Primary Care And Health System Performance: Adults’ Experiences In Five Countries
By Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Karen Davis, Kinga Zapert, and Jordon Peugh
Health Affairs – October 28, 2004
This paper reports on a 2004 survey of primary care experiences among adults in Australia, Canada, New Zealand, the United Kingdom, and the United States.
Across multiple dimensions of care, the United States stands out for its relatively poor performance. With the exception of preventive measures, the U.S. primary care system ranked either last or significantly lower than the leaders on almost all dimensions of patient-centered care: access, coordination, and physician-patient experiences. These findings stand in stark contrast to U.S. spending rates that outstrip those of the rest of the world. The performance in other countries indicates that it is possible to do better. However, moving to a higher-performing health care system is likely to require system redesign and innovative policies.
The challenge in all five countries is finding the right combination to improve primary care and move to a high-performance care system. The lack of a strong patient-centered or primary care orientation in the United States emerges throughout the survey and underscores the importance of examining international strategies that could be adapted and instituted at home.
The full report:
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.487
The Commonwealth Fund release:
http://www.cmwf.org/publications/publications_show.htm?doc_id=245178
Comment: Never again can you allow to stand unchallenged the statement that the United States has the greatest health care system on earth. We may have the most expensive system, but it’s a lousy system.
This article does reconfirm the well documented concept that the United States lacks an adequate primary care infrastructure. We certainly have the funds that could ensure stable, timely, and coordinated access to care for everyone. But we can do that only if we establish a system that will ensure that our health care dollars are used to support incentives that would strengthen the primary care base. Our current market based system establishes preferential incentives for high priced, high tech services that are selected based more on marketing successes rather than on improved health care outcomes.
Single payer funding alone won’t solve all of the problems in health care. But it would certainly set us off in the right direction by giving us control of our health care budget. Without such control, mediocrity will continue to be the best that we can ever hope for.