Wednesday, January 27, 2010

Which countries have the longest waits for medical care?

Yesterday, I borrowed liberally from Dr. Seuss' "Oh, the Places You Will Go" to describe the "weirdish, wild space" - The Waiting Place - in which we now find health reform.

This got me thinking about The Waiting Place in a different context: the time it takes to get an appointment with a physician. Anyone one of us who has had to wait weeks, or even months, for an appointment would agree that The Waiting Place is, as Dr. Seuss described it, a "most useless place" to be.

Critics of the pending health reform bills, like Conservatives for Patient Rights argue that they will lead to longer wait times for appointments. Their argument being that "government-run" health care, as exists in Canada or the United Kingdom, has been demonstrated to result in long waits for medical appointments.

I would dispute the premise that the reforms being considered by Congress are akin to the systems in place in Canada or the United Kingdom. Like it or not, the House and Senate bills would maintain private, employer-based health coverage as the principal source of insurance coverage. Still, I began to wonder about what the data show about wait times in different countries.

In 2007, the Commonwealth Fund released a report that compared U.S. health care against several other countries based on a variety of benchmarks. The data were principally derived from statistically random surveys of adult residents and primary care physicians from 2004 to 2006, in the following countries: United States, Canada, New Zealand, United Kingdom, Germany, and the Netherlands. This is what the researchers found:

* Canada had the highest percentage of patients (36%) who had to wait six days or more for an appointment with a doctor, but the United States had the second highest percentage (23%) who reported that they had to wait at least this long. New Zealand, Australia, Germany, and the U.K. all had substantially smaller numbers of people reporting waits of 6 days or longer. Canada and the United States, in that order, also had the lowest percentage of persons who said they could get an appointment with a doctor the same or next day.
* The United States had the largest percentage of persons (61%) who said that getting care on nights, weekends, or holidays, without going to the emergency room, was "very" or "somewhat" difficult. In Canada, it was 54%, and in the U.K, 38%. Germany did the best, with only 22% saying that it was difficult to get after-hours care.
* The United States, though, scored well on physicians' perceptions of how many patients experience long waits for diagnostic tests. 57% of physicians in the U.K, and 51% of Canadian physicians reported that their patients experienced long waits for diagnostic tests, compared to only 9% of U.S. physicians who reported the same.
* The U.K (60%) and Canada (57%) had the highest numbers of persons who had to wait four weeks or more to get to see a specialist physician. In the U.S., only 23% reported a wait of four weeks or more for specialty care.
* The U.S. also did very well on measures of wait times for non-emergency or elective surgery. Only 8% of surveyed patients in the United States reported a wait time of four months or more for elective surgery, compared to 33% in Canada and 41% in the U.K. Germany scored the best, with only 6% reporting a long wait for elective surgery.

The take-away message is that both the United States and Canada do pretty poorly, compared to most other industrialized countries, on how long patients have to wait to get a regular appointment with a primary care physician or after-hours care, but the U.S. does better than most on having shorter wait times for diagnostic procedures, elective surgery, and specialty care. Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn't seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.

Today's question: What is your reaction to the data on each country's experience with wait times for medical care?

1 comment :

Rich Neubauer MD said...

As with many other things that have emerged in the great health care debate of 2009-10, the perception of excellence that we have in this country in regards to how we stack up against other countries is not always supported by data. This seems to be another example.

I hate overused terms, but this is an area where "granularity" of the data is important. Waiting times for elective things is very different from waiting for things that should be readily accessible and could be dangerous if otherwise. In the data you outline there are some disturbing things -- most notable to me was access to a primary care physician. This type of access should be quick to be most beneficial to the patient.

Which brings me to the last point which I've been thinking about anyway lately. Conceptually, I'll call this inadvertent rationing. We do that by inattention but the result is the same as if it was done purposefully -- an essential resource that we allow to wither to a point of being inaccessible to those who need it. This is inexcusable and just another reason why we really do need comprehensive health care reform not just a few bandaids on the insurance industry.