By Christopher Lee Washington Post Friday, November 3, 2006; Page A14
Americans have a harder time than residents of several other countries getting after-hours appointments with a nurse or primary care physician without going to an emergency room, a study released yesterday found.
Forty percent of U.S. primary care doctors said they had arrangements for after-hours care, according to the survey of more than 6,000 physicians in seven countries. That compared with 95 percent in the Netherlands, 90 percent in New Zealand, 87 percent in the United Kingdom, 76 percent in Germany and 47 percent in Canada.
The study, published online by the journal Health Affairs, also found that the United States trails other countries in adopting electronic medical records and computerized systems to remind patients about follow-up care, prompt physicians to give patients test results and warn of potentially harmful drug interactions. It found that primary care doctors in America were less likely to have financial incentives to improve the quality of the care they provide.
"Although the U.S. pays more for health care than any other country, we are under-investing in our primary care system," Karen Davis, president of the Commonwealth Fund, the foundation that sponsored the survey, said in a statement. "Other countries have made high-quality primary care a priority by putting into place the financial and technical systems that support access to, and delivery of, such care."
The study is the latest of many to document that the United States lags on some measures of health and care despite spending more on medical care than any other nation. Annual U.S. medical spending was $5,635 per person in 2003. The next highest among the seven countries surveyed was $3,003 in Canada; the Netherlands spent the least, $1,886 per person. In that vein, U.S. primary care doctors were the most likely to say their patients often had difficulty paying for medications or other care, the survey found.
Advocates say greater use of electronic records would improve patient care, reduce errors, curb unnecessary tests and cut paperwork. About 28 percent of U.S. primary care doctors said they use such records, compared with 98 percent in the Netherlands, 92 percent in New Zealand, 89 percent in the United Kingdom, 79 percent in Australia and 42 percent in Germany. Only Canada ranked lower, at 23 percent.
Twenty-three percent of U.S. physicians said they had a computerized system to alert them to a potential problem with a drug dose or interaction. In all other countries except Canada (10 percent), more physicians reported using such systems. The Netherlands was highest at 93 percent. The United States and Canada also ranked lower than the others in use of computerized systems to remind patients to get follow-up care or to remind doctors to give patients test results.
Only 30 percent of U.S. doctors said they have financial incentives to improve the quality of the care they provide, even as more policymakers say physicians should be rewarded for the quality, rather than just the volume, of services. The United Kingdom ranked highest, with 95 percent of doctors saying they received such incentives. The United States was last, the survey found.
One area where "pay for performance" is making significant inroads in the United States is in HMOs, according to a separate study published yesterday in the New England Journal of Medicine.
The study, by Harvard School of Public Health researchers, found that 52 percent of managed-care plans, accounting for more than 81 percent of people enrolled in HMOs, base payments to their providers in part on quality. The authors said the study provided the first national estimate of the use of pay for performance by the nation's health plans.
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