The 2009 Commonwealth Fund International Health Policy Survey published online in the journal Health Affairs of more than 10,000 primary care physicians in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and the United States describes a U.S. primary-care system that is under stress and highlights areas where the United States can learn from other countries. The United States could improve by using financial incentives to upgrade quality and efficiency, and expanding the use of health-information technology to prevent medical errors.
U.S. doctors, for example, are far less likely to use health-information technology that helps reduce errors and improve care. Only 46 percent of U.S. doctors in the survey use electronic medical records, compared to 99 percent of doctors in the Netherlands and 97 percent of doctors in New Zealand and Norway.
“Access barriers, lack of information and inadequate financial support for preventive and chronic care undermine primary care doctors’ efforts to provide timely, high-quality care and put the U.S. far behind what many other countries are able to achieve,” says Commonwealth Fund President Karen Davis. “Our weak primary-care system puts patients at risk, and results in poorer health outcomes and higher costs.”
Among the findings:
Health-information technology: While nearly half (46 percent) of U.S. primary-care doctors report using electronic medical records (EMRs) – up from 28 percent in 2006 – U.S. primary-care practices, along with Canadian doctors, continue to lag well behind other leading countries. EMRs are nearly universal in the Netherlands (99 percent), New Zealand (97 percent), the United Kingdom (96 percent), Australia (95 percent), Italy (94 percent), Norway (97 percent) and Sweden (94 percent).
In addition to basic EMRs, the survey asked about a range of 13 possible computer functions, including electronic-medication prescribing and alerts for medication errors, ordering lab tests and viewing test results, and support and prompts for preventive care and follow-up care with patients. Here, country results varied widely, ranging from nearly all to half of doctors reporting at least nine of 14 possible computerized functions in New Zealand (92 percent), Australia (91 percent), the United Kingdom (89 percent), Italy (66 percent) and the Netherlands (54 percent), to one fourth or fewer practices in the United States (26 percent), Canada (14 percent), France (15 percent) and Norway (19 percent).
In the United States, according to the survey, advanced information capacity is concentrated in larger group practices and those affiliated with integrated-care systems. In contrast, in the seven countries with near universal use of EMRs, there was little or no difference in advanced health-information technology use by practice size. In these countries, national policies and standards have supported wide adoption of information technology in primary-care practices.
Financial incentives to improve quality: Every country in the survey, to some degree, uses financial incentives to improve primary care, preventive care or disease management. Primary-care physicians in the United States, however, are among the least likely to report that they receive financial incentives for quality improvement, such as bonuses for achieving high patient-satisfaction ratings, increasing preventive care, use of teams, or managing patients with chronic disease or complex needs. Only one-third of U.S. physicians reported receiving any financial incentives for the six quality improvement measures in the survey. Rates were also low in Sweden and Norway.
In contrast, significant majorities of doctors in the United Kingdom (89 percent), the Netherlands (81 percent), New Zealand (80 percent), Italy (70 percent) and Australia (65 percent) report some type of extra financial incentive or target support to improve primary-care capacity.
Quality reporting and feedback: Many countries in the survey have also been investing in information on performance to provide incentive and benchmarks. Asked about comparative information systems, doctors in the United Kingdom are most likely to routinely receive and review data on clinical outcomes (89 percent), followed by Sweden (71 percent), New Zealand (68 percent) and the Netherlands (65 percent). Just 43 percent of U.S. doctors report such reviews.
