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Background The United States is considering enacting a national health plan and global health care budget similar to those in other countries. There are few data on the effects of such policies on physicians and patients.
Methods We conducted a telephone survey of 602 physicians in the United States, 507 physicians in Canada, and 519 physicians in the former West Germany from February through May 1991; the response rates were 44 percent, 49 percent, and 41 percent, respectively. Among other topics, the questionnaire included measures of satisfaction with the health care system and with medical practice.
Results In the United States, 23 percent of the physicians surveyed thought the health care system worked well, as compared with 33 percent in Canada and 48 percent in West Germany. Seventy-three percent of U.S. physicians reported that patients' inability to afford necessary treatment was a serious problem, as compared with 25 percent in Canada and 15 percent in West Germany. Seventy-seven percent of West German physicians, 56 percent of Canadian physicians, and 54 percent of U.S. physicians said the shortage of competent nurses was a serious problem. In Canada, 50 percent of the respondents cited the lack of well-equipped medical facilities as a problem, as compared with 14 percent in the United States and 20 percent in West Germany.
Conclusions Programs of universal coverage and cost containment necessitate important trade-offs. In Canada and West Germany, physicians do not report serious problems of access to care for the poor and uninsured. In the United States, doctors do not face the limited access to sophisticated forms of medical technology that was reported in Canada or the diminished quality of some services reported in West Germany.
Source Information
From the Department of Health Policy and Management, Harvard School of Public Health, Boston (R.J.B., K.D., A.E., C.K., S.W.L.); Louis Harris and Associates, New York (R.L.); the Department of Medical Care Policy, Harvard Medical School, Boston (A.E.); the Robert Wood Johnson Foundation, Princeton, N.J. (J.C.C.); the Institute for the Future, Menlo Park, Calif. (I.M., T.M.); and the Institute for Health Policy, Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University, Waltham, Mass. (A.B.C.).
Address reprint requests to Dr. Blendon at the Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115.
Related Letters:
Reforming Our Health Care System
Freedman J. K., Korns N., Robb J. A., Hurt M. A., Grosz R., Armey D., Beach S. G., Longo D. R., Angell M.
Extract |
Full Text
N Engl J Med 1993;
329:806-808, Sep 9, 1993.
Correspondence
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