1. Potera, Carol


Americans pay more for a system that provides less.


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A survey of 12,000 adults in seven countries has revealed that Americans are less satisfied with their health care than are those abroad. The 2007 Commonwealth Fund International Health Policy Survey showed that twice as many U.S. residents polled believe that our health care system needs a complete overhaul as those in Canada, Australia, Germany, United Kingdom, New Zealand, and the Netherlands. Worse, the United States spends more than twice as much on health care per capita as the next highest-paying country (Austria), yet Americans pay the most out of pocket, and this country has a greater proportion of uninsured and more medical errors. Here are some other glaring discrepancies:


* Thirty percent of U.S. patients pay $1,000 or more in out-of-pocket costs, nearly twice the amount paid in the next highest-paying country.


* One-fifth of U.S. adults can't pay their medical bills.


* Americans are least likely to get same-day appointments with physicians and more likely to go to EDs.


* Chronically ill U.S. patients are most likely to skip care because of cost.


* U.S. physicians rank last in having patients' medical records at hand during a visit.


* U.S. patients are least likely to say physicians spend enough time with them.


* The highest rate of laboratory test errors occurs in the United States.



The survey also found that in all countries, patients who receive their primary care through a "medical home" model, meaning that they have regular primary care providers who know their medical histories and coordinate care (see AJN Reports, January), report more positive experiences. The medical home approach "makes primary care accessible, personalized, and coordinated," says economist Cathy Schoen, lead author and senior vice president at the Commonwealth Fund. "It expands the role for nurses," Schoen points out. Also, she says, in the Netherlands nurses coordinate after-hour care at community cooperatives, and physicians are called only for cases that nurses cannot handle. "There's much lower ED use because of this," Schoen says.


Carol Potera


Schoen C, et al. Health Aff (Millwood) 2007;26(6):w717-34.