Health care quality slips as costs rise

WASHINGTON – Americans pay more when they get sick than people in other Western nations and receive more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.

The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost, the survey found, and more than a third endured mistakes and disorganized care when they did get treated.

While patients in every nation sometimes run into obstacles to getting care and deficiencies in treatment, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found.

“What’s striking is that we are clearly a world leader in how much we spend on health care,” said Cathy Schoen, senior vice president for The Commonwealth Fund, a private, nonpartisan, nonprofit foundation based in New York that commissioned the survey. “We should be expecting to be the best. Clearly, we should be doing better.”

The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period of time.

The survey, published in the journal Health Affairs, questioned 6,957 adults who had recently been hospitalized, undergone surgery or reported health problems between March and June of this year.

Nearly a third of U.S. patients reported spending more than $1,000 in out-of-pocket expenses for their care, far outpacing all other nations. Canadians and Australians came next, with only 14 percent of patients spending that much. The proportion reporting similarly high costs was far lower in the other countries.

While Americans had the easiest access to specialists, they experienced the most problems getting care after hours, and Americans and Canadians were the most likely to report problems seeing a doctor the same day they sought one.

Americans were also much more likely to report forgoing needed treatment because of cost. About half of Americans said they had decided not to fill a prescription, see a doctor when they were sick or get recommended follow-up tests. About 38 percent of patients in New Zealand reported going without care, as did 34 percent in Australia, 28 percent in Germany, 26 percent in Canada and 13 percent in Britain.

Americans also reported the greatest number of medical errors. Thirty-four percent reported getting the wrong medication or dose, incorrect test results, a mistake in their treatment or care, or being notified late about abnormal test results. Only 30 percent of Canadian patients, 27 percent of Australian patients, 25 percent of New Zealanders, 23 percent of Germans and 22 percent of Britons reported errors.