In Chronic Condition: Experiences of Patients with Complex Health Care Needs, in

[Guest guest]

Poster's Note: In case this does not show up in the groups, there is an

interesting chart on this webpage showing *Access, Coordination, & Safety*

for

each country. Think I should go the Netherlands next time I need to go to the

hosptial.........

 

In Chronic Condition: Experiences of Patients with Complex Health Care

Needs, in Eight Countries, 2008

_http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=726

492_

(http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=72649\

2)

 

In the Literature

 

Synopsis

 

A 2008 survey of chronically ill adults in Australia, Canada, France,

Germany, the Netherlands, New Zealand, the United Kingdom, and the United

States

found major differences in health care access, safety, and efficiency, with

U.S. patients at particularly high risk of forgoing care because of costs and

experiencing errors or inefficient, poorly organized care.

 

 

 

 

The Issue

 

Across industrialized nations, patients with multiple chronic conditions

account for a disproportionate share of national health spending. Such patients

often see multiple clinicians in a variety of care settings, putting them at

heightened risk for experiencing medical errors and having poorly coordinated

care. Because of their extensive contact with the health care system, these

patients offer unique perspective on many aspects of system performance.

 

Key Findings

 

- More than half (54%) of U.S. patients did not get recommended care, fill

prescriptions, or see a doctor when sick because of costs, versus 7 percent to

36 percent in the other countries.

 

- About one-third of U.S. patients—the highest proportion in the survey—

experienced medical errors, including delays in learning about abnormal lab

test

results.

 

- Similarly, one-third of U.S. patients encountered poorly coordinated care,

including medical records not available during an appointment or duplicated

tests.

 

- The U.S. stands out for patient costs, with 41 percent reporting they

spent more than $1,000 on out-of-pocket costs in the past year. U.K. and Dutch

patients were most protected against such costs.

 

- Only one-quarter (26%) of U.S. and Canadian patients reported same-day

access to doctors when sick, and one-fourth or more reported long waits. About

half or more of Dutch (60%), New Zealand, (54%), and U.K. (48%) patients were

able to get same-day appointments.

 

- A majority of respondents across the eight countries saw room for

improvement. Chronically ill adults in the U.S. were the most negative;

one-third

said the health care system needs a complete overhaul.

 

- In the past two years, 59 percent of U.S. patients visited an emergency

room (ER); only Canada had a higher rate (64%). In both countries, one of five

patients said they went to the ER for a condition that could have been

treated by a regular doctor if one had been available.

 

 

Study Implications

 

While the U.S. did comparatively well on some measures of hospital discharge

instructions and patient-centered care, chronically ill Americans often

cannot afford to follow recommended care. Gaps in coverage and cost-sharing are

undermining access and adherence. The survey finding that in all eight

countries, patients most often reported that errors happened outside the

hospital

highlights the need to focus on ambulatory care and medication safety.

Initiatives under way across nations to improve performance through payment

reform,

information systems, and managing chronic conditions offer cross-national

opportunities to learn

 

 

About the Study

 

The 2008 Commonwealth Fund International Health Policy Survey of Sicker

Adults interviewed 7,500 chronically ill patients in eight countries.

Respondents

had at least one of seven conditions: hypertension, heart disease, diabetes,

arthritis, lung problems, cancer, or depression.

 

The Bottom Line

 

Compared with their counterparts in seven other countries, chronically ill

adults in the U.S. are far more likely to forgo care because of costs. They

also experience the highest rates of medical errors, care coordination

problems, and high out-of-pocket costs.

 

 

Citation

 

C. Schoen, R. Osborn, S. K. H. How, M. M. Doty, and J. Peugh, In Chronic

Condition: Experiences of Patients with Complex Health Care Needs, in Eight

Countries, 2008, Health Affairs Web Exclusive, Nov. 13, 2008, w1-w16

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