U.S. spends most, but health quality lags

Americans are more likely than people in 10 other countries to have trouble getting medical treatment because of insurance restrictions or cost, an international survey of primary care doctors released on Wednesday found.

While the United States spends more than twice as much as other developed countries on healthcare, it lags well behind in key measures of quality, the annual survey found.

Our weak primary care system puts patients at risk and results in poor health outcomes and higher costs, said Karen Davis, president of the Commonwealth Fund, a private health policy group that sponsored the survey.

The survey provides yet another reminder of the urgent need for reform that makes acceptable, high-quality care a national priority, Davis told a news briefing.

Other countries have solved problems the United States is still struggling to conquer, she said.

The survey of more than 10,000 primary care doctors in 11 developed countries -- Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom -- found problems in all of them.

In the United States, cost and access to care stood out as a major challenge for primary care doctors.

The majority of U.S. doctors -- some 58 percent -- say their patients often have difficulty paying for medications and other medical care, by far the highest rate in the survey, Cathy Schoen of the Commonwealth Fund, whose study appears in the journal Health Affairs, told the briefing.

Paying for healthcare was a problem in 5 to 37 percent of other countries surveyed.

Insurance restrictions, such as provisions to limit or control medication or treatment, are a major impediment for U.S. doctors, with half of 1,400 physicians surveyed saying the time they and their staff spend dealing with insurance companies is a major problem.

The survey from February to July 2009 was conducted by mail, online and by phone.

AFTER HOURS

It appears that U.S. doctors are adding staff to their offices that would not be typical of other countries just to cope with our complex, fragmented insurance system and advocate for their patients, Schoen said.

The survey also asked doctors if patients in their country could see a doctor after regular business hours without being forced to go to the emergency room.

Nearly all doctors surveyed from the Netherlands, New Zealand and the United Kingdom said this was offered, compared with just 29 percent of doctors in the United States -- which ranked lowest in the survey.

The vast majority say they have no arrangement at all, Schoen said, adding that the 29 percent figure is a drop from 40 percent reported in 2006.

By contrast, doctors in the United States and Britain were least likely to say their patients faced long waits to see a specialist, compared with Canadian and Italian doctors, who were most likely to say this was a problem.

The study also shows the United States and Canada trail other developed countries in the use of basic electronic medical records. Less than half of U.S. doctors (46 percent) say they have electronic medical records, and just 37 percent of doctors in Canada have them.

Electronic medical records are nearly universal in the Netherlands, New Zealand, the United Kingdom, Australia, Italy, Norway and Sweden.

The findings underscore the extent to which national policies matter, Schoen said.