Quality of medicine a problem worldwide, doctors say

Medical errors, nursing shortages and high prescription costs trouble other nations, too.

By Susan J. Landers, amednews staff. Nov. 6, 2000.

Washington -- U.S. physicians aren't alone in many of their complaints about the health care system.

Physicians surveyed in five English-speaking nations, including the United States, reported that their ability to provide quality care has deteriorated during the past five years despite increased health care spending and medical advances.

Quality slide

"What's worse is that many doctors in all five countries fear this decline in quality will continue," said Robert J. Blendon, ScD, survey author and professor of health policy and political analysis at Harvard University.

"Doctors' concerns sound a wake-up call," he said. "The good news is that they don't view the situation as irreversible and offer concrete suggestions for improvement."

Almost three-quarters of physicians in all five countries reported that if they could spend more time with patients, the quality of care would improve. A substantial number of physicians in all countries also endorsed electronic prescribing and electronic patient medical records as ways to improve quality.

The findings were released last month by Harvard and the Commonwealth Fund during a news briefing attended by U.S. Health and Human Services Secretary Donna Shalala, PhD, and the health ministers of the nations included in the survey.

When asked for a solution, Dr. Shalala suggested a team approach that includes physician input to improve the U.S. health care system.

Australian Health Minister Dr. Michael Wooldridge said the complexity of health care systems makes it difficult to implement changes in the short time available to a particular political party before the next election ushers in a different agenda.

About 500 physicians in each of the countries were surveyed on a range of issues, including the detection of medical errors and shortages of both nurses and the latest medical and diagnostic equipment.

Many physicians in all five countries said their hospitals do a "poor" or "fair" job finding and addressing medical errors. In the United States, about one-third of physicians faulted hospitals' performances, and dissatisfaction with hospitals ranged even higher among physicians elsewhere.

Nursing shortages emerged as a key concern for U.S. physicians -- the only resource widely viewed as being in short supply here. Although physicians in the other four countries also reported a shortage of nurses, they said patients' lengthy waits for specialist care and a lack of hospital beds and diagnostic equipment posed more serious problems.

Physicians in the United States and New Zealand expressed concern about patients' ability to pay for care. U.S. doctors were especially concerned about high prescription drug costs. About half of the U.S. doctors surveyed identified the affordability of prescription drugs for their patients as a major problem.

The views of the public in each country about their health care systems might be even more pessimistic than those of doctors. Responding to a 1998 Harvard/Commonwealth survey, 14% to 35% of the public in each country called for a complete rebuilding of their health care system. In the current survey, fewer than 12% of doctors surveyed from any country held the same view.

ADDITIONAL INFORMATION:

Quality slide

A survey of physicians shows that more generalists believe their ability to provide quality care has worsened in the past five years. (Chart excludes "about the same" and "don't know" responses.)

               Worsened   Improved
               --------   --------
  Australia       38%        27%
  Canada          59%        10%
  New Zealand     54%        20%
  United Kingdom  45%        26%
  United States   56%        15%

Source: Commonwealth Fund/Harvard/Harris