Patients Report Dissatisfaction With Care

Survey of five industrial nations finds Americans most unhappy

THURSDAY, Oct. 28, 2004 (HealthDayNews) -- A survey of patients in five of the world's top industrialized nations finds wide variations in primary care quality and access -- and considerable dissatisfaction with care, especially in the United States.

"The survey indicates shortfalls in accessibility, coordination, safety, and patient-centered care," said Cathy Schoen, lead author of the report and a vice president for health policy, research, and evaluation at The Commonwealth Fund.

But identifying the problem is often the first step toward solving it, others pointed out.

"This is a wonderful tool and gift that's been given to us," said Dr. Andrew Bindman, associate professor of medicine, epidemiology, and biostatistics at the University of California, San Francisco.

Both Schoen and Bindman spoke Thursday at a news briefing in Washington, D.C., to unveil the survey results; the session was attended by health ministers from seven countries. The findings also appear in the Oct. 28 online edition of the journal Health Affairs.

Primary care can be considered a bellwether for how well the overall health-care system is doing. "Primary care is instrumental to country performance, and helps countries integrate complex or multiple sites of care," Schoen said.

The report, titled Primary Care and Health System Performance: Adults' Experiences in Five Countries, is based on the 2004 Commonwealth Fund International Health Policy Survey, which polled 1,400 adults in each of the five nations -- Australia, Canada, New Zealand, the United Kingdom, and the United States -- between March and May 2004. The report is the seventh in a series of annual international surveys.

Respondents in the United States were most negative in their overall views of primary care, while respondents in the United Kingdom were the least negative, echoing previous findings. One-third of U.S. adults called for rebuilding the health-care system. Views in New Zealand and Canada have grown increasingly positive over the past six years, with fewer calls to rebuild. The mood in Australia, meanwhile, has fluctuated. Still, the majority in each of the nations favored major reform, with only a minority indicating they were "very confident" they would get high-quality and safe medical care when they needed it.

"In no country is the majority of patients satisfied," Schoen said. "Most indicate a need for substantial reform."

Patients in the United States and Canada reported the most difficulty getting same-day appointments when they were sick, and reported waits of six days or more. Not surprisingly, this lack of access translated into higher use of emergency rooms for non-emergencies in both countries.

While about half of patients rated their emergency-room experiences as excellent or very good, sizable proportions in all five countries said they had waits of two or more hours before being treated.

Perhaps more disturbing, up to 15 percent of patients in each country reported getting incorrect test results or delays in being notified of abnormal results. The problem was most acute in the United States.

"This is a missed opportunity for engaging patients in their own care," said Robin Osborn, a report co-author and vice president and director of the Commonwealth Fund's International Program in Health Policy and Practice. "This finding points to other system failures that may have serious consequences in terms of coordination of care."

The United States had the best rates of preventive care, such as Pap tests and mammograms, but reported the most out-of-pocket medical costs.

One-fourth of U.S. respondents said they had paid more than $1,000 in out-of-pocket medical costs in the past year, compared to 4 percent to 14 percent in the other countries. Perhaps as a result of this, U.S. patients were also more likely to say they had gone without needed care because of cost issues, with two out of five reporting access problems related to cost.

"Cost affects access, and we see quite stark country differences that reflect insurance systems and the comprehensiveness of benefit packages," Schoen said. "The U.S. stands out as the most exposed to medical bills when seeking medical care, and the U.K. stands out as the most protected." Britons are covered under a nationwide health system run by the government.

Lower-income adults in all countries were more likely to forgo medical care, but the rates were again highest in the United States, with 57 percent saying they went without care vs. 12 percent in the United Kingdom.

The report also tracked communication and relationship issues between doctors and patients. Respondents in all nations said the doctor spends enough time, although Australia and New Zealand had the highest ratings in patient-centered care. The United States scored last on this count.

While the report highlighted deficiencies, it also pointed to opportunities, the authors said. "These shortfalls are amenable to policy action, and we have a great opportunity," Osborn said.

More information

To see the full report, click on Health Affairs.

SOURCES: Oct. 28, 2004, news conference with Cathy Schoen, vice president for health policy, research, and evaluation, The Commonwealth Fund; Robin Osborn, vice president and director, International Program in Health Policy and Practice, The Commonwealth Fund; Andrew Bindman, M.D., associate professor of medicine, epidemiology and biostatistics, University of California, San Francisco; Oct. 28, 2004 Health Affairs online
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