Defacto Rationing of Healthcare in America

[FayeforCure]

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.

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.

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.



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. patientsâ€"the highest proportion in the surveyâ€"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.

http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2008/Nov/In-Chronic-Condition--Experiences-of-Patients-with-Complex-Health-Care-Needs--in-Eight-Countries--20.aspx

[CMG22]

I enjoyed listening this morning to the Diane Rehm show.  Her guest stated that the US spends two times more on health care per capita than any other industrialized nation--$7,900/person in 2007.  Despite that, we have no better levels of care.  That means that our $4,000/person extra that we spend goes where, people?  Listen online to the show, and find out...