs

In the U.S., 37 percent of all adults surveyed—and 42 percent of those

with chronic conditions—skipped medications, did not see a doctor when

sick, or did not obtain recommended care in the past year because of

the cost. These rates are well above those found in the other six

countries. Few people in Canada, the Nether-lands, and the U.K.

reported skipping care because they could not afford it.

A high proportion of U.S. adults also have serious problems paying

medical bills—nearly one-fifth (19%), more than double the rate in the

next highest country.

Nearly one-third (30%) of U.S. survey respondents spent more than

$1,000 in the past year in out-of-pocket medical costs. Nineteen

percent of Australians and 12 percent of Canadians spent this much;

rates were even lower elsewhere.

Affordability concerns may well be the reason that a third (34%) of

U.S. respondents said the health care system needs to be rebuilt

completely. This was the highest rate of any of the seven countries.

Access to Care, Care Coordination

All the countries surveyed, except the U.S., have universal health

insurance systems. Despite arguments that such systems result in long

waits for care, or even rationing, half or more adults in Germany, the

Netherlands, and New Zealand reported having rapid access to

physicians. Yet in the U.S., only 30 percent of adults said they could

get same-day appointments with their doctors when sick. Moreover,

two-thirds of U.S. adults—as well as two-thirds of adults in Canada

and Australia—reported difficulty getting care on nights, weekends, or

holidays.

Adults in the U.S. also reported high rates of coordination problems

and billing hassles. For example, 23 percent of U.S. adults said that

either test results were not available at the time of an appointment

or doctors ordered duplicate tests. Nineteen percent of Germans and 18

percent of Australians reported these problems; rates were lower

elsewhere.

Medical Homes Could Improve Performance

Cross-national and U.S.-specific studies find an association between

access to comprehensive primary care and both better health outcomes

and lower medical costs. In light of such evidence, a movement has

emerged to transform primary care practices into " medical homes " that

provide an array of patient services in an efficient manner.

To determine if respondents had a medical home, the survey asked if

they had a regular doctor or source of primary care; if their provider

had information about their medical history; if their provider could

be contacted by phone during office hours; and if the provider

coordinated their care.

According to these criteria, only about half of adults in all seven

countries have medical homes. In each country, patients with medical

homes reported more positive care experiences than those who did not,

including more time spent with their doctors and greater involvement

in care decisions.

In the U.S., the uninsured were at high risk of missing such a

connection to the health system: just 26 percent of uninsured adults

under age 65 had a medical home, versus 53 percent of the insured.

Those with a medical home were also much less likely to report medical

errors, receive conflicting information from different doctors, or

encounter coordination problems.

" Achieving better care coordination will likely require designs that

include a mix of formally integrated organizations, co-locating or

sharing services, and connecting through information systems, " the

authors conclude. " Developing medical home approaches offers the

potential to move toward higher performance. "