In an eight-nation survey of people with chronic conditions, patients in the Netherlands were most positive about their country's health care system—reporting affordable, accessible care with low rates of errors—while U.S. patients were the most likely to say their system was in need of major revision.
The study, published online, showed that patients in all nations report gaps in care when being discharged from the hospital, such as providing written care plans, follow-up care, instructions about symptoms to watch for, and what institution to contact with questions about condition or treatments.
The survey included more than 9,000 patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States from March through May 2008. Patients had developed hypertension, heart disease, diabetes, arthritis, chronic lung conditions, depression, or cancer, and the share of patients with two or more conditions ranged from 51% in New Zealand to 71% in the United States, according to the survey.
The researchers, from the Commonwealth Fund, a New York-based charitable foundation, said just 9% of patients in the Netherlands called for health care restructuring, significantly less than the 33% of the respondents in the United States (Health Aff. 2008 Nov. 13 [doi 10.1377/hlthaff.28.1.w1]).
"It goes back to primary care as the core of [the Dutch] system," Robin Osborn, vice president of the International Program in Health Policy and Practice at the Commonwealth Fund, said in a teleconference to discuss the findings. "Patients register with a doctor. There is gatekeeping. The benefit is great. Eighty percent of the patients had been with their doctors for 5 years or more," In the United States, just 53% of subjects had been with their physicians 5 years or more.
U.S. patients faced the greatest cost and access issues, with 41% spending more than $1,000 out of pocket, significantly more than the seven other countries, with France (5%) and the United Kingdom (4%) paying the lowest.
U.S. patients were significantly more likely (43%) than all other countries to skip doses of prescribed medicine or not fill prescriptions because of costs.
U.S. patients were also significantly more likely than most other countries to say it was "very difficult" to get out-of-hours care, according to the survey. Australia and Canada had similar negative response levels at 34% and 33%, respectively.
The United States scored comparatively well on care when patients transition from hospital care to the community. U.S. patients were significantly less likely than all other countries to report gaps in discharge information, the survey found. In the United States, 38% of hospital patients reported deficiencies; the highest rate was in France, with 71% of hospital patients reporting gaps, the report said.
The United States scored well on waiting times, the researchers found. Of patients needing to see a specialist, 74% waited less than 4 weeks, with Germany (68%) and the Netherlands (69%) also having short waits. Forty-two percent of Canadians reported waits of 2 months or longer, significantly higher than all other countries, according to the survey.