During the past decade there have been many studies done on the United States healthcare system, more specifically on primary care, due to the efforts to try and change the healthcare system for the better. The legislation that started it all was the Affordable Care Act (ACA), whose main goal was to expand the access of health coverage for Americans; with others aims being to protect patients against irrational actions by insurance companies and to lower costs. Because ACA started the change to a better healthcare system, we are now finally making a transition from a fee-for-service reimbursement structure to a value-based care reimbursement structure and are now more than ever, focused on the benefits of an efficient and effective primary care system.
What better way to improve our own health care system than to look at the structures of other countries healthcare and primary care?
Here are some of the main statistics and facts from a slew of research studies including the 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians:
- Nearly 25% (1 in 4) of primary care physicians in the US report that they are not prepared to care for the sickest and weakest patients, and 84% say that they are not prepared to manage patients with serious mental health illness.
- The US has a younger patient population but still a higher share of patients with chronic illness, mental health issues and other significant health problems.
- In the US only 31% of primary care physicians report that they get notified when a patient is sent to the ED or is discharged from the hospital, compared to the 69% of PCPs in the Netherlands who report to always getting notified when these events happen.
- Slightly less than 40% of US PCPs had made arrangements for patients to get after hours care without going to the ED which was the lowest rate in one of the surveys, this was compared to 94% in the Netherlands and 92% in New Zealand and 89% in the UK.
- Only 6% of US PCPs can make home visits compared to more than 80% in the UK and the Netherlands.
- In the US 57% of PCPs communicate with patients via email (within and EHR software) and 60% allow patients to access their medical records online, but only 52% of doctors say that they are satisfied with their EHR system.
- 80% of Americans who needed to see a specialist were seen in less that 4 weeks compared to 41% in Canada.
- The US is in 7th place in regards to the percent of adults (57%) who can see a doctor or nurse the same day that they need care, with 19% of adults having to wait 6 or more days to see a healthcare professional.
- 1 in 3 American adults skipped a doctor’s visit, didn’t pick up a prescription or get other care in the past year (survey done in 2009) because it costs too much.
- The US had the highest rate of poor primary care coordination out of 11 countries at 9.8%.
- Poor primary care coordination was more likely to occur among patients with chronic conditions and those younger than 65.
- Patients with poor care coordination were more likely to be hospitalized and more likely to visit the emergency department.
- 59% of US physicians said that their patients often have difficulty paying out-of-pocket costs for medical care, higher than all other 10 countries.
- US and German physicians are the most negative about their healthcare systems.
- More than half of US respondents (physicians) said that they or their staff spend too much time getting patients care because of coverage restrictions on treatment or medications.
- In the Health Affairs surveys in 2012, all countries in the survey (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Switzerland, UK and the US) besides the US and Canada, have policies for after-hours coverage and access to primary health care services.
- The countries in the survey stated above all provide universal coverage (besides the US), and with the exception of Switzerland have little or no cost sharing for primary care and essential medications. As well as all of the other countries limiting out-of-pocket expenses to levels well below those typical in US insurance.
- In Sweden and in the US 1 in 6 physicians reported that their practice was not well prepared for patients dealing with mental health or substance abuse issues.
- A larger percentage of doctors in the US provide their patients online access to view, download, or transmit information from their medical record; with the US at 60% and all other countries at 28% or below. Therefore there is a larger use, and transitions to using EHR systems in the US.
Some takeaways from these studies have shown that the US healthcare system needs reform, including enhanced access to care for all patients. The US primary care practices are behind other countries in their readiness to manage the care of high-needs patients and that we need to strengthen our primary care infrastructure to be able to ensure affordable and high-quality health care for our sick and complex patients as well as all patients.
US consumers have better access to speciality care but have a harder time seeing a doctor on the day they need help and paying their medical bills than consumers in other countries. We need to figure out a way to make it easier for patients to get care on nights and weekends and be able to enable access to social services.
The only area that the US exceeded in, compared to the other countries was the fact that our primary care physicians are using and implementing EHR systems in their practices much more than physicians in other countries. Using EHR systems benefits us because it helps our physicians coordinated care more efficiently, although we are still behind other countries because they have other tactics to help increase care coordination such as always getting notified when one of their patients is seen in the Emergency Department and when their patients are discharged from a hospital.
In these surveys better care coordination was associated with having an established relationship with a regular physician, indicating the ongoing benefits of strengthening of primary care and another reason why we should be focusing on the enhancement of primary care practices.