New York City, May 6, 2003—A Commonwealth Fund/Harvard/Harris Interactive survey of patients with health problems in the United States and four other industrialized countries reveals disturbingly high rates of medical errors, lack of coordination in patient care, poor communication between doctors and patients, and barriers when accessing care. The findings, published today in a Health Affairs article, point to widespread error, inefficiency, and missed opportunities in the health systems of Australia, Canada, New Zealand, the United Kingdom, and the U.S. The authors suggest that reforms targeted to populations with health problems could reap system-wide improved quality and potential cost savings.
"Frequent error, miscommunication, and wasted resources from duplicate tests, delays, and conflicting information are common problems in the health systems of all the countries studied," said Karen Davis, president of The Commonwealth Fund. "These findings highlight serious problems with quality of care and wasted resources, and make a compelling case for implementing interventions that we know will make a difference, including electronic medical records and computerized systems for physician ordering of prescription drugs."
The article, "Common Concerns Amid Diverse Systems: Health Care Experiences in Five Countries," discusses findings from a survey of the health care experiences of patients age 18 or older who reported fair or poor health, a serious illness, injury, or disability, or major surgery or hospitalization for something other than a normal delivery in the past two years. It was prepared by health policy analysts Robert J. Blendon and Catherine DesRoches of the Harvard School of Public New Health, Cathy Schoen and Robin Osborn of The Commonwealth Fund, and Kinga Zapert of Harris Interactive.
Medication and Medical Errors
One-fourth of adults with health problems in Australia, Canada, New Zealand, and the U.S. and one-fifth of this population in the U.K., reported they had experienced a medication error or medical error in the past two years. Among those reporting a medication or medical error, majorities in every country said the error caused serious health consequences. As a result, among all respondents, the percent reporting an error that caused serious health problems was 13% in Australia, 15% in Canada, 14% in New Zealand, 9% in the United Kingdom, and 18% in the U.S.
Care Coordination Problems
Lack of coordination of care was a problem for significant proportions of patients. One of five sicker adults in Canada (20%) and the U.S. (22%) reported being sent for duplicate tests by different health professionals, as did one of six in New Zealand (17%) and one of eight in Australia (13%) and the U.K. (13%). In all five countries, about half the individuals said they had to repeat their health history to multiple health professionals (US=57%, CAN=50%, AUS=49%, UK=49%, NZ=47%).
One-fourth of U.S. (25%) and U.K. (23%) respondents, one-fifth (19%) of Canadian respondents, and one of six in Australia (14%) and New Zealand (16%) said that their medical records did not reach a doctor's office in time for an appointment. About one-fourth of respondents in Australia, Canada, New Zealand, and the U.S, and one-fifth in the U.K. (19%), reported receiving conflicting information from different health professionals.
U.S. patients were more likely than those in the other countries to report communication difficulties with their physicians. Three of 10 respondents in the U.S. (31%) said they left a doctor's office without getting important questions answered, compared with one of five in Australia (21%), New Zealand (20%), and the U.K. (19%), and one of four Canadians (25%). Two of five (39%) U.S. respondents said they did not follow a doctor's advice, compared with three of 10 in Australia (31%) and Canada (31%), one of four in New Zealand (27%), and one of five (21%) in the U.K. The primary reasons given for not following a doctor's advice was that they did not agree with the doctor's recommendations or the advice was too difficult to follow.
A surprisingly high proportion of adults with health problems—half of those in Australia, Canada, New Zealand, and the U.S., two-thirds in the U.K.—reported their regular doctor does not ask for their ideas and opinions about treatment and care. From one-fifth to one-quarter of respondents in four countries, and two of five in the U.K., said their doctor did not make clear specific goals for treatment.
Half of respondents in four countries (CAN=55%, AUS=54%, NZ=54%, US=51%) and two-thirds (66%) of U.K adults with health problems said their physician had not discussed the emotional burden of coping with their condition.
Underscoring further concerns about both quality of care and ensuring that health expenditures are actually benefiting patients, the survey found that more than one in six adults with health problems stopped taking prescription medications without their doctor's advice, because of the side effects (US=19%, CAN=17%, NZ and UK=16%, AUS=15%).
Access and Cost Problems
Not surprisingly, a higher proportion of U.S. respondents compared with the four other countries said they encountered problems accessing health care because of the cost-although cost did affect access to some extent in all the countries. In the U.S., one-third of adults with health problems did not fill a prescription (35%), and one-fourth did not get medical care (28%) or a recommended test, treatment, or follow-up (26%), due to cost.
Respondents in other countries also cited cost-related access problems: one-fifth of respondents in Australia (23%), Canada (19%), and New Zealand (20%) said they did not fill a prescription due to cost, although only 10 percent of U.K. respondents reported the same. One-fourth (26%) of adults with health problems in New Zealand said they did not get medical care because of cost, as did one of six (16%) Australian respondents. U.K. respondents were least likely to report access problems due to cost: 4 percent cited cost as the reason they did not get medical care, and 5 percent said it was the reason they did not get a recommended test, treatment, or follow-up.
About one of six (16%) U.S. adults with health problems said they skipped doses to make their medication last longer, while fewer than 10 percent of those in the other four countries reported skipping medication doses.