INTERNATIONAL/POLICY: Sick patients in six countries

No reader of THCB will be surprised that the cross-national series which the Commonwealth Fund has sponsored for several years now (and for which my old colleague and friend at Harris, Kinga Zapert has been running the surveys) continues to find that sick people here have it worse than sick people in other countries. Their latest work was published in Health Affairs yesterday and it’s called Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries. Here’s the press release if you don’t want to read the whole thing.

The headlines have been taken by the finding that patients in the US were more likely to say that they’d experienced a medical error (34% here versus between 30% and 22% elsewhere). But no one really has got the medical error situation under control, and it’s likely that patient reporting isn’t such a great measure of medical errors in reality. After all, Brent James has shown us that clinician reporting is a lousy guide to whether mistakes have been made. And in general all countries need to do better on care management of sick people, including treatment planning and clinician co-ordination.

But of course the study continues to find the the US is a real outlier when it comes to the financial impact on patients of being sick.

• Half of U.S. adults reported that they had gone without care because of costs in the past year• In contrast, just thirteen percent of U.K. adults reported not getting needed care because of cost• One-third of U.S. patients reported out-of-pocket expenses greater than $1,000 in the past year• U.K. patients were the most protected from high cost burdens, with two-thirds having no out-of-pocket expenses. The variations were notable given the study’s design focus on sicker adults with recent intensive use of medical care. (My emphasis)

And while we continue to hear reams of rubbish about the terrible impacts of waiting lists in Canada, none of the America-first crowd in Health Care seem too bothered by the confirmation that speedy access to primary care is none too good here, and ends up increasing emergency room use.

Access—including after-hours access—and waiting times to see a doctor when sick differed markedly across the countries:• Canadian and U.S. adults who needed medical care were the least likely to report fast access (same day) to doctors (30 percent or fewer of U.S. or Canadian patients) (My emphasis)• In contrast, majorities of patients in New Zealand (58 percent) and Germany (56 percent) reported that they were able to get same-day appointments, as did nearly half of patients in Australia (49 percent) and the United Kingdom (45 percent)• Majorities of patients in Germany (72 percent), New Zealand (70 percent), and the United Kingdom (57 percent) also reported easy after-hours (nights, weekends, or holidays) access to a doctor• In contrast, majorities of patients in the United States (60 percent), Australia (58 percent), and Canada (53 percent) said that it was very or somewhat difficult to get after-hours care• The four countries with comparatively more rapid access to physicians—Australia, Germany, New Zealand, and the United Kingdom—also had lower rates of emergency room use, with Germany having the lowest rates• One-fifth of Canadians and one-fourth of U.S. patients who reported going to the ER said that it was for a condition that could have been treated by their regular doctor if available. (My emphasis)

I know this is just piling on, but for the gazillionth time let me remind you that the biggest difference between the US and the rest of these countries is that they cover their entire populations and do it for remarkably less per head than we do. And in virtually no other country are people financially destroyed just because they are sick.

There’s an awful lot wrong with health care everywhere, but my guess is that if there’s one reason that foreigners are saying Vive La Difference, it’s that one.

The authors, though, find a few other ways to put the boot in:

In past patient surveys among the five English-speaking countries, the United States has stood out for having relatively short waiting times for specialized care. Based on patients’ reports in this study, Germany also provides rapid access to such care. Understanding how Germany has achieved access to physicians, after-hours care, and specialized care while spending much less than the United States spends as a percentage of national income could help inform U.S. policy.Symptoms of inadequate insurance coverage and more fragmented care in the United States emerged throughout the survey. The United States outspends the other countries, spending 14.6 percent of national income compared with Germany’s 10.9 percent, Canada’s 9.6 percent, Australia’s 9.1 percent, New Zealand’s 8.5 percent, and the United Kingdom’s 7.7 percent.Yet the United States often ranks last or tied for last for safety, efficiency, and access. With one-third of U.S. patients reporting medical, medication, or lab errors and a similar share citing duplicate tests or medical record delays, our findings indicate widespread performance deficiencies that put patients at risk and undermine care. Moreover, a recent study finds that the United States is not systematically a leader in clinical outcomes.Confirming spending data from the Organization for Economic Cooperation and Development (OECD), the United States also stands out for its patient cost burdens, with consequences for access.U.S. physician visit rates are already low by OECD standards.To the extent that U.S. insurance continues to move toward higher front-end patient deductibles, these rates could go up, as increasing numbers of insured patients become “underinsured,” lacking access or adequate financial protection.Contrasts between the United States and Germany, in particular, indicate that it is possible to organize care and insurance to achieve timely access without queues, while ensuring that care is affordable at the point of service. There are clear opportunities for the United States to learn from other countries’ insurance systems.

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12 replies »

  1. I think England is worse than the rest of Europe with dead women with breast cancer. I notice that when George Harrison was sick he came to the United States. Same with the King of Jordan.
    That would be because they are rich.

  2. Thank you for the compliment Matthew. Still trying to pass opinion polls off as hard facts again huh? Remember how bad John Kerry felt when the opinion polls were wrong and the voters picked President George W. Bush for four more years, with a manDate? I just hate to see you set yourself up for failure like that. That was no more than an opinion poll, admit it. I left a comment over there too, right under yours. I should have said, Who are you jivin’ with this cosmic debri, Matthew? Ask your so-called question again Matthew.

  3. Ron, you are getting closer and closer to the edge of reason…you may have to change your name to Bridgit Jones. I asked you a question about HSAs 6 months ago that you never answered because you can’t. And yes I agree with you about emplyer based health inurance terminating sick people. But unlike the insurance you sell, they let them have insurance in the first place. The insurance you sell IS a serious ethics violation.
    Meanwhile, the article you sent me to is more bunk, albeit from someone a little cleverer than you. See my comment over there. http://www.outsidethebeltway.com/archives/12552
    But well done on staying under 10 lines.

  4. Matthew I always answer direct questions. Remember you are the one who won’t answer any questions. Like, why do you support group-employer-based insurance terminating sick cancer patient after a very short COBRA, just because they cant work 30 hours per week? That is so deadly what you suggest but I do admit it’s still legal, for now. Think of the consumers for once in your life Matthew. Lucky you are not licensed to sell insurance because that is a SERIOUS ETHICS VIOLATION Matthew, have a heart.

  5. Matthew, I’ve read the “O Canada” piece, and I know that the Canadians fleeing to America line is a complete canard, but a lot of people say it. It’s absurd and stupid, but if enough people repeat a lie, it has a power independent of its truth value.
    I would love to do some organizing in churches or something and savvy advertising to get the truth out.

  6. Abby, No point in ever posing Ron a direct question as he never answers them. It is of course true that one piece of questionable data dredged up by a loony at Fraser or Manhattan immediately invalidates a now 8 year series of peer-reviewed research from an established team published in Health Affairs, and we are very lucky that Ron is prepared to set us straight.
    Meanwhile, if you care, my “Oh Canada” piece references the article that completely debunks the “Canadians crossing hte border for care” myth as being just that.
    Most amusingly it seems to have escaped Ron’s notice that all his examples of foreginers coming to receive great medical care in the US are dead!

  7. Matthew, Ron’s comment is instructive, because you hear this sort of thing all the time. Buffalo is just chock full of Canadians trying to get care etc.

  8. Matthew show the stats on breast cancer deaths between the USA and England. I think you would be better off if you were a woman with breast cancer to live in the United States than in England. I think England is worse than the rest of Europe with dead women with breast cancer. I notice that when George Harrison was sick he came to the United States. Same with the King of Jordan. Arifat went to Paris and look what happenned to him, poor guy.