Original Source
The Commonwealth Fund
1 East 75th Street,
New York, NY 10021
Phone: 212.606.3800
E-mail:
..
November 3, 2005
..
Taking the Pulse of Health Care Systems:
Experiences of Patients with Health Problems
in Six Countries
..
Cathy Schoen, M.S., Robin Osborn, M.B.A., Phuong Trang Huynh, Ph.D.,
Michelle Doty, Ph.D., Kinga Zapert, Ph.D., Jordon Peugh,
M.A., Karen Davis, Ph.D.,
Health Affairs Web Exclusive,
W5-509-W5-525
..
A new international survey supported by The Commonwealth Fund finds that
one-third of U.S. patients with health problems reported experiencing medical
mistakes, medication errors, or inaccurate or delayed lab results-the highest
rate of any of the six nations surveyed. While sicker patients in all
countries reported safety risks, poor care coordination, and inadequate
chronic care treatment, with no country deemed best or worst overall, the
United States stood out for high error rates, inefficient coordination of
care, and high out-of-pocket costs resulting in forgone care.
..
Results and analysis from the survey-the eighth in a series of Fund-supported
cross-national surveys-are discussed in
Taking the Pulse of Health Care
Systems: Experiences of Patients with Health Problems in Six
Countries
(Health
Affairs Web Exclusive, November 3, 2005).
..
For the first time, the survey includes Germany, in addition to Australia,
Canada, New Zealand, the United Kingdom, and the United States. The 2005 study
examines issues of safety, health care coordination, chronic disease care, and
access to care. Adults who had recently been hospitalized, had surgery, or had
health problems were interviewed by telephone between March and June 2005.
..
Medical, Medication, and Lab Errors
One-third (34%) of U.S. respondents reported at least one of four types of
errors: they believed they experienced a medical mistake in treatment or care,
were given the wrong medication or dose, were given incorrect test results, or
experienced delays in receiving abnormal test results. Three of 10 (30%)
Canadian respondents reported at least one of these errors, as did one-fifth
or more of patients in Australia (27%), New Zealand (25%), Germany (23%), and
the U.K. (22%). While patient safety efforts have focused chiefly on hospital
settings, most patients (60% or more) said these errors occurred outside the
hospital-a signal that safety initiatives should also focus on ambulatory
care, said Cathy Schoen, the study's lead author and a senior vice president
at The Commonwealth Fund.
..
Patients receiving complex care may be at even higher risk of medical errors:
the incidence of patient-reported errors rose sharply with the number of
physicians seen. Despite studies showing patients value discussion about
mistakes or errors, most patients (61% to 83%) in each country said the health
care providers involved did not tell them about the mistakes.
..
Communication and Care Coordination
..
Communication issues also adversely affect patients' experiences during
hospital stays. At least one-fifth of patients (19% to 26%) in the six
countries reported communication gaps between themselves and hospital staff,
and one-sixth said they would have liked greater involvement in decisions made
about their care.
Good transitional care-helping patients transfer from hospital to home-also
relies on clear communication and coordination. In all six countries, however,
at least one-third of patients said they did not receive instructions about
symptoms to watch for, did not know whom to contact with questions, or were
left without follow-up care arrangements. German patients had the highest rate
of coordination deficiencies when discharged from the hospital, with 60
percent reporting failures to coordinate care. According to the authors, poor
transitional care can result in complications and increase the likelihood of
hospital readmission, raising concerns about costs as well as quality.
..
While the U.S. performed better than most countries on the hospital transition
measure, it had the highest rate of patients reporting coordination problems
during doctor visits. One-third (33%) of U.S. respondents said that either
test results or records were not available at the time of appointments or that
doctors duplicated tests. These delays and duplications are a clear sign of
inefficient care, the authors said, and waste both physicians' and patients'
time and resources. Rates of care coordination problems in the other survey
countries were significantly lower, ranging from one-fifth to one-quarter of
patients reporting such problems.
..
Access Issues, Financial Burdens, and Forgone Care
As was found in past surveys, the U.S. is an outlier in terms of financial
burdens placed on patients. One-half of adults with health problems in the
U.S. said they did not see a doctor when sick, did not get recommended
treatment, or did not fill a prescription because of cost. Despite these high
rates of forgone care, one-third of U.S. patients spent more than $1,000
out-of-pocket in the past year. In contrast, just 13 percent of U.K. adults
reported not getting needed care because of costs, and two-thirds had no
out-of-pocket costs.
..
There were wide and significant variations in access and waiting times on
multiple dimensions across the six countries. Respondents in Canada and the
U.S. were significantly less likely than those in other countries to report
same-day access and more likely to wait six days or longer for an appointment.
At the same time, majorities of patients in New Zealand (58%) and Germany
(56%), and nearly half in Australia (49%) and the U.K. (45%), were able to get
same-day appointments. Waiting times for elective surgery or specialists were
shortest in Germany and the U.S., with the majority of patients in both
countries reporting rapid access.
..
Overall Performance
The authors say that no country emerges as a clear winner or loser. All survey
countries experience high rates of safety risks, failure to coordinate care
during transitions, inadequate communication, and a lack of support for
chronically ill patients. These areas of shared concern, they conclude, will
likely require policy innovations that transcend current payment and delivery
systems.
..
Facts and Figures:
- More than one of four patients in each country (28% to 32%) said
risks were not completely explained during their hospital stay.
..
- In all countries, sizable majorities of patients said physicians
had not always reviewed all their medications during the past year, and
one-third or more reported infrequent reviews.
..
- Across countries, one-sixth to one-fourth of patients said
physicians only sometimes, rarely, or never make goals of care and
treatment clear or give them clear instructions.
..
- Relative to the U.S. and Canada, the four countries reporting
comparatively rapid access to physicians-Australia, Germany, New
Zealand, and the U.K.-also had significantly lower rates of emergency
room use
..