Health care: High cost does not bring high quality

Despite spending more than twice as much as other developed countries, the United States still lags behind in terms of access and quality, an international survey said Wednesday.

Insurance restrictions and health care costs make US patients more likely than people in 10 other countries to struggle to receive treatment, according to the annual survey of over 10,000 primary care physicians.

“We spend far more than any of the other countries in the survey, yet a majority of US primary care doctors say their patients often can’t afford care,” said lead author Cathy Schoen, senior vice president of the Commonwealth Fund.

Some 58 percent of primary care doctors in the United States said their patients have trouble paying for care and medication, compared to five to 37 percent in the other countries.

The study, published in the journal Health Affairs, comes as US President Barack Obama faces a pitched and prolonged battle in Congress over his plans to reform the country’s health care system.

The United States is the only industrialized democracy that does not ensure that all of its citizens have health care coverage, with an estimated 36 million Americans uninsured.

Yet the country spent about 7,290 dollars per person in 2007 — more than double expenditures by Britain, France and Germany — with no meaningful edge in the quality of care as it lags behind in life expectancy and infant mortality, according to the Organization for Economic Cooperation and Development.

Half of US doctors were found to spend “substantial” time addressing restrictions insurance companies place on the care of their patients in the study.

“The survey provides yet another reminder of the urgent need for reforms that make accessible, high-quality primary care a national priority,” said Commonwealth Fund President Karen Davis.

US physicians are at least four times more likely than their counterparts in countries like Australia, the Netherlands, Sweden and Britain to report major problems with the time spent getting patients needed care or medication due to the restrictions, it said.

“The patient-centered chronic care model originated in the US, yet other countries are moving forward faster to support care teams including nurses, spending time with patients and assuring access to after-hours,” said Schoen.

Almost all doctors surveyed from Britain, the Netherlands and New Zealand said they had arrangements for patients to see a doctor after normal business hours without having to go to the emergency room, a far more costly undertaking.

But only 29 percent of US physicians — the lowest ranking in the study — said they offered such an arrangement.

“Our weak primary care system puts patients at risk, and results in poorer health outcomes, and higher costs,” warned Davis.

Most US primary care physicians also lack health information technology to access test results for their patients, help reduce medication errors and improve care, the study found.

Only 46 percent of US doctors were found to use electronic medical records, compared to 99 percent of their colleagues in the Netherlands and 97 percent in New Zealand and Norway.

Eleven developed countries — Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Britain and the United States — were surveyed for the study.

The survey was conducted by mail, phone and online from February to July 2009.