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Which Patients Are Happiest With The Care They Receive?

Adults who received care from a medical home in 11 Westernized countries were less likely to report medical errors and were happier with their care, according to a new Commonwealth Fund international survey.

The 2011 survey included more than 18,000 ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. It included people who reported they were in fair or poor health, had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury or disability in the past year. The vast majority had seen multiple physicians.

A medical home was defined as patients reporting a regular source of care that knows their medical history, is accessible and helps coordinate care received from other providers. Results were published in Health Affairs.

Sicker adults in the U.S. were the most likely to have problems paying medical bills. More than 42% reported not visiting a doctor, not filling a prescription, skipping doses or not getting recommended care. U.S. rates of forgone care because of cost were at least double the rates in every other country except Australia, New Zealand, and Germany.

Also in the U.S., 27% said they could not pay or had serious problems paying medical bills, compared with between 1% and 14% of adults in the other 10 countries. And, 36% spent more than $1,000 on medical costs, compared with fewer than 10% in France, Sweden, and the U.K., the countries with the lowest rates.

Patients reporting medical errors, such as prescription- and lab-test errors, ranged from a low of 8% to 9% in the U.K. and Switzerland to 22% or more in New Zealand, Norway and the U.S.

When asked about seeking non-emergency care during evenings and weekends without going to the emergency department, more than half of the sicker adults in Canada, Australia, the United States, France, and Sweden reported difficulty. Swiss and UK patients were the least likely to report difficulty gaining access after hours, followed by those in The Netherlands and Norway.

In all eleven countries one-third or more of the sicker adults had visited the emergency department in the past two years, since these facilities play a role in treating sicker patients. About half or more of patients in Canada, Sweden, the United States, Australia and New Zealand were significantly higher than use rates in the other countries. Canadian patients reported the highest use rates, which probably reflects the lack of after-hours alternatives, the authors wrote.

Gaps also emerged in all countries at the point of hospital discharge, with at least one in four patients indicating lack of follow-up instructions or arrangements or clear medication directions. U.S. patients reported among the lowest rates of gaps in coordination of hospital discharge, perhaps reflecting intensified payer and policy focus on discharge planning to lower readmission rates, the authors wrote. U.S. patients also have shorter hospital stays, meaning they may also be sicker and more in need of coordination to ensure appropriate transitional care after discharge.

*This blog post was originally published at ACP Internist*


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