U.S. Lagging in Heath Care Access, Quality, and Health Information Technology

Fifty-eight percent of primary care doctors in the U.S. report their patients often have difficulty paying for medications and care, and half of U.S. doctors spend substantial time dealing with restrictions insurance companies place on their patients' care, according to findings from the 2009 Commonwealth Fund International Health Policy Survey published online today in the journal Health Affairs. The responses of U.S. doctors also stand out in the 11-country survey because the vast majority (69%) report that their practices do not have provisions for after-hours care, forcing patients to seek care in emergency departments. U.S. doctors were also far less likely to use health information technology that helps reduce errors and improve care-only 46 percent of U.S. doctors use electronic medical records compared to 99 percent of doctors in the Netherlands and 97 percent of doctors in New Zealand and Norway.

Many of the areas in which the U.S. lags would be addressed by proposed health reform legislation currently under consideration in Congress. "We spend far more than any of the other countries in the survey, yet a majority of U.S. primary care doctors say their patients often can't afford care, and a wide majority of primary care physicians don't have advanced computer systems to access patient test results, anticipate and avoid medication errors, or support care for chronically ill patients," said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article. "The patient-centered chronic care model originated in the U.S., yet other countries are moving forward faster to support care teams including nurses, spending time with patients, and assuring access to after-hours. The study underscores the pressing need for national reforms to close the performance gap to improve outcomes and reduce costs."

The survey of more than 10,000 primary care physicians in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States describes a U.S. primary care system that is under stress and highlights areas where the U.S. can learn from other countries. Notably, the U.S. could look to improve by using financial incentives to improve quality and efficiency, expanding access to health care and simplifying insurance, expanding the use of health information technology to prevent medical errors, and using a medical home approach to primary care where patients have options for care at any time of day or night, teams of health care providers to manage conditions, and continuity of care.

"Access barriers, lack of information, and inadequate financial support for preventive and chronic care undermine primary care doctors' efforts to provide timely, high quality care and put the U.S. far behind what many other countries are able to achieve," said Commonwealth Fund President Karen Davis. "Our weak primary care system puts patients at risk, and results in poorer health outcomes, and higher costs. The survey provides yet another reminder of the urgent need for reforms that make accessible, high-quality primary care a national priority."

Survey Highlights:

Access and Barriers to Care - More than half of U.S. physicians (58%) report their patients often have difficulty paying for medications or other out-of-pocket costs, compared to between 5 percent and 37 percent in the other countries.

U.S. physicians are also 4 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 staff spend getting patients needed medication or treatment due to insurance coverage restrictions. About half (48%) of U.S. physicians report this is a major problem, compared to just 6 percent in the U.K.

Twenty-eight percent of U.S. doctors report their patients often face long waits to see a specialist-a rate similar to that reported by