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Taking The Pulse Of Health Care Systems: Experiences Of Patients With
Health Problems In Six Countries
Patients’ voices can provide policy leaders with a
window onto what is happening at the front lines of care.
by Cathy Schoen, Robin Osborn, Phuong Trang Huynh,
Michelle Doty, Kinga Zapert, Jordon Peugh, and Karen Davis
For the full article see:
http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.509/DC1
ABSTRACT:
This paper reports on a 2005 survey of sicker adults in Australia,
Canada, Germany, New Zealand, the United Kingdom, and the United States.
Sizable shares of patients in all six countries report safety risks,
poor care coordination, and deficiencies in care for chronic conditions.
Majorities in all countries report that mistakes occurred outside the
hospital. The United States often stands out for inefficient care and
errors and is an outlier on access/cost barriers. Yet no country
consistently leads or lags across survey domains. Deficiencies in
transition care during hospital discharge and coordination failures
among patients seeing multiple physicians underscore shared challenges
of improving performance across sites of care.
Advanced industrialized countries around the world share the quest for
health reforms that improve the performance of their medical care
systems.1 Clinical and pharmaceutical advances that have improved
medical care have at the same time fueled more complex, specialized, and
fragmented care, with accompanying risks to patients and increased
costs. In each country, health spending is highly concentrated among
patients with chronic care needs, who are often hospitalized or receive
major surgery. These patients often see multiple physicians across sites
of care, which heightens the risk of errors or breakdowns in care
coordination.
Patients’ experiences can provide feedback on the “pulse” of health care
systems as countries seek to redesign care delivery, payment, or
insurance. From patients’ perspectives, a health system is likely to be
judged by timely access, affordability, safety, responsiveness to
preferences, efficient care coordination, and perceived clinical
outcomes. As patients move across sites of care, their voices can
provide policy leaders with a window onto the front lines of care.
To provide a patient and cross-national perspective, the 2005
Commonwealth Fund International Health Policy Survey interviewed adults
in six countries who had recently been hospitalized, had surgery, or
reported health problems. The eighth in a series of cross-national
surveys, the 2005 survey for the first time includes Germany in addition
to Australia, Canada, New Zealand, the United Kingdom, and the United
States.2 Conducted in countries with distinct insurance and care
delivery arrangements, the study examines country systems’ performance,
with a focus on safety, coordination, access, and chronic disease
management.3
Overall, the findings reveal strikingly similar deficiencies in care in
many areas. Medical errors and failures to coordinate care, especially
during transitions, emerge as shared concerns, along with missed
opportunities to elicit patients’ views and engage chronically ill
patients in their care. However, the study also finds sizable
differences across countries. The United States often stands out with
high medical errors and inefficient care and has the worst performance
for access/ cost barriers and financial burdens. In contrast, Germany
often ranks high for timely access. Yet no country is consistently worst
or best across all dimensions included in the survey. Performance
deficiencies indicate the shared challenges countries face as they seek
to redesign twenty-first-century systems to provide safer and more
effective, responsive, and efficient care and increase the value of
society’s investment in health care.
--
Kathrynne Holden, MS, RD < [log in to unmask] >
"Ask the Parkinson Dietitian" http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
http://www.nutritionucanlivewith.com/
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