Patients in five countries reveal healthcare deficiencies

Disturbingly high rates of medical errors, lack of care co-ordination, poor communication between doctors/patients, and barriers when accessing care, are experienced by patients in the United States (US), Australia, Canada, NZ (NZ) and the United Kingdom (UK).

These findings - from a survey conducted by the Commonwealth Fund, a private foundation supporting independent research on health and social issues, and published recently in Health Affairs - point to widespread error, inefficiency and missed opportunities in the five countries’ healthcare systems. The authors, health policy analysts R J Blendon and C DesRoches of the Harvard School of Public Health, C Schoen and R Osborn of The Commonwealth Fund, and K Zapert of Harris Interactive, suggest that reforms targeted at populations with health problems could reap system-wide improved quality and potential cost savings.

‘Frequent error, miscommunication, and wasted resources from duplicate tests, delays, and conflicting information are common problems in the health systems of all the countries studied,’ said Karen Davis, President of The Commonwealth Fund. ‘These findings highlight serious problems with quality of care and wasted resources, and make a compelling case for implementing interventions that we know will make a difference, including electronic medical records and computerised systems for physician ordering of prescription drugs.’

The survey of healthcare experiences involved patients aged from 18 years, who reported fair or poor health, serious illness, injury, disability, major surgery or hospitalisation for something other than a normal delivery in the past two years.

Medication and medical errors - One-fourth of adults with health problems in Australia, Canada, NZ, and the US and one-fifth in the UK, reported experiencing a medication error or medical error in the past two years. Most of these, in every country, said the error caused serious health consequences. Among all respondents, this represented 13% in Australia, 15% in Canada, 14% in NZ, 9% in the UK and 18% in the US.

Lack of care co-ordination - One in five of the more ill adults in Canada (20%) and the US (22%) reported being sent for duplicate tests by different health professionals, as did one in six in NZ (17%), one in eight in Australia (13%) and the UK (13%). In all five countries, about half of the patients said they had to repeat their health history to multiple health professionals
One-fourth of US (25%) and UK (23%) respondents, one-fifth (19%) of Canadian respondents, and one in six in Australia (14%) and NZ (16%) said their medical records did not reach a doctor’s office in time for an appointment. About one-fourth of respondents in Australia, Canada, NZ, and the US, and one-fifth in the UK (19%), reported receiving conflicting information from different health professionals.

Communication - US patients were more likely than those in the other countries to report communication difficulties with their physicians. Three in 10 in the U.S. (31%) said they did not have important questions answered by their physicians, compared with one in five in Australia (21%), NZ (20%), and the UK. (19%), and one in four Canadians (25%).

Access and Cost Problems - Not surprisingly, a higher proportion of US respondents said they encountered problems accessing healthcare due to cost - although cost did affect access to an extent in all the countries. Also due to cost, in the US 35% of respondents did not fill a prescription (35%), and 28% did not receive medical care or a recommended test/treatment/follow-up (26%). 23% in Australia, 19% in Canada, and 20% in NZ, said they did not fill a prescription due to cost, but only 10% in the UK said the same.

26% of NZ respondents said they did not have medical care due to cost, as did 16% in Australia. UK respondents were least likely to report this: 4% cited cost as the reason they did not have medical care and 5% said cost influenced the lack of a recommended test/treatment.
About 16% of US respondents said they skipped doses to make their medication last longer, but less than 10% did this in the other four countries.

Full details or to order publications: www.cmwf.org.

01.07.2003

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