Is U.S. Health Care Really THAT Bad?

Is American health care that awful?  Listen to the pundits and it's easy to believe that other developed nations are blessed with 24-7 access to primary care, minimum out-of-pocket expenses and highly integrated electronic record systems and information sharing.

Cathy Schoen and colleagues from the Commonwealth Fund and Harris Interactive say it's not quite that simple.  While the U.S. system could be better and cheaper, there were some areas where is wasn't all that bad.

Their article was published in the December 12 issue of Health Affairs.

The authors conducted follow-up mail and phone interviews of primary care physicians from ten developed countries* who had previously participated in a 2009 quality survey.  Physicians were asked about topics that included their patients' access to care, use of health information technology (HIT) and satisfaction with medical practice. Sample sizes of interviewees from each country ranged from 500 to 2000 and response rates ranged from a low of 20% (Germany) to 48% (Netherlands).

Among the more interesting findings:

The majority of Dutch, French, German And Swiss docs are in clinics with 2 or fewer physicians.
86% of respondents from France said most patients can obtain same day access vs. 22% in Canada. The U.S. rate was 47%, which was higher than Norway and Australia.

The Netherlands (94%) and New Zealand (90%) led the way in access to after-hours care. The U.S. rate was the lowest at 34%.

59% of U.S. physicians said their patients had difficulty paying for health care.  At the same time, only 28% had long waits to see a specialist.  In Canada, the rates were 25% (payment) and 73% (specialists), respectively.  In Norway, 4% had difficulty paying but 60% had long waits for specialists.

Nearly all physicians in Australia, the Netherlands, New Zealand, Norway and the United Kingdom use electronic records.  The U.S. rate was 69%, while in Switzerland, Canada and France it's 41%, 56% and 67%, respectively.

The top four countries reporting that they had "engaged" a nurse case manager were the United Kingdom (78%), the Netherlands (73%), New Zealand (68%) and Switzerland (68%).  The rates in Canada, the U.S and Germany were 44%, 43% and 20%, respectively. 

Transfer of information about an emergency room visit or a hospital discharged occurred less than half the time in Australia, Canada, France, Germany, Switzerland, United States, Norway and the United Kingdom.

DMCB takeaways:

If other developed nations are role models for the U.S., large clinic systems are not necessarily the way to go.

There may be an inverse correlation between patients' ability to pay for care and access to specialist care.

The U.S. is in the middle of the pack when it comes to EHR use.

Nurse-led care manage is not uncommon overseas and a 43% rate in the U.S. is higher than generally realized.

Timely transmittal of emergency room and hospital discharge information seems to be a problem everywhere.


*Australia, Canada, France, Germany, Switzerland, United States, Netherlands, New Zealand, Norway and the United Kingdom