U.S. patients face high costs, access barriers.(Practice Trends)

WASHINGTON -- Patients in the United States face some of the highest health care costs and barriers to primary care access, according to a study that compares the U.S. system with four other countries.

"There are shortfalls both in accessibility, coordination, safety, and patient-centered care in all countries, but also notable country variations," Cathy Schoen, lead author of the study, said at a briefing sponsored by the Commonwealth Fund.

The U.S. health care system received some of the lowest ratings from patients in patient-centered care, cost, and access to needed care. But the United States did better on preventive measures such as administering Pap tests and mammograms.

The Commonwealth Fund study, which was published as a Health Affairs Web exclusive, examined primary care and health system performance in the United States, Australia, Canada, New Zealand, and the United Kingdom. It is based on a telephone survey conducted by Harris Interactive between March and May 2004.

In all five countries, most respondents said they have a usual doctor or place where they receive care. However, in the United States, only about 37% of patients have been with the same doctor for 5 years or more, compared with half or more in the other countries.

More than half of patients in New Zealand and Australia reported they could get a same-day appointment with their primary care doctor when they were sick, compared with 33% in the United States and 27% in Canada.

About 25% of respondents from Canada and 19% of respondents from the United States said they had waited 6 days or more to get an appointment with their primary care physician the last time they were sick.