International Survey of Primary Care Doctors

The Commonwealth Fund has undertaken several projects to compare health systems in multiple countries.  Health Affairs reports on the results of the latest such survey.  (Health Affairs Article) Primary care physicians in eleven countries, including the United States, Canada, Australia and several in Europe, were randomly sampled and asked to respond to questions regarding several aspects of health care.

The doctors practice in a variety of systems, most with national health insurance and some with nationalized care providers.  Sweden, for example, has most of its doctors on the public payroll.  Many have little patient cost-sharing, particularly as compared to the United States.   Several countries–Australia, Italy, the Netherlands, New Zealand, Sweden and the UK–have nearly universal use of multi-function EMRs, but these systems generally do not include widespread use of decision support tools such as guidelines.  The United States lags other countries in availability of non-ER after hours care and in doctors reporting significant patient inability to pay for care.

On the other hand, patients in the United States have fewer issues with access to diagnostic tests or with extensive waits to see specialists.  In Canada, Italy, Germany and Sweden patients often have long waits or difficulty accessing specialty services.   Use of guidelines for caring for chronic disease patients was inconsistent across all countries, but team-based care for such patients is becoming more prevalent.  Many primary care doctors have the potential to get incentives for quality care, particularly in the UK, New Zealand, Australia, Italy and the Netherlands.  Somewhat surprisingly, a small portion of US doctors report being eligible for such incentives.  Overall, the survey results suggest that the United States could do a better job of creating and implementing universal policies to improve primary care practice.