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Study: Care Abroad Cheaper, Faster, On the Whole No Better

NOVEMBER 4, 2005 -- Americans are much likelier to skip care because of costs and to get hit with high out-of-pocket expenses than are the British, Canadians, Australians, Germans, and New Zealanders, according to a report released Thursday by the policy journal Health Affairs. The survey was conducted by Harris Interactive for The Commonwealth Fund, a nonpartisan think tank.

But the study shied away from concluding that any one of the countries had the best or worse health care system overall, noting that all six suffered from poorly coordinated care, medical errors, and faulty medical management of chronic diseases.

The countries of study were chosen for the survey because of their participation in an ongoing health symposium organized by The Commonwealth Fund.

The findings revealed a stark contrast between out-of-pocket spending in the United Kingdom and the United States. In the United Kingdom, 13 percent of adults reported foregoing at least one of the following in the past year because of costs: prescription drugs, a trip to the doctor when ill, testing, treatment or follow-up care. The United States had the highest percentage of adults who skipped care—51 percent—followed by Germany at 38 percent.

Sixty-five percent of Britons said they had no out-of-pocket care costs in the past year, compared with 15 percent of Americans. Thirty-four percent of Americans reported out-of-pocket health spending exceeding $1,000 in the past year, compared with 4 percent of Britons.

The United States also had the highest rate of patients reporting "coordination of care" problems, the study found. One-third of U.S. respondents said within the past two years, either the test results or records were not available at the time of a doctor's appointment, or that a doctor had ordered a test that had already been done.

But medical error rates and care coordination problems were high in all the countries. Each country could "gain through strategies to improve the quality and efficiency of care, such as implementing modern information technology systems, supporting patient engagement in care, and improving management of chronic conditions," said Karen Davis, president of The Commonwealth Fund, which funded the study.

Majorities of patients in Germany, New Zealand and the United Kingdom reported "easy" access to care at night, on weekends or on holidays. Most Americans, Australians, and Canadians said it was difficult to get after-hours care.

Most patients in New Zealand and Germany could get same-day appointments, compared with 30 percent of U.S. patients. But only 8 percent of Americans reported waits of four months or more for non-emergency surgery, while 41 percent of Britons did so. Seven percent of American adults who had been hospitalized in the past two years reported developing an infection while in the hospital, compared with 10 percent of adults in the United Kingdom and 3 percent of those in Germany.

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