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Subject: qotd: Primary care physicians' experiences in ten countries;
U.S. stands out
Date: Mon, 19 Nov 2012 12:18:41 -0800
From: Don McCanne <firstname.lastname@example.org>
To: Quote-of-the-Day <email@example.com>
November 15, 2012
A Survey Of Primary Care Doctors In Ten Countries Shows Progress In Use
Of Health Information Technology, Less In Other Areas
By Cathy Schoen, Robin Osborn, David Squires, Michelle Doty, Petra
Rasmussen, Roz Pierson and Sandra Applebaum
To explore the experiences of physicians as health reform policies
unfold, we surveyed primary care physicians in the following ten
countries in 2012: Australia, Canada, France, Germany, the Netherlands,
New Zealand, Norway, Switzerland, the United Kingdom, and the United States.
Swiss and US patients often face substantial deductibles as well as cost
sharing, although Swiss health insurance standards reduce rates for
low-income people and limit out-of-pocket liability to levels well below
those in the United States.
The United States is alone among the study countries in segmenting the
population by income and age for government-sponsored health insurance
and in its lack of coordinated policies across multiple private and
US and Canadian physicians' responses to questions regarding after-hours
arrangements mirror patients' experiences: In the 2010 international
population survey on patient experience with health care services,
Canadian and US patients were more likely than those in other countries
to have used emergency departments and among the most likely to say that
it was difficult to obtain health care after hours.
In 2012, 59 percent of US physicians said that their patients often have
difficulty paying out-of-pocket costs for medical care - a percentage
well above that in any other country.
In the United States, physicians' perceptions of affordability or
difficulties getting specialized care varied by patient insurance mix.
Doctors with high proportions of uninsured or Medicaid patients were the
most likely to say that their patients often faced long waits for
To gauge primary care physicians' perspectives overall, the survey asked
about their views of their country's health system, their satisfaction
with the practice of medicine, and their perceptions of change in recent
years. Repeating a pattern observed in earlier surveys, US and German
physicians were the most negative about their health care systems, with
only 15 percent and 22 percent, respectively, saying that the system
needs only minor changes versus fundamental change or rebuilding. German
and US physicians were also the least likely to say that they were
satisfied or very satisfied with practicing medicine.
As countries aim to reduce health care costs, some countries have looked
to coverage restrictions on treatments or medications or to reviews of
physician care decisions. Although such interventions may target the
appropriateness of care, they can also have the unintended consequence
of imposing time and administrative burdens on physicians. Among the
study countries, US physicians were the most likely to say that such
time concerns are a major problem: More than half of US respondents said
that they or their staff spend too much time getting patients care
because of coverage restrictions on treatment or medications.
Notably, the share of Dutch doctors expressing concern about this issue
has more than doubled since the 2009 survey (increasing from 10 percent
to 26 percent). This suggests that problems are emerging with the
growing complexity of health insurance practices in the Netherlands.
Regarding after-hours access to primary health care services, all of the
study countries except the United States and Canada have policies for
after-hours coverage. The low rates of after-hours arrangements reported
by Canadian and US physicians indicate that such arrangements are slow
to develop if they must depend on the actions of individual practices.
Insurance design also matters. US physicians stand out, as they have in
past surveys, for saying that their patients often have difficulty
paying for care and that insurance restrictions on care decisions
consume substantial doctor and staff time. The other countries in the
study all provide universal coverage and, with the exception of
Switzerland, have little or no cost sharing for primary care and
essential medications. All of the other countries limit out-of-pocket
expenses to levels well below those typical in US insurance.
In contrast to other countries with multiple insurers, US private
insurers often use prior authorization and employ varying drug
formularies and complex benefit designs, with little standardization.
Recent studies confirm that the resulting insurance-related complexity
adds substantially to US practice costs as a result of increased
paperwork and time demands.
In patient surveys, the United States also stands out for
insurance-related time concerns. US experiences provide a cautionary
example for other countries regarding the time and resource costs of
In general, US primary care physicians' views and experiences endorse
the need for reform, including enhanced access. US physicians who
reported that their patients often faced cost or other access barriers
were the most likely to say that the system required major change.
Comment: We spend by far the most money per capita on health care. Yet,
compared to primary care physicians in other nations, U.S. physicians
are by far the most negative about our health system, with only 15
percent saying that "the system needs only minor changes" (versus
fundamental change or rebuilding).
The perspective provided by the excerpts posted above should drive the
citizens of our nation to demand comprehensive reform. Are we up to it?