Key Findings
* Patient safety: Among sicker adults, Americans had the highest rate of receiving wrong medications or doses in the prior two years. Among sicker adults who had a lab test in the past two years, adults in the U.S. were more likely than their counterparts in the other countries to have been given incorrect results or experienced delays in notification about abnormal results, with rates double those reported in Germany or the U.K. Rates of lab errors were also relatively high in Canada.
* Effectiveness: The indicators of effectiveness in the 2004 and 2005 surveys were grouped into four categories: prevention, chronic care, primary care, and hospital care and coordination. Compared with the other five countries, U.S. patients fared particularly well on receipt of preventive care and care for the chronically ill, although all countries had considerable room for improvement. Canada scored well on primary care, and Germany ranked first on hospital care and coordination. Across the indicators of effectiveness, the U.S. ranked first and New Zealand ranked last.
* Patient-centeredness: In 2004 and 2005, survey questions asked patients to rate the quality of their physician care in four areas: communication, choice and continuity, patient engagement, and responsiveness to patient preference. On measures of communication and patient engagement, New Zealand ranked highest. Germany was first on measures of choice and continuity, and Australia performed well on responsiveness to patient preference. Across the measures of patient-centeredness, Germany generally was highest, followed by New Zealand. The U.S. ranked last on nearly all aspects of patient-centeredness.
* Timeliness: Germany and the U.S. stand out among the six countries in terms of patients with health problems reporting the least difficulty waiting to see a specialist or have elective or non-emergency surgery. Yet Americans, along with Canadians, were more likely to say they waited six days or more for an appointment with a doctor or had trouble getting care on nights and weekends. Across all five measures of timeliness, Germany and New Zealand ranked first and second, respectively. The U.K. ranked fifth, and Canada ranked last.
* Efficiency: The 2005 survey included four questions on coordination of care that serve as indicators of health care system efficiency. Compared with their counterparts in other countries, sicker adults in the U.S. more often reported that they visited the emergency room for a condition that could have been treated by a regular doctor had one been available and that their medical records or test results failed to reach their doctor's office in time for appointments. About one of four U.S. sicker adults reported these concerns. U.S. sicker adults, along with their German counterparts, also were more likely to be sent for duplicate tests by different clinicians. On measures of efficiency, the U.S. ranked last among the six countries, with Germany and New Zealand ranking first and second, respectively.
* Equity: Nine measures from the two surveys gauged the extent to which patients' income affected their ability to access care. The U.S. scored last on seven of the nine measures of low-income patients not receiving needed care and had the greatest disparities in terms of access to care between those with below-average and above-average incomes. With low rankings on all measures, the U.S. ranked last among the six countries in terms of equity in the health care system. The U.K. ranked first, with no or negligible differences in terms of patients' access to care by income. The U.S. is the only country surveyed with large numbers of uninsured, and this contributed to its low rating for equity in the health care system. But even among above-average income respondents, the U.S. lagged considerably behind their counterparts in other countries.
