Doctor Survey: US Health System Lags on Access, Quality

Posted by: Cathy Arnst on November 05

Another survey out today blows holes in the oft-repeated claim that the U.S. has the best health care in the world. The survey, of 10,000 primary care doctors in 11 wealthy nations, found that American patients are far more likely to lack access to medical treatment because of insurance restrictions or cost, despite the fact that the U.S. spends twice as much per capita on health care as any other developed nation.

All told, 58% of U.S. doctors said their patients often have difficulty paying for medications and other medical care, compared with 5% to 37% in the other countries surveyed. In addition, U.S. doctors are less likely than those in the other countries surveyed to offer care outside of regular office hours, and are far, far behind several other nations in the use of electronic health records that could reduce errors.

The survey, conducted by the nonprofit Commonwealth Fund, questioned 10,000 doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Britain and the U.S. between February and July of this year.

The U.S. spent $7,290 per person on health care in 2007 — more than double the expenditures by Britain, France and Germany — with no meaningful edge in the quality of care on a number of measures, according to the Organization for Economic Cooperation and Development. The UN ranks France the best in the world for health care.

The Commonwealth Fund concludes:

Despite spending more on health care than other countries, an international survey finds the United States lags behind on important measures of access, quality, and use of health information technology. There are opportunities to learn as other countries move ahead to enhance the primary care foundations of their health care systems.

Other findings from the survey:

Insurance restrictions: 48% of U.S. physicians reported major problems with the time they or their staff spend getting patients needed medication or treatment due to insurance coverage restrictions. That's four times or more as high as physicians in Australia, Netherlands, Sweden and Britain.

Waits for specialist: 28% of U.S. doctors report their patients often face long waits to see a specialist, higher than Britain, where 22% of doctors report long waits, but lower than Australia (35%). Three-quarters of Canadian and Italian physicians reported long waits.

After-hours care: Just 29% of U.S. doctors report any arrangement for patients to see a doctor or nurse after hours, a drop from 40% in a 2006 Commonwealth Fund survey. That means their patients are more likely to seek emergency room care on nights and weekends. Nearly all doctors in the Netherlands (97%), and large majorities in New Zealand (89%) and Britain (89%) report after-hour provision, as do more than three of four doctors in France (78%) and Italy (77%).

Electronic records: Nearly half (46%) of U.S. primary care doctors report using electronic medical records, up from 28% in 2006. But they lag well behind other leading countries. Electronic records are nearly universal in the Netherlands (99%), New Zealand (97%), Britain (96%), Australia (95%), Italy (94%), Norway (97%), and Sweden (94%).

Financial Incentives: Every country in the survey, to some degree, uses financial incentives to improve primary care, preventive care, or disease management. But only one-third of U.S. primary care physicians reported receiving such incentives, and rates were also low in Sweden and Norway. In contrast, significant majorities of doctors in the U.K (89%), the Netherlands (81%), New Zealand (80%), Italy (70%) and Australia (65%) report some type of extra financial incentive or target support to improve primary care capacity.

Coordination of care: Teams that include health professionals such as nurses and dieticians are increasingly used to manage care for patients with chronic illness, such as diabetes. The survey found that the use of teams is widespread in Sweden (98%), Britain, (98%), the Netherlands (91%), Australia (88%), New Zealand (88%), Germany (73%) and Norway (73%). Use of teams was far less frequent in the United States (59%), Canada (52%), and France (11%).

The survey was conducted on behalf of Commonwealth by Harris Interactive, which surveyed the physicians by a combination of mail, phone and internet questions. The final study includes 1,016 primary care doctors in Australia, 1,401 in Canada, 502 in France, 715 in Germany, 844 in Italy, 614 in Netherlands, 500 in New Zealand, 774 in Norway, 1,450 in Sweden, 1,062 in Britian, and 1,442 in the U.S. It is published online at the website of the journal Health Affairs.