Although the United States spends a vast amount of money on healthcare, its successes--including in the health IT area--pale in comparison with other countries, concluded the authors of a report based on a Commonwealth Fund survey.

The 2009 survey--published Nov. 2 online in Health Affairs--polled primary care doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and the U.S. It found vast differences in practice systems, incentives, perceptions of access to care and use of health IT programs to improve quality among the 11 countries.

The authors found that U.S. primary care physicians continue to lag well behind in health IT capacity, are the least likely to have arrangements for after-hours care and report few incentives or targeted support for improving primary care.

Primary care physicians in each country were sampled and surveyed using a common questionnaire. Practicing physicians were chosen randomly from public and private lists. Response rates for the survey exceeded 40 percent except in four countries: the U.S. (39 percent); Canada (35 percent); the U.K. (20 percent); and France (7 percent).

According to the survey, 46 percent of U.S. respondents use EMRs in practice. In the Netherlands, New Zealand, Australia, Sweden and the U.K., EMRs are nearly countrywide. New Zealand and Australia topped the charts with respondents citing 97 and 95 percent of EMRs in use, respectively.

To assess multifunctional capacity, the authors created a summary variable counting the number of functions and categorized systems as low (0-3), middle (4-8) or high (9-14). The U.S. found most of its EMRs utilized to be in the low system ranking (51 percent). Percentages in the middle and high functionality groups were similar with 23 percent and 26 percent, respectively.

Australia had 91 percent of highly functional EMRs, second to New Zealand's 92 percent.

The survey also found that:

• 58 percent of the U.S. respondents said that their patients often have difficulty paying for medications or other medical care. In comparison, just 6 percent of Swedish respondents reported this to be a concern.
• 48 percent of U.S. physicians reported that the time spent getting patients needed medications and treatment because of coverage restrictions was a concern. The U.S. ranked the highest in this category followed by Italy (42 percent), Germany (34 percent) and Canada (19 percent).

Overall, the authors concluded that the survey highlights the lack of national policies focused on U.S. primary care.

The advanced health IT capacity, extensive quality incentives and team use reported by Australian, Dutch and New Zealand doctors reflected national payment and information system policies focused on primary care, the authors found.

In all countries with widespread adoption and use of health IT, a combination of financial incentives, standards and technical support has been instrumental in their deployment, the authors stated.

“Unless primary care practices are part of more integrated care systems [in the U.S.], they are on their own facing multiple payers with uncoordinated policies,” the authors stated.