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Studies Find Disparities in Health Care Between U.S., Other Nations

APRIL 4, 2006 -- Despite the perception that the U.S. health care system is the best in the world, studies released Tuesday conclude that Americans are not getting their money's worth.

The first of two reports from the Commonwealth Fund found that the U.S. health care system performed poorly compared with other countries in terms of providing care equitably, safely, efficiently, or in a patient-centered manner. The second study concluded that U.S. adults with below-average incomes fare worse than their counterparts in four other countries.

While the U.S. system scored well on effectiveness of care—in particular preventive care—there are wide disparities based on income, according to patient surveys.

"The U.S. is far from being the best performing system in the world," Donald Berwick of the Harvard School of Public Health said in analyzing the studies' findings.

Commonwealth Fund President Karen Davis said America's "fragmented health care system and a lack of a strong primary care foundation show up in performance gaps" throughout the studies, with particularly negative results for patients vulnerable due to poor health or lower incomes.

Contrasting the experiences of patients in the U.S. with those in other countries "provides evidence that it is possible to provide care that is more efficient, effective, safe, patient-centered, and equitable," Davis said.

Robert B. Helms, resident scholar and director of Health Policy Studies at the American Enterprise Institute, said that while "there are lots of things that are inefficient about the U.S. health care system, whether they're more or less inefficient than in other countries is a difficult thing (to judge). . . . This is more of an opinion survey versus hard evidence on medical outcomes."

The Commonwealth studies found that when ranked against adults' health care experiences in Australia, Canada, Germany, New Zealand, and the United Kingdom, sicker adults in the United States have the highest rate of receiving wrong medications or doses of medicine or experiencing a medical mistake in the previous two years.

German and U.S. patients with health problems said they had the least difficulty waiting to see a specialist or have elective or non-emergency surgery, but both Americans and Canadians reported they were more likely to wait six days or more for an appointment with a doctor or had trouble getting care on nights and weekends.

Sicker adults in the United States more often reported that they visited the emergency room for a condition that could have been treated by a regular doctor had one been available, and that their medical records or test results failed to reach their doctor's office in time for appointments.

The U.S. also ranked last among the six countries in terms of equity in the health care system, while the United Kingdom ranked first with no or negligible differences in terms of patients' access to care by income, researchers found.

American adults with below-average incomes had the worst experiences on measures of primary care access, coordination, and doctor–patient relationships, according to the studies.

"These surveys reflect that no one in the U.S. is benefiting . . . from the health care system as a whole," said Andrew Bindman of the University of California at San Francisco.

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