Chronically ill U.S. patients have the least access, the worst coordination of care, and the worst medical safety experiences among patients in the developed world's eight most developed nations, a new study released last week in Health Affairs In Chronic Condition: Experiences Of Patients With Complex Health Care Needs, In Eight Countries, 2008
- shows. Regardless of the fact that we pay more, we get far less. In essence, this study also shows beyond a shadow of a doubt that the US is rationing healthcare. Healthcare that the chronically ill in most other developed nations usually receive is unaffordable to many chronically ill adults in the US.
For the chronically ill in the US, this often results in tragic outcomes that are completely preventable.
In Chronic Condition:
Experiences Of Patients With
Complex Health Care Needs,
In Eight Countries, 2008
Chronically ill U.S. patients have the most negative access,
coordination, and safety experiences.
by Cathy Schoen, Robin Osborn, Sabrina K.H. How,
Michelle M. Doty, and Jordon Peugh
This 2008 survey of chronically ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States finds major differences among countries in access, safety, and care efficiency. U.S. patients were at particularly high risk of forgoing care because of costs and of experiencing inefficient, poorly organized care, or errors. The Dutch, who have a strong primary care infrastructure, report notably positive access and coordination experiences. Still, deficits in care management during hospital discharge or when seeing multiple doctors occurred in all countries. Findings highlight the need for system innovations to improve outcomes for patients with complex chronic conditions. [Health Affairs 28, no. 1 (2009): w1-w16 (published online 13 November 2008; 10.1377/hlthaff.28.1.w1)]
Medical science advances and improved living standards have saved lives and contributed to longer life expectancy, yet industrialized nations now face the growing challenge of caring for patients with chronic diseases. Health systems initially designed to respond to acute, episodic illness increasingly care for patients with ongoing conditions, where the goals include preventing complications or deterioration rather than cure. Often coping with multiple conditions, chronically ill patients may see multiple clinicians at different care sites, increasing the risks of errors and poor care coordination. Across industrialized nations, chronically ill patients account for a disproportionate share of national health spending, placing them at the center of initiatives to improve health system performance.1
Experiences of chronically ill patients, especially those with recent hospitalizations or serious illnesses, offer unique perspectives. To learn from such patients, the 2008 Commonwealth Fund International Health Policy Survey interviewed adults with chronic conditions who had recent health care experiences in eight countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Including France for the first time, the survey builds on an annual series that informs a symposium with ministers and policy experts from surveyed countries. This study focuses on access, coordination, safety, and care management experiences.
The countries participating in the survey represent a diverse mix of insurance designs and primary care systems. Among the eight countries, the United States stands out for having the most expensive system ($7,000 per capita compared to under $3,500 in the other countries as of 2006), for its gaps in coverage, and for high cost sharing even for patients with insurance.2 The other seven countries have systems with comprehensive minimum benefits and universal coverage. Canada, the Netherlands, and the United Kingdom have no cost sharing for primary care. France's insurance system protects patients with specific chronic illnesses from coinsurance. Germany limits cost sharing to 1 percent of income for the chronically ill and 2 percent for all households.3 The Netherlands, New Zealand, and the United Kingdom require patients to register with a general practitioner (GP) who acts as a gateway to more specialized care. The Netherlands and the United Kingdom are noted for their strong primary care foundations.4