Taking the Pulse of Health Care Systems: Experiences of Patients with
Health Problems in Six Countries

In the Literature

A new international survey supported by The Commonwealth Fund finds
that one-third of U.S. patients with health problems reported
experiencing medical mistakes, medication errors, or inaccurate or
delayed lab results-the highest rate of any of the six nations
surveyed.

While sicker patients in all countries reported safety risks, poor care
coordination, and inadequate chronic care treatment, with no country
deemed best or worst overall, the United States stood out for high
error rates, inefficient coordination of care, and high out-of-pocket
costs resulting in forgone care.

Results and analysis from the survey-the eighth in a series of
Fund-supported cross-national surveys-are discussed in Taking the
Pulse of Health Care Systems: Experiences of Patients with Health
Problems in Six Countries (Health Affairs Web Exclusive, November 3,
2005).

For the first time, the survey includes Germany, in addition to
Australia, Canada, New Zealand, the United Kingdom, and the United
States. The 2005 study examines issues of safety, health care
coordination, chronic disease care, and access to care. Adults who had
recently been hospitalized, had surgery, or had health problems were
interviewed by telephone between March and June 2005.

Medical, Medication, and Lab Errors
One-third (34%) of U.S. respondents reported at least one of four types
of errors: they believed they experienced a medical mistake in
treatment or care, were given the wrong medication or dose, were given
incorrect test results, or experienced delays in receiving abnormal
test results. Three of 10 (30%) Canadian respondents reported at least
one of these errors, as did one-fifth or more of patients in Australia
(27%), New Zealand (25%), Germany (23%), and the U.K. (22%). While
patient safety efforts have focused chiefly on hospital settings, most
patients (60% or more) said these errors occurred outside the
hospital-a signal that safety initiatives should also focus on
ambulatory care, said Cathy Schoen, the study's lead author and a
senior vice president at The Commonwealth Fund.

Patients receiving complex care may be at even higher risk of medical
errors: the incidence of patient-reported errors rose sharply with the
number of physicians seen. Despite studies showing patients value
discussion about mistakes or errors, most patients (61% to 83%) in each
country said the health care providers involved did not tell them about
the mistakes.

Communication and Care Coordination
Communication issues also adversely affect patients' experiences during
hospital stays. At least one-fifth of patients (19% to 26%) in the six
countries reported communication gaps between themselves and hospital
staff, and one-sixth said they would have liked greater involvement in
decisions made about their care.

Good transitional care-helping patients transfer from hospital to
home-also relies on clear communication and coordination. In all six
countries, however, at least one-third of patients said they did not
receive instructions about symptoms to watch for, did not know whom to
contact with questions, or were left without follow-up care
arrangements. German patients had the highest rate of coordination
deficiencies when discharged from the hospital, with 60 percent
reporting failures to coordinate care. According to the authors, poor
transitional care can result in complications and increase the
likelihood of hospital readmission, raising concerns about costs as
well as quality.

While the U.S. performed better than most countries on the hospital
transition measure, it had the highest rate of patients reporting
coordination problems during doctor visits. One-third (33%) of U.S.
respondents said that either test results or records were not available
at the time of appointments or that doctors duplicated tests. These
delays and duplications are a clear sign of inefficient care, the
authors said, and waste both physicians' and patients' time and
resources. Rates of care coordination problems in the other survey
countries were significantly lower, ranging from one-fifth to
one-quarter of patients reporting such problems.

Access Issues, Financial Burdens, and Forgone Care
As was found in past surveys, the U.S. is an outlier in terms of
financial burdens placed on patients. One-half of adults with health
problems in the U.S. said they did not see a doctor when sick, did not
get recommended treatment, or did not fill a prescription because of
cost. Despite these high rates of forgone care, one-third of U.S.
patients spent more than $1,000 out-of-pocket in the past year. In
contrast, just 13 percent of U.K. adults reported not getting needed
care because of costs, and two-thirds had no out-of-pocket costs.

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