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U.S. Health System Not Measuring Up

The United States spends more than twice as much as some other industrialized countries on health care. Yet, based on reports from patients, the U.S. health system does not perform as well as systems in several other countries in terms of the safety, efficiency, equity, and "patient-centeredness" of the care provided.

So find two new analyses of patients' health care experiences in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. The findings are based on a 2004 survey of primary care experiences in five countries and a 2005 survey of patients with health problems in six countries. The authors of the analyses use a framework created by the Institute of Medicine to evaluate the quality of health care systems.

Both studies find that the U.S. ranks last on patient safety, patient-centeredness, efficiency, and equity, and third on timeliness, compared with adults in the other nations surveyed. The U.S. performed best on delivering preventive care services, one of the indicators of health care quality.

Key findings from Mirror, Mirror, on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens include:

  • Patient safety: The U.S. ranks last on patients experiencing a lab test error, including wrong tests or delays in being notified about abnormal results.
  • Effectiveness: The U.S. ranks first on provision of preventive services such as pap tests, mammograms, and counseling on diet and exercise. However, it ranks last on patients not filling a prescription, skipping a recommended test, treatment, or follow-up, or not visiting a doctor when needed due to cost.
  • Patient-centeredness: The U.S. ranks last on patients leaving a doctor's appointment without getting important questions answered.
  • Timeliness: The U.S. ranks last on difficulty of getting needed care on nights or weekends; Australia also ranks low on this measure. The U.S. and Germany had the shortest waiting times for elective/non-emergency surgery.
  • Efficiency: The U.S. ranks last on visiting the emergency room for a condition that could have been treated by a regular doctor.
  • Equity: The U.S. ranks last on disparities between below- and above-average income groups regarding not filling a prescription or skipping medication doses due to cost.

"Our fragmented health care system and lack of a strong primary care foundation show up in performance gaps throughout the studies," says Fund President Karen Davis, the report's lead author.

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In the second report, The U.S. Health Care Divide: Disparities in Primary Care Experiences by Income, Phuong Huynh, associate director of the Fund's International Health Policy program, reports with colleagues the greater likelihood of low-income Americans to have negative experiences with their health care compared with low-income patients in the other countries surveyed.

In the U.S., there were significant disparities between below- and above-average-income patients on 21 of 30 measures of primary care access, coordination, and doctor–patient relationships. U.K. patients had the most equitable experiences. Income-related disparities were also relatively rare in Australia, Canada, and New Zealand.

"These patient reports reveal a health divide, with negative consequences for the health and productivity of our workforce as well as for modest and lower-income families," says Fund Senior Vice President Cathy Schoen, a coauthor of the study. "The nation stands to gain if we could provide more timely and coordinated access to care with financial protection."

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