Americans are more dissatisfied than citizens of other nations with their basic health care (search) even while paying more of their own money for treatment, a five-nation survey released Thursday notes.
The study shows that people in the U.S. face longer wait times to see doctors and have more trouble getting care on evenings or weekends than do people in other industrialized countries. At the same time, Americans were more likely to receive advice on disease prevention and self-care than others.
One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.
“In no country is the majority of adults satisfied,” says Cathy Schoen, a vice president at the Commonwealth Fund (search), a nonprofit group that conducted surveys of some 7,000 patients in the five countries.
The U.S. is the only industrialized country that does not offer government-sponsored health coverage for all citizens. Proponents of market-driven health care often point to long wait times for services in other countries when warning of the dangers of a government-run system.
Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33 percent of Americans who got such speedy care. Only Canada scored lower, with 27 percent saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.
Four in 10 U.S. adults told researchers that they had gone without needed care because of the cost, including skipping prescriptions, avoiding going to the doctor, or skipping a recommended test or treatment.
Meanwhile, 26 percent of Americans surveyed said that they had faced more than $1,000 in out-of-pocket health care costs in the last year, compared with 14 percent of Australians, and 4 percent of Britons.
“The U.S. stands out as the patients the most exposed to medical bills,” Schoen says.
A Silver Lining in American Health Care
The results seemed to discourage American officials, though they say they were heartened by other figures showing that U.S. patients were the most likely to receive several forms of preventive care, including Pap smear tests.
Eighty-six percent of American women respondents between 50 and 64 years of age said they got a mammogram (search) in the past three years, six points higher than in Australia and nine higher than in the U.K.
“We’ll take good news where we can get it,” says Carolyn M. Clancy, MD, director of the U.S. Agency for Healthcare Research and Quality. “The other findings are clearly of concern,” she says.
Clancy stresses that government officials have been actively pushing programs to promote preventive medicine, pointing to the Medicare reforms passed last year that will add preventive care and chronic disease management to the program’s list of paid services for seniors.
Though their countries generally outperformed the U.S., officials from the survey’s other nations also acknowledged it as proof that their government must do more to promote primary health care and better medical information technology.
John Hutton, a British Member of Parliament and the Minister of State for Health, says, “When they tell us a message, I think we should listen to it.”
By Todd Zwillich, reviewed by Brunilda Nazario, MD
SOURCES: “The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries,” Commonwealth Fund, Oct. 28, 2004. Cathy Schoen, vice president, Commonwealth Fund. Carolyn M. Clancy, MD, director, Agency for Healthcare Research and Quality. The Honorable John Hutton, MP.
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