How Does Primary Care in the U.S. Compare to Other Countries?

As a nurse practitioner, you have an idea of how the average American primary care visit works.  The patient arrives at the clinic, is greeted by a receptionist and instructed to fill out a few forms...on paper.  Then, the patient waits...and waits some more until they are called back to the exam room.  Then, following the visit a complex billing mess ensues.  This is the routine Americans have grown to expect when seeking primary care.  But what about in other countries?  Which countries are most satisfied with their primary care systems?

Researchers from the Commonwealth Fund and Harris Interactive surveyed over 8500 physicians in the United States, Canada, Germany, France, the United Kingdom, the Netherlands, Norway, Switzerland, New Zealand and Australia making some interesting discoveries.  Here are some of their key findings:

  • In the U.S., the only country surveyed without universal health coverage, 59% of physicians reported their patients often have difficulty paying for their medical care.  Physicians from Norway (4%), Switzerland (16%), Germany (21%), the U.K. (13%), and Australia (25%) had much less concern about patient's ability to afford medical care. 
  • 52% of U.S. physicians said they spend too much time deling with insurer's restrictions on covered treatments or medications.  Just 9% of physicians in the U.K and 10% of physicians in Sweden and Australia report frustration in dealing with insurance restrictions.
  • In the U.S., 69% of physicians say they use electronic medical records.  This is compared to 98% in the United Kingdom, Norway, New Zealand and the Netherlands.  The country with the lowest EMR usage was Switzerland at 41%.  Although most countries report a high rate of EMR usage, half or fewer physicians in every country but New Zealand report being able to exchange patient information electronically with physicians outside their practices. 
  • 28% of U.S. primary care doctors say their patients have long waits to to see a specialist compared to just 10% in Switzerland.  In Canada, however doctors report 73% of their patients have excessive waits to receive specialty care. 
  • 21% of primary care physicians in the U.S. say the quality of care their patients receive has improved in the past 3 years, 25% report quality of care has decreased.  In France, the highest percentage of doctors (37%) believe primary care care has worsened.  Physicians from the Netherlands reported primary care had improved at the highest rate, 38%.

What can we make if these survey results?  It seems that all countries struggle with their primary care systems.  In fact, out of 11 countries surveyed, in 8 countries less than half of physicians believe their health care system works well.  The U.S. had the lowest rate, 15%, of physicians reporting that the country's health care system works well.  Our country certainly needs changes made to the primary care system on a large scale.  What changes do you think need to be made?  How should we implement these changes?  What changes can you make on a smaller level in your practice?