Health Care Costs, Error Rates Higher in U.S. Than in Other Countries

Out-of-pocket health care costs and medical error rates are higher for patients in the U.S. than in five other Western nations, according to a Commonwealth Fund survey published on Thursday in the online version of Health Affairs, the Washington Post reports. For the report, researchers surveyed 6,957 adults between March and June 2005 who recently had been hospitalized, had surgery or reported health problems in the U.S., Australia, Canada, Britain, New Zealand and Germany.

The survey, which is the largest to examine health care in several nations during the same time period, found that U.S. residents were more likely to forego medical care than patients in other nations because of costs. In addition, U.S. respondents reported the easiest access to specialists but the most difficulty getting care during nights and weekends (Stein, Washington Post, 11/4).

Patients from all six countries reported medical errors, uncoordinated care and poor management of chronic diseases (CQ HealthBeat, 11/3). The study also found that:

• 34% of U.S. patients surveyed reported getting the wrong medication or dose, incorrect test results, a mistake in their treatment or late notification of abnormal test results, compared with 30% of Canadians, 27% of Australians, 25% of New Zealanders, 23% of Germans and 22% of Britons;
  


• About half of U.S. residents surveyed reported that they had decided not to fill a prescription, see a doctor while sick or undergo recommended follow-up tests because of costs, compared with 38% of patients in New Zealand, 34% in Australia, 28% in Germany, 26% in Canada and 13% in Britain;
  


• Nearly one-third of U.S. patients surveyed reported paying more than $1,000 in out-of-pocket medical expenses in the past year, compared with 14% of Canadian and Australian patients and a much lower proportion of patients in the other countries (Washington Post, 11/4);
  


• 15% of U.S. residents surveyed said they had no out-of-pocket health care costs in the past year, compared with 65% of British patients;
  


• Most patients surveyed in New Zealand and Germany reported ease in acquiring same-day appointments, compared with 30% of U.S. patients;
  


• 8% of U.S. residents surveyed reported waiting four months or more for nonemergency surgery, compared with 41% of British patients;
  


• 7% of U.S. residents surveyed who had been hospitalized in the past two years reported developing an infection while in the hospital, compared with 10% of Britons and 3% of Germans (CQ HealthBeat, 11/3); and
  


• More than half of U.S. patients surveyed received appropriate care for chronic conditions such as hypertension or diabetes.

Cathy Schoen, one of the study's authors, attributed the U.S. medical error rate to a lack of coordination among health care providers (Higgins, Washington Times, 11/4). She added, "What's striking is that we are clearly a world leader in how much we spend on health care. We should be expecting to be the best. Clearly, we should be doing better" (Washington Post, 11/4).

Agency for Healthcare Research and Quality officials said the national effort to create a electronic health records could help with coordination problems and reduce health care costs (Washington Times, 11/4).

AHRQ Director Carolyn Clancy said, "The findings show that we have a lot to learn from our colleagues," adding, "The findings here reinforce how difficult it is coordinating care."

Lucian Leape, a professor and patient safety researcher at the Harvard School of Public Health, said, "This provides confirming evidence for what more and more health policy thinkers have been saying, which is, 'The American health care system is quietly imploding, and it's about time we did something about it" (Washington Post, 11/4).

The study is available online.