Study: U.S. Pays More, but Health Care Is Worse

Commonwealth Fund Report Says 'Medical Homes' Are the Key to Better Health Care

Medically Reviewed by Laura J. Martin, MD on November 08, 2011

Nov. 9, 2011 -- We not only pay a lot more for health care in the U.S. than in other countries, but a new study suggests the care we get is often slower and more poorly coordinated.

That's because other industrialized countries do a better job of giving patients easy access to primary care and to "medical homes" responsible for guiding care and complex treatment, according to a study published today by the Commonwealth Fund.

A medical home is a regular place of care where health care providers are accessible, know the patients' medical history, and help to coordinate care.

The study credits medical homes with lower rates of medical errors, poor information, coordination gaps, and emergency room visits.

For example, 42% of ill American patients reported duplicate tests, gaps in care, or other problems during the last year. That was about double the rate than in the U.K. and Switzerland, where medical homes are in wider use.

"For sicker patients and patients having chronic disease, having a medical home makes a difference. It makes a difference in every country," says Cathy Schoen, MS, senior vice president at the Commonwealth Fund.

Health Care Costs More Prohibitive in U.S.

The group surveyed roughly 18,000 chronically or seriously ill patients in 11 countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S.

It found the rate of patient-reported medical errors to be two to three times higher among U.S. patients than among patients in the U.K. or Switzerland.

The survey also finds that U.S. patients are more likely to forgo care because of cost than are patients in any of the other countries. More than four in 10 reported not visiting a doctor, skipping care, or not filling a prescription because of out-of-pocket costs. It was more than double the rate seen in several other countries.

However, U.S. patients had the most positive experiences concerning the ease of calling to ask a question or get advice from their health care provider between visits.

The Affordable Care Act, signed in 2009, promotes the idea of medical homes as a way to better coordinate care and cut errors. Officials at the Commonwealth Fund say their study backs up the idea.

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Commonwealth Fund: "New 2011 Survey of Patients with Complex Care Needs in Eleven Countries Finds Care is Often Poorly Coordinated."

Cathy Schoen, MS, vice president, Commonwealth Fund.

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