U.S. patients rate their health care among the worst in the industrialized world, despite spending more on medical care than patients in other countries, a multinational report concluded Tuesday.

Americans were more likely than patients in four other rich countries to report poor care coordination, lab test and diagnostic errors, and high costs that stand in the way of obtaining needed care. The report also shows that low-income Americans have far more difficulty with most areas of their medical care than similar patients in other nations.

The report is not the first to expose glaring shortcomings in the U.S health system when compared to other countries.

Low Rankings

The U.S. ranks 33rd in infant mortality and 28th in disease-free life expectancy, according to the World Health Organization. Meanwhile, the U.S. spent $6,280 per capita on medical care in 2004, more than twice as much as any other industrialized nation.

In the survey, Americans were more likely than residents of the U.K., Australia, New Zealand, or Canada to report having spent $1,000 or more of their own money for medical care in the last year. Lower-income Americans were also far more likely than lower-income patients of those nations to say they’ve gone without a needed medical test or treatment because of cost.

“Higher spending doesn’t mean we receive more or better care. We simply pay more,” said Karen Davis, president of the Commonwealth Fund, a nonprofit group that issued the report.

Poor Coordination of Health Care

The report notes that the U.S. does a particularly poor job of organizing care for patients with chronic diseases, though such patients use close to 80 percent of all health care dollars.

Nearly one-quarter of U.S patients told researchers they had received incorrect lab results vs. 9 percent to 18 percent of patients from the other countries. American patients were in some cases twice as likely to report that their medical records did not make it to a doctor’s office in time for an appointment.

The U.S system did show a few bright spots. American patients were equally or more likely to receive preventive medical services like blood pressure screening or Pap smear tests for cervical cancer.

But experts said the overall health picture for Americans is marked by inefficiency, duplication, and a lack of coordination that often leaves patients to navigate the system with little guidance from a doctor or other expert.

Primary Care Shortcomings

Andrew Bindman, MD, chief of the internal medicine division at San Francisco General Hospital, says fewer and fewer young doctors are choosing to train in primary care, a dynamic that tilts the U.S. system toward more expensive specialty care.

“We’re seeing an erosion in the primary care infrastructure,” Bindman says.

Donald M. Berwick, MD, president of the Institute for Healthcare Improvement, says the nation is making some strides toward improving efficiency. The Bush administration has spearheaded efforts to increase the use of electronic medical records and to tie health payments to quality of care.

But the U.S. system still relies too heavily on new technologies and hi-tech tests that sometimes drive up the cost of care without improving overall health, he says.

“We have a big job here, to wean ourselves from the ‘more is better’ philosophy,” Berwick says.

By Todd Zwillich, reviewed by Louise Chang, MD

SOURCES: Commonwealth Fund 2004 International Health Policy Survey, April 4, 2006. Karen Davis, president, the Commonwealth Fund. World Health Organization. Centers for Medicare and Medicaid Services. Andrew Bindman, MD, chief, department of general internal medicine, San Francisco General Hospital, University of California at San Francisco. Donald M. Berwick, MD, president, Institute for Healthcare Improvement.