When it comes to paying for healthcare, the United States—when compared with 10 other industrialized countries—tops the list as having the highest spending per capita ($7,290), while lagging behind those nations in access, quality, and use of health information technology, according to the Commonwealth Fund's 12th annual international health policy survey.
The spending per capita was 50% more than the next highest country, Norway ($4,762), and triple the rate of the lowest country compared with in the study, New Zealand ($2,510), according to the survey that appears Thursday in an online issue of Health Affairs. More than 10,000 primary care physicians were surveyed this year in the countries that also include: Australia, Canada, France, Germany, Italy, the Netherlands, Sweden, and the United Kingdom.
"An overriding message of this survey ... is that access barriers, lack of information, inadequate financial support for preventive and chronic care undermine primary care doctors' efforts to provide timely high quality care," said Karen Davis, the Commonwealth Fund's president, at a telebriefing discussing the findings. This puts "the U.S. far behind what other countries are achieving."
"The concept of the patient-centered chronic care model using teams [and] engaging patients to help prevent complications originated in the U.S. But we find such efforts are spreading faster in other countries," said Commonwealth Fund Senior Vice President Cathy Schoen, a lead author of the article. "We need to close the performance gap for the health of the nation."
Among the areas examined in the survey are:
Access and Barriers to Care. More than half of American physicians (58%) reported their patients had difficulties paying for medications or other out of pocket costs, compared to between 5% and 37% in the other countries.
U.S. physicians also were four times or more as likely as physicians in some other countries—Australia, Netherlands, Sweden, and the U.K.—to report major problems with the time they or their staffs spent in getting patients needed medication or treatment because of insurance coverage restrictions.
After hours care outside the emergency room. Many American primary care physicians (71%) said they had no arrangement for access to care after normal office hours—except for directing patients to a hospital emergency room. This was a drop from 40% in the 2006 international health policy survey, Schoen said.
On the other hand, nearly all physicians in the Netherlands (97%), and many in New Zealand (89%) and the U.K (89%) report after-hour provision, as do more than three of four doctors in France (78%) and Italy (77%).
Health information technology. While about half (46%) of U.S. primary care physicians reported using electronic medical records (EMR)—up from 28% in 2006—American primary care practices, along with those in Canada, continued to lag behind other leading countries. EMRs were found in nearly all practices in the Netherlands (99%), New Zealand (97%), the U.K. (96%), Australia (95%), Italy (94%), Norway (97%), and Sweden (94%).
Use of care teams and systems to care for patients with chronic Illness. Teams that include health professionals, such as nurses, served an important role in managing care—especially for chronic conditions. The survey found that the use of teams was widespread in Sweden (98%), the U.K, (98%), the Netherlands (91%), Australia (88%), New Zealand (88%), Germany (73%), and Norway (73%). The use of teams was less frequent in the U.S. (59%), Canada (52%), and France (11%) based on physician reports.
Tracking medical errors. The study found that half or more primary care physicians in Canada, France, Germany, Italy and the Netherlands report not yet having a process to identify "adverse events" and take action. About 20% of American primary care physicians said they have a process that works well to identify risks and take follow up actions, while a third said they have no process.
Financial incentives to improve quality. Every country in the survey used financial incentives to improve primary care, preventive care, or disease management. However, primary care physicians in the U.S. were among the least likely to report that they received financial incentives for quality improvement efforts, such as bonuses for achieving high patient satisfaction ratings or managing patients with chronic disease or complex needs.