Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries
By Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Kinga Zapert, Jordan Peugh, Karen Davis
Health Affairs
November 3, 2005
This paper reports on a 2005 survey of sicker adults in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. Sizable shares of patients in all six countries report safety risks, poor care coordination, and deficiencies in care for chronic conditions. The United States often stands out for inefficient care and errors and is an outlier on access/cost barriers.
As found in past surveys, the United States is an outlier for financial burdens on patients and patients forgoing care because of costs. Half of sicker adults in the United States said that they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost. On each access/cost question, the U.S. rate was 1.5 to double the forgone care rates reported in the next-highest country.
Moreover, the percentage of U.S. sicker adults forgoing care because of costs was much higher on all three indicators compared with the 2002 survey of sicker adults. Despite these high rates of care forgone, one-third of U.S. patients spent more than $1,000 out of pocket in the past year, a level rare in the other countries. Insured and uninsured U.S. patients were about equally likely to report expenditures this high (34 percent insured and 32 percent uninsured).
Symptoms of inadequate insurance coverage and more fragmented care in the United States emerged throughout the survey. The United States outspends the other countries, spending 14.6 percent of national income compared with Germany’s 10.9 percent, Canada’s 9.6 percent, Australia’s 9.1 percent, New Zealand’s 8.5 percent, and the United Kingdom’s 7.7 percent. Yet the United States often ranks last or tied for last for safety, efficiency, and access.
With one-third of U.S. patients reporting medical, medication, or lab errors and a similar share citing duplicate tests or medical record delays, our findings indicate widespread performance deficiencies that put patients at risk and undermine care. Moreover, a recent study finds that the United States is not systematically a leader in clinical outcomes.
Confirming spending data from the Organization for Economic Cooperation and Development (OECD), the United States also stands out for its patient cost burdens, with consequences for access. U.S. physician visit rates are already low by OECD standards. To the extent that U.S. insurance continues to move toward higher front-end patient deductibles, these rates could go up, as increasing numbers of insured patients become “underinsured,” lacking access or adequate financial protection. Contrasts between the United States and Germany, in particular, indicate that it is possible to organize care and insurance to achieve timely access without queues, while ensuring that care is affordable at the point of service. There are clear opportunities for the United States to learn from other countries’ insurance systems.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.509v1
Release from The Commonwealth Fund:
http://www.cmwf.org/publications/publications_show.htm?doc_id=313012&#doc313012
Comment: This is yet another report that confirms that the United States does not have “the greatest health care system on earth,” even though we are paying enough such that we should have it. Our lowest ratings in these international comparisons stem from our fragmented system of funding care.
We can learn much from other countries’ insurance systems. Combining optimal insurance policies with our great resources should provide the first giant step toward providing us with what would truly be the greatest health care system on earth.