A Survey Of Primary Care Physicians In Eleven Countries, 2009: Perspectives On Care, Costs, And Experiences

Abstract

This 2009 survey of primary care doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States finds wide differences in practice systems, incentives, perceptions of access to care, use of health information technology (IT), and programs to improve quality. Response rates exceeded 40 percent except in four countries: Canada, France, the United Kingdom, and the United States. U.S. and Canadian physicians lag in the adoption of IT. U.S. doctors were the most likely to report that there are insurance restrictions on obtaining medication and treatment for their patients and that their patients often have difficulty with costs. We believe that opportunities exist for cross-national learning in disease management, use of teams, and performance feedback to improve primary care globally. Health Aff (Millwood). 2009;28(6):w1171-83 (published online 5 November 2009 10.1377/hlthaff .28.6.w1171)] P r i m a ry c a r e c l i n i c i an s i n m o s t c o u n t r i e s provide the foundation for health care systems and serve as the linchpin that improves access, connects care, and provides continuity for patients and families. Research shows that strong primary care is associated with good outcomes and lower costs.1-3 Aging populations, prevalence of chronic disease, and increasing ability to deliver complex care outside the hospital have prompted international efforts to redesign primary care to improve outcomes and efficiency. Consequently, primary care practices often face new requirements for accountability as well as incentives to improve. C a r e & C o s t s H E A LT H A F F A I R S~We b E x c l u s i v eTo varying degrees, health systems are investing in information technology (IT), round-the-clock access, providers working in teams, integration, and quality improvement. Reforms in delivery systems and payment policies seek to spur innovations for managing chronic conditions and supporting frail elderly or disabled people living in the community.Primary care physicians' experiences and perspectives in a period of rapid change offer a unique view from the front lines. To track developments in countries with diverse health systems, this 2009 study surveyed primary care physicians in eleven countries: Australia, Canada, France, Germany, Italy, New Zealand, the Netherlands, Norway, Sweden, the United Kingdom, and the United States. This survey, the twelfth in a series that informs a symposium of health ministers and policy experts, focused on access, chronic care management, health IT, and financial and information incentives-key areas that have been targets of reforms. Eleven-Country ContextThe countries studied represent a mix of primary care and insurance systems (Exhibit 1). The United States is distinct in its reliance on internal medicine and pediatrics for primary care and its highly decentralized referral systems. The other countries rely extensively on general or family practice (GP/FP) physicians, often augmented by use of pr...

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