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In a freshly minted radio commercial, Republican Presidential candidate Rudy Giuliani boasts, "We have the best health-care system in the world." It's an oft-heard refrain from politicians and policymakers. Patients beg to differ.



According to a survey published on Nov. 1 in the journal Health Affairs, one-third of U.S. adults believe that the U.S. health-care system has to be rebuilt completely -- double the percentage who want a dramatic overhaul in the six other nations whose residents took part in the survey. The U.S. ranked dead last on the question whether more than minor system changes were needed.



The nonpartisan New York City-based Commonwealth Fund, which studies health-care issues, interviewed 12,000 adults in Canada, Germany, the Netherlands, New Zealand, Britain, Australia, and the U.S. this spring to get a handle on actual patient experiences and perceptions. The results paint a damning picture of user satisfaction with the American health-care system and could provide fodder in a Presidential campaign where health care is expected to play a major role [BusinessWeek.com, 9/17/07]. All the countries in the survey except the U.S. have universal health coverage, and the percentage of GDP the U.S. spends on medical care is about twice as high as the other six.



Best in Bummers

U.S. patients were the only ones to report serious problems paying bills [19%]. Plus, 30% of patients paid $1,000 or more out-of-pocket over the past year, while the percentage of patients laying out that much in the other six ranged from 4% [Britain] to 19% [Australia]. Nearly two out of five U.S. adults and 42% of those with chronic illnesses skipped medications or did not see a doctor when sick because of cost. Those rates are much higher in the U.S. than in any other country.



"The U.S. often stands out [in the survey] for negative care experiences," says lead author Cathy Schoen, Commonwealth Fund senior vice-president. In a Commonwealth study released last year, the U.S. received low grades [BusinessWeek.com, 9/21/06] in outcomes, quality of care, access to care, and efficiency, compared with other industrialized nations.



According to Schoen, the more negative or costly the experience, the more negative the overall perception of the health-care system. Dissatisfaction with the U.S. system crosses socioeconomic lines, too. Both high- and low-income respondents had similarly negative views of the U.S. health-care system, Schoen notes.



Would Never Be Good?

Though they're not happy with aspects of the system, U.S. residents are about as confident as those of other nations that they would get high-quality care and the best drugs and medical technology. The Netherlands consistently scored higher in all three categories. Still, U.S. patients can't count on speedy access to care; 51% said they could not get an appointment [BusinessWeek.com, 6/22/07] the same or the next day when they were sick. Only Canada scored worse, with 64% saying they had to wait.



Once in the health-care system, 32% of U.S. patients suffered medical mistakes, the highest rate of the seven nations. That could be because the U.S. ranked last when it came to their doctors having access to their medical records at the time of an office visit.



The full survey can be read at commonwealthfund.org.