A new survey indicates patients in several industrialized countries with national health care programs are more satisfied with their care than patients in the United States, where most people's health care is arranged privately or through their jobs.
The survey of patients in five industrialized nations finds that Americans are the most inclined to say their health care system needs to be reworked, with one-in-three calling for a total overhaul.
That was the finding of a telephone poll of 1,400 U.S. patients, who were asked to discuss their perceptions of their health care system. In addition, the survey polled the same number of patients in Britain, Canada, Australia and New Zealand, where every citizen has access to a government health care program.
Cathy Schoen, a vice president of The Commonwealth Fund, which commissioned the survey, says Britons are the most likely to give their health care system high marks.
"[Patients in] the United Kingdom are most satisfied, the least likely to call for rebuilding their system, the most likely to say the system works basically well, a pattern that has persisted over six years, but grown more positive since 2001," she said.
It's a finding that may be surprising to many Americans, who commonly think nationalized health care leads to long lines and compromised quality.
But the survey of patients' perceptions paints a different picture. Britons say they pay less to visit a doctor than their counterparts in the other survey countries, and they often are able to see a doctor the day they call for an appointment. In addition, Britons reported the fewest instances of inaccurate test results, and said they were quickly notified of any problems revealed by their tests.
Health policy experts caution that the results of this study are based only on patients' perceptions of care, not documented facts about each nation's health care system. But they believe the study can help policy makers develop ways to deliver what people want from their health care systems.
Ms. Schoen explains that part of health care dissatisfaction lies in the cost of medical care. The survey finds that more than 25 percent of Americans surveyed report spending more than $1,000 on medical bills in a year.
"On the other end of the spectrum, the UK stands out as the most protected, with the majority of patients saying they had no out-of-pocket costs," she said.
In each country, some people report that cost prevented them from seeking out medical treatment. The issue is most severe in the United States, where the study finds 40 percent of Americans sometimes decide to forgo treatment for financial reasons.
To a lesser degree, cost is an issue in New Zealand, Australia and Canada. Again, the survey finds British patients have the fewest complaints, with only one-in-ten saying fees keep them from visiting a doctor or taking the proper amount of prescription medication.
But Ms. Schoen says cost is not the only barrier to medical care. Many Americans and Canadians say it is difficult to get a doctor's attention on nights, weekends or holidays.
"The U.S. and Canada also stand out on this measure as the most likely to say they went to the emergency room because they didn't have access in the community," she noted. "I might point out these are the same two countries least likely to have same-day access to their doctors."
Meanwhile, the majority of New Zealanders and Australians say they were able to get an appointment right away the last time they were sick. Roughly 41 percent of British patients say the same.
Canada's assistant deputy health minister, Ian Shugart, attended the launch of the study. He says health care reform requires more than a quick fix.
"When the patient itches, we need to be prepared to scratch there, but with the right policy solutions that will support reform in the long term," he explained.
Health care reform was a major issue in the just-concluded U.S. presidential election campaign, with the Democratic Party candidate John Kerry advocating the creation of a government-sponsored health program and President Bush favoring more modest reforms. President Bush's re-election likely means there will not be any major restructuring of the U.S. health care system during the next four years. But he has talked about finding ways to reduce costs, and says he is committed to ensuring that patients and their doctors make health care decisions, without government interference.
