Large Differences between Primary Care Practices in the United States, Australia, Canada, Germany, New Zealand, the Netherlands and the United Kingdom
The United States and Canada compare unfavorably with the other five countries on the use of information technology, access, and "pay for performance" incentives to improve quality
Among the most interesting and, we believe, the most important research projects by Harris Interactive® are the nine multi-national surveys of health care systems we have conducted each year since 1998 for the Commonwealth Fund. This year’s surveys were conducted among primary care physicians in Australia, Canada, Germany, The Netherlands, New Zealand, the United Kingdom and the United States between February and July, 2006. The results were published online in a paper by Cathy Schoen, Robin Osborn, Phoong Trang Huynh, Michelle Doty, Jordon Peugh and Kinga Zapert in Health Affairs, in November 2006. This year’s survey allows each of the seven countries to benchmark key elements of primary care with the other countries.
Use of Health Information Technology (HIT)
There are huge differences in the percentages of primary care doctors using health information technology across the seven countries. For example:
-79 percent or more of primary care doctors in the Netherlands (98%), New Zealand (92%), the United Kingdom (89%) and Australia (79%) use electronic medical records. Only 28 percent of primary care doctors in the United States and 23 percent in Canada do so.
-The sharing of records electronically with doctors outside their practice varies from six percent in Canada to 45 percent in the Netherlands.
-The routine use of electronic prescribing varies from 11 percent in Canada to 85 percent in the Netherlands.
-The use of electronic systems to routinely alert doctors about potential drug interactions varies from 10 percent in Canada to 93 percent in the Netherlands.
-The proportions of physicians who use electronic systems to routinely send patient reminders for follow-up care vary from eight percent in Canada to 93 percent in New Zealand.
-The capacity to easily generate lists of patients by diagnosis ranges from a low of 26 percent in Canada to a high of 92 percent in the UK.
Overall country comparisons on the use of HIT
Using composite score based on the use of seven or more of the 14 different HIT functions, the "best" countries are New Zealand (87%), the United Kingdom (83%), and Australia (72%).
The "worst" countries with the lowest use of the 14 functions are Canada (8%), the United States (19%) and Germany (32%).
The survey included three questions related to access:
-In five countries, more than three-quarters of primary care doctors reported that their practices had arrangements for patients to see doctors or nurses after hours. Less than half of doctors in the U.S. (40%) and Canada (47%) have such arrangements.
-In most countries rather small minorities, from seven percent in the Netherlands to 27 percent in New Zealand, report that their patients often have difficulty paying for medications. The 51 percent of primary care doctors in the U.S. who report this is much higher than elsewhere.
-Large numbers of doctors in the United Kingdom (57%) and Canada (51%) report that their patients often experience long waits for diagnostic tests. Hardly any doctors in Australia (6%), Germany (8%) or the U.S. (9%) report this happens often.
Participation in quality activities
Primary care physicians in Germany (76%) and New Zealand (78%) are the most likely to have participated in quality improvement programs. Canadian (48%) and U.S. (49%) doctors are the least likely to have done so.
Doctors in the United Kingdom (96%) are the most likely to have conducted clinical audits of patient care. Doctors in Canada (45%) and the Netherlands (46%) are the least likely to have done this.
United Kingdom and German doctors (both 70%) are the most likely to have worked with formal targets for clinical performance. Australian (26%) and Canadian (27%) doctors are the least likely to have done so.
Availability of data on clinical outcomes or performance
The proportions of primary care physicians who have available data on clinical outcomes are highest in the United Kingdom (78%) and Germany (71%) and lowest in Canada (24%).
United Kingdom doctors also head the list by a wide margin (89%) of those who use surveys of patient satisfaction and experiences. Few doctors in Canada (11%) and the Netherlands (16%) use patient surveys.
Use of documented process for following up or analyzing adverse events
The great majority (79%) of primary care doctors in the United Kingdom have a documented process for following up or analyzing all adverse events. An additional eight percent have a documented process to follow up drug reactions only. Only 13 percent of United Kingdom physicians have no such process. No other country comes close to the United Kingdom, with between 37 percent (in the U.S.) and seven percent (in the Netherlands) having a process to follow up all adverse events.
"Pay for performance" incentives
There are huge differences between the seven countries in their use of financial incentives linked to quality of care. Most (95%) United Kingdom primary care doctors can receive payments based on some measure of the quality of care they provide. Only 30 percent of U.S. doctors do so, with other countries varying from 79 percent in New Zealand to 41 percent in Canada.
The survey asked doctors about five specific types of incentives. United Kingdom doctors scored by far the highest numbers of any of them – from 92 percent on "achieving certain clinical care targets" to 52 percent on their ratings for patient satisfaction.
In the United States, the highest numbers were for physicians’ potential to be paid for achieving certain clinical targets (23%) and ratings for patient satisfaction (20%). Less than two in 10 can be paid extra for how they manage patients with chronic conditions and complex needs (8%), enhanced preventive care activities (12%) or participation in quality improvement programs (19%).
For complete study information and results, see 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians Conducted by Harris Interactive (www.cmwf.org).
This complete release with tables and other downloadable PDFs of Healthcare News are posted at http://www.harrisinteractive.com/news/newsletters_healthcare.asp