In all five countries, the survey found shortfalls in the delivery of safe, effective, timely, patient-centered, efficient and equitable care, with substantial variation among the nations. Patients in each country experienced problems accessing care when sick, with U.S. and Canadian adults the least likely to be able to see a doctor the same day and the most likely to use emergency rooms for non-emergency care. Up to 15 percent of patients who had a lab test in the past two years reported getting incorrect test results or a delay in receiving abnormal test results. On issues of doctor-patient communication, one of three or more respondents across the countries said their doctor does not tell them about treatment choices or ask for their opinion. U.S. patients were the most likely to have high out-of-pocket costs and to forgo care because of costs.

In reacting to the findings, Andrew Bindman, M.D., of the University of California, San Francisco, emphasized the critical role of a strong primary care infrastructure in underpinning a high-performing health care system.

In a policy roundtable discussion, health ministers or their designates from Australia, Canada, Germany, Mexico, New Zealand, the U.K., and the U.S. had a candid exchange of views on such issues as health care quality, health system sustainability, and priorities. Senior policymakers and scholars then introduced national approaches to redesigning and improving the delivery of primary health care, ensuring same-day appointments, coordinating care for chronically ill patients through learning collaboratives, and implementing electronic health records.

The last day of the symposium—which focused on opportunities for the U.S. to learn from international innovations—was held on Capitol Hill, with the cooperation of the Alliance for Health Reform. As panel reactors, congressional staff commented on the relevance and potential transferability of Germany's disease management program, New Zealand's no-fault medical malpractice system, and the U.K.'s use of financial incentives to improve quality of care.

Commissioned papers presented at the symposium will be submitted for consideration as part of a series of Health Affairs international Web Exclusive articles. The symposium is cosponsored by the journal in collaboration with founding editor John K. Iglehart.