Editorial - The New York Times
Chronically ill Americans suffer far worse care than their
counterparts in seven other industrial nations, according to a new
study by the Commonwealth Fund, a New York-based foundation that has
pioneered in international comparisons. It is the latest telling
evidence that the dysfunctional American health care system badly needs
reform.
The results of the study, published by the respected journal Health
Affairs, belie the notion held by many American politicians that health
care in this country is the best in the world. That may be true at a
handful of pre-eminent medical centers, but it is hardly true for the
care provided to a huge portion of the population.
The Commonwealth Fund’s survey of 7,500 patients in Australia,
Canada, France, Germany, the Netherlands, New Zealand, Britain and the
United States focused on patients who suffered from at least one of
seven chronic conditions: hypertension, heart disease, diabetes,
arthritis, lung problems, cancer or depression.
The care they received in this country — or more often did not
receive — ought to be a cause for shame. More than half of the American
patients went without care because of high out-of-pocket costs. They
did not visit a doctor when sick, skipped a recommended test or
treatment or failed to fill a prescription. The uninsured suffered
most, but even 43 percent of those who had insurance all year skipped
care because of costs.
Americans also were most likely to report wasting time because their
care was so poorly organized. About a third reported that medical
records and test results were not available when needed or that tests
were duplicated unnecessarily. A third experienced a medical error,
such as being given the wrong medication or test results. Some 40
percent found it very difficult to get after-hours care without going
to an emergency room.
The United States did comparatively well in some areas, such as
providing relatively prompt access to specialists and clear
instructions to patients leaving the hospital. But the nation’s overall
performance was abysmal.
By contrast, Dutch patients reported far more favorable experiences
with their health care system, largely because the Netherlands provides
universal coverage (through individual mandates and private health
insurance), a strong primary care system and widespread use of
electronic medical records. It should be possible to achieve the same
level of performance here.