The U.S. compared to other nations health care systems

This is a copied article from Nurse Connect by Jennifer Decker Arevalo.

I found this to be very balanced in it's presentation and facts. I believe it better to show the article in its entirety rather than excerpts.

This article supports my position that we are in need of reform in the US. The money we spend is not providing the care we deserve or have paid for. We are getting ripped off and should demand more. The world has provided us templets to adopt and creat a fair and effective health care system. Get away from the idea of adopting one system from another nation but the idea that we can take the best pieces from the other nations of the world to provide our citizens the best in the world. We must however take profit out of the equation our we will fail. Our goal should be to be fiscaly balanced and to provide the best care.

I hope you read the entire article below and think about why we rank so poorly when compared to other nations despite the fact that we pay twice as much per patient as any other country.

Review by Nurse Advocate.

Article by:
Jennifer Decker Arevalo, MA, contributor

When it comes to issues, such as affordability, access, care coordination and patient safety how does the U.S. stack up against other countries? Not so good, according to the Commonwealth Fund's 10th International Health Policy Survey released in October 2007.
Results from a Harris Interactive survey of 12,000 adults in Australia, Canada, Germany, New Zealand, the United Kingdom, the United States and for the first time, the Netherlands, were published as a Health Affairs Web Exclusive, entitled Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries.

Thirty-four percent of American adults indicated that the U.S. health care system needed to be rebuilt completely; this rate was higher than in any of the other six countries. Although there is no perfect health care system, much can be learned from the innovations and strengths of other countries and then considered for transferability to the U.S.
Affordability

According to senior vice president for Research and Evaluation and study co-author, Cathy Schoen, in the Commonwealth Fund’s website presentation, “U.S. adults are the most likely to go without care because of costs.”

Thirty-seven percent reported that they skipped medications, did not visit a doctor when they got sick or did not get recommended care because of financial reasons, compared to people from Canada, the Netherlands and the U.K., who were the least likely to skip care because they could not afford it. This may directly correlate to the 47 million Americans who lack health insurance coverage, unlike citizens of the other six countries who have some type of universal health coverage.

“In the U.S., both the insured and uninsured population reported out-of-pocket medical costs as high as $1,000,” said Schoen in the web cast. “Such high out-of-pocket expenses were rare in other countries.”
Only five and four percent of adults in the Netherlands and the U.K., respectively, paid over $1,000 in the past year compared to 30 percent of Americans, 19 percent of Australians and 12 percent of Canadians.
Nearly one-fifth (19 percent) of U.S. adults had trouble paying medical bills; this was more than double the rate of the next highest country.
Access

Schoen also stated in the website presentation that, “US and Canadian adults were the least likely to report rapid access to seeing a doctor in their community when they got sick.”
For same day appointments, 30 percent of Americans and 22 percent of Canadians had quick access, compared to 50 percent or more of Germans, Dutch and New Zealanders. In the U.S., Canada and Australia, over two-thirds of those surveyed reported difficulty getting care on nights, weekends or holidays.
“The Netherlands reported the least difficulty in getting after hours care,” added Schoen, most probably due to nurses and physicians who staff phone banks to provide assistance.
Care Coordination

Across all seven countries, only 50 to 60 percent of adults had access to a “medical home,” as determined by the following criteria: the physicians and staff knew a patient’s medical history, were available by phone during office hours and coordinated a patient’s care with other providers.

“The vast majority reported having a regular doctor and source of primary care where the staff knew information about their medical history,” said Schoen. “However, this percentage dropped off and varied by country when asked about access, that is how easy and quickly it was to get in. It dropped off even more when asked about coordination of care.”
“In all of the countries, patients with a medical home were the least likely to report problems with coordination of care and the most likely to report that information had flowed well and that their primary care physician had helped them to find the right specialist,” continued Schoen in the web cast.

However, for patients without medical homes, 23 percent of U.S. adults stated that either test results were unavailable at the appointment time or doctors ordered duplicate tests; 19 percent of Germans and 18 percent of Australians reported similar problems.
Across all seven countries, patients in medical homes had more: positive care experiences, time spent with their doctor, and involvement in their care decision.
Patient-centered care is a key element of medical homes. “Across all countries, three out of four patients with a medical home said their doctor provided these key elements of patient-centered care,” said vice president and director of International Program in Health Policy and Practice and study co-author, Robin Osborn, during the website presentation. “This was 20 to 30 percent higher than for those without a medical home.”

“It is critical for patients with chronic medical conditions to have a medical home, as they see multiple providers, take multiple medications, are at higher risk for hospital or emergency room admissions and are at greatest risk for poor handoffs between providers and settings of care,” continued Osborn. “This is the most vulnerable population in the health care system; vulnerable to system shortfalls in coordination of care.”

Patients with medical homes were less likely to report medical errors and the study authors believe that regardless of the type of health system patients have, medical homes improve patient safety and satisfaction, as well as efficiency and care coordination.
Patient Safety

Out of all seven countries, adults in the U.S. reported the highest rates of lab test errors and some of the highest rates of medical or medication errors. Patients with multiple doctors or chronic illnesses experienced most of the reported errors, across the board.
“Combining medical and medication errors, as well as diagnostic test errors, one in five patients in Australia and the U.S. experienced an adverse event,” said Osborn. “This is stunning given that it was a general population sample. As you might expect, the rates went up dramatically with patients’ medical complexity.”

Thirty-two percent of U.S. patients with two or more chronic conditions reported a medical, medication or lab test error in the past two years, compared with 28 percent of patients in Canada, 26 percent in Australia and fewer patients in the other countries. Among adults with multiple chronic conditions, error rates were lowest in Germany, at 16 percent, according to the study authors.

“Country patterns reflect striking differences in policy,” summarized Osborn. “Universal coverage matters for access, quality and equity, as does benefit design. Across all seven countries, the survey underscored the pressing need to develop more system integration. Most compelling, there was overwhelmingly strong public support for designing the health care system around the medical home.”