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Major differences in health care access, safety, efficiency observed across eight countries, study shows; all countries have opportunities for improvement

Thursday, November 20 2008 | Comments

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What's This? Although there are vast differences in health care access, safety and efficiency in industrialized countries and all systems appear to need improvement, the United States often lags behind the rest, a new report demonstrates.

Harris Interactive Inc. and The Commonwealth Fund designed the survey, which was administered to approximately 7,500 individuals with at least one chronic illness (i.e., hypertension, heart disease, diabetes, arthritis, lung problems, cancer or depression) in eight countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United States) from March to May. Approximately 1,000 adults from the United States responded.

Most survey participants saw room for improvement in their own health systems, but the U.S. respondents were the most negative. In fact, 33 percent of the U.S. respondents said the health system should be rebuilt completely, while 46 percent claimed fundamental changes were needed. In both France and the Netherlands, more than 40 percent of the respondents said only minor changes were needed and that the system worked well. 

The perception of inefficient or wasteful care was most common in the U.S., French and German systems. Specifically, 46 percent of the U.S. patients and 43 percent of both the German and French patients versus 27 percent of the U.K. patients reported that physicians recommended treatment perceived to be of little/no value and/or that time was wasted because of the poor organization of medical care.

The data found that 54 percent of the U.S. respondents chose not to receive recommended care, not to fill prescriptions, skipped doses or decided not to visit the physician when sick because of costs. In comparison, 7 percent of the respondents in the Netherlands and 36 percent of the Australian respondents experienced any of these cost-related access problems.

Furthermore, while 81 percent of the U.K. respondents had out-of-pocket expenses totaling less than $500 during the past year, 41 percent of the U.S. respondents reported more than $1,000 in out-of-pocket expenses.

Rates of the convenience and quickness of care varied. In terms of same- or next-day access to care, the Dutch and New Zealand residents were most likely to report this access, while the Canadian and U.S. residents were the least likely. Furthermore, the U.S. and Australian respondents were least likely to report it being "very or somewhat easy" to obtain after-hours care without going to the emergency department. During the past two years, 59 percent of the U.S. respondents and 64 percent of the Canadian respondents visited the emergency department, often for a condition that could have been treated by a regular physician.

Thirty-four percent of the U.S. respondents versus 14 percent of the Dutch respondents reported that test results/medical records were not available at the time of a scheduled appointment and/or that their physicians ordered an unnecessary/duplicate test. Deficiencies in transitional care during hospital discharge were also common in each country, although the United States did comparatively well. From 50 percent (Canada and the United Kingdom) to 71 percent (France) of the patients in all countries but the United States reported some type of discharge gap, such as not receiving a written plan for care following discharge. In the United States, the rate was only 38 percent.

Insurance played a role in health care rankings for the United States, but not for the other systems, which had comprehensive minimum benefits and universal coverage. In Canada, the Netherlands and the United Kingdom, there was no cost sharing for primary care. Under France's insurance system, patients with chronic illnesses were protected from coinsurance. At the time of the U.S. survey, 29 percent of the American participants lacked insurance. Those who were without insurance were found to be at a higher risk for access, coordination and safety problems. Still, even the insured fared worse than their counterparts in other countries.

Overall, from 14 percent (France) to 23 percent (United States) reported either a medical mistake in treatment or a mistake in medication, or both events, during the past two years.

"As countries seek to innovate with goals of better health and value, the international community has opportunities to learn from negative as well as positive experiences," the researchers wrote. "In an era of rising rates of chronic disease, public health initiatives as well as system innovations will be essential to enable all patients to achieve healthier, longer and more productive lives."

Complete data were published as a Nov. 13 Web exclusive by the journal Health Affairs.

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