How does the United States compare with other countries on measures of efficiency and coordination of care?

The U.S. ranked last or next-to-last on three measures of efficiency and coordination of care asked of sicker patients in a 2005 survey conducted in six developed countries. When similar questions were asked of primary care physicians in a 2006 survey in seven countries, the U.S. ranked close to the bottom on one question and near the middle of the pack on two questions.

Why is this important?

A recent international review by the 30-nation Organisation for Economic Co-operation and Development suggests that there may be substantial variations in the efficiency of the health care delivery across countries. The OECD authors noted that "over the long term, improvements in efficiency may be the only way—certainly the most appealing way—of reconciling rising demands for health care with public financing constraints" (OECD Health Project 2004).

Findings

The Commonwealth Fund collaborated with five other developed nations—Australia, Canada, Germany, New Zealand, and the United Kingdom—to survey patients who had a high incidence of chronic illness and made recent intensive use of health care (Schoen et al. 2005). On three questions, patients in the United States were more likely than patients in most other countries to report experiences suggesting inefficient use of resources. Specifically:

• U.S. patients were more likely than patients in all five comparison countries to report that they went to the emergency room for conditions that could have been treated by a regular doctor.
• U.S. patients were more likely than patients in four comparison countries (except Canada) to report that records or results did not reach their doctor's office in time for their appointment.
• U.S. patients were more likely than patients in four comparison countries (except Germany) to report that doctors unnecessarily ordered duplicate medical tests.

In a 2006 international survey that asked similar questions of primary care physicians, physicians were even more likely than were patients in the 2005 survey to express concern about missing clinical information and problems resulting from poor coordination of care. U.S. physicians were about equally likely as U.S. patients were to report duplication of tests or procedures.

Implications

These measures provide a window on some sources of inefficiency in health care and suggest the need for improved access to primary care, better care coordination, and more robust information management tools.

Measure:

For the 2005 survey, the denominator is sicker adults, defined as those who rated their health as fair or poor; reported that they had a serious illness, injury, or disability that required intensive medical care in the past two years; or reported that in the past two years they had major surgery or had been hospitalized for something other than a normal pregnancy. The numerator is the subset of the denominator population who answered "yes" to the question (Schoen et al. 2005).

For the 2006 survey, the denominator was primary care physicians. "The definition of primary care included [general practitioners] and [family physicians] in all countries and also general internist and pediatricians in Canada, Germany, and the United States in proportion to their share of primary care physicians in each country" (Schoen et al. 2006). The numerator is the subset of the denominator population who answered "often" or "sometimes" to the question.

Limitations:

These data are limited in scope and do not necessarily represent the most important sources of inefficiency in health care. Patient-reported data are subject to potential recall bias. Expectations may be influenced by cultural factors that differ from country to country.

Source:

The 2005 Commonwealth Fund International Health Policy Survey was a telephone survey of random, representative samples of adults in each country conducted by Harris Interactive and its affiliates (Schoen et al. 2005).

The 2006 Commonwealth Fund International Health Policy Survey was a mail and telephone survey of representative samples of primary care physicians in each country conducted by Harris Interactive, its country affiliates, and the Radboud University Nijmegen Centre for Quality of Care Research in the Netherlands (Schoen et al. 2006).

References:

* Indicates source of data used in the chart(s).

OECD Health Project. 2004. Towards High-Performing Health Systems. Paris, France: Organisation for Economic Co-operation and Development.

* Schoen, C., R. Osborn, P. T. Huynh et al. 2006. On the Front Lines of Care: Primary Care Doctors' Office Systems, Experiences, and Views in Seven Countries. Health Affairs 25 (6): w555–71.

* Schoen, C., R. Osborn, P. T. Huynh et al. 2005. Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries. Health Affairs Suppl. Web Exclusives: W5-509–W5-525.