Many Americans Dissatisfied With Their Medical Care

"The Netherlands stands out for strong positive endorsement of their health-care system -- confidence in care, quality and safety, and access to the latest technology," Schoen said. "The Netherlands also stands out with low concern with access due to cost, as do Canada and the U.K.," she added.

Moreover, one-fifth of patients in the United States said they had serious problems paying medical bills. That was more than double the rate in the next highest country. In addition, 30 percent of American patients spent more than $1,000 in the last year on out-of-pocket medical expenses.

The survey also found that patients gave the highest grades to health-care systems in which people had one doctor in charge of their medical care. But, across all the countries surveyed, only 45 percent to 61 percent of adults said they had a primary source of care, sometimes called a "medical home." In the United States, only 26 percent of uninsured patients had a medical home, compared with 53 percent of insured adults under 65, the researchers found.

One expert said the survey revealed -- once again -- the shortcomings of the U.S. health-care system.

"Comparing the U.S. health-care system to other industrialized countries is not for the faint of heart. The deficiencies in the U.S. system are painfully evident in every such study, and this one is no exception," said Dr. David Katz, director of Yale University School of Medicine's Prevention Research Center. "We manage to spend more on less efficient health care than any country in the world."

The real message from this survey is not about countries or health-care systems, but people, Katz said.

"What seems to predict better care, better outcomes, and more patient satisfaction is the most fundamental aspect of care there is -- a caring relationship. Patients with a health-care provider they know and trust and can rely on and call their own have a better health-care experience," he said.

More information

For more on improving health care, visit The Commonwealth Fund.

SOURCES: Oct. 31, 2007, teleconference with Karen Davis, president, The Commonwealth Fund, and Cathy Schoen, vice president and research director, Commission on a High Performance Health System, The Commonwealth Fund, New York City; David Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Nov. 1, 2007,Health Affairs, online