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Friday, November 2nd 2007

Your Opinion Counts

It is difficult to argue that single payer or socialized medicine systems, with some minimal adequate threshold of funding, do not increase both access and overall health by utilitarian measures as compared to how the U.S. does things. That being said, these user surveys the Commonwealth Fund keeps spitting out are just non-starters, which shed virtually no light on the condition of the American health care system.

In the newest one, the most laughable results involve medical errors,

Among adults in the seven countries, U.S. adults reported the highest overall error rates, including lab and medication errors. One-third of U.S. patients (32%) with chronic conditions reported a medical, medication, or lab test error in the past two years, compared with 28 percent of patients in Canada, 26 percent in Australia, and fewer patients in the other countries. Patient-reported errors were highest in every country for those seeing multiple doctors or with multiple chronic illnesses.

Self reporting medical errors? I’m not sure most adults can even define medical errors. It’s just chock full of potential bias. Consider the relative health literacy of the patients in the various countries, consider the relative expectations for health care in the various countries. The list goes on and on. “Data” like this is sensationalism and nothing more.

In the United States, Canada, New Zealand, Australia, and the United Kingdom, 49.5 percent, 40.2 percent, 29.6 percent, 27.3 percent, and 13.3 percent of respondents, respectively, had spent more than fifteen minuteswith the doctor at their most recent visit. On the other hand, satisfaction rates for respondents were lowest in the country that reported the most time spentwith the doctor. The lowest rate of satisfaction was reported in the United States (75.5 percent), compared with higher percentages in Canada (82.8 percent), the United Kingdom (83 percent), Australia (84.8 percent), and New Zealand (84.8 percent). Satisfaction surveys do not necessarily reflect variations in how people are actually treated by the system.

But instead surveys like the Commonwealth Fund’s reflect expectations versus actual outcomes. Such likely influences a whole swath of questions, including the reporting of medical “errors.” And it is hard to imagine a “correction” for such relative expectations.

The point is the American public has greater expectations for health outcomes than virtually any other developed nation. That sits as merely one example of the extreme limitations of these consumer surveys.

That isn’t to say there isn’t a place for attempting to improve patient satisfaction. Dear me, I think providers should be held to far better standards than they are in this country. But these kind’ve reports reek of just sensational bias by a group with a clear agenda. This “study” is nothing but fodder for candidates and soft NYT op/eds.

Here’s the full text in Health Affairs. Shame on them for printing it.