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U.S. leads in medical errors -- study

By LAURA GILCREST, Health Business Editor

WASHINGTON, Nov. 3 (UPI) -- The U.S. healthcare system has the highest rate of medical errors and out-of-pocket costs compared to six other countries, according to a survey released Thursday.

But the new study also underscored the urgent need for all of the countries surveyed -- the United States, Britain, Canada, Australia, New Zealand and Germany -- to do better in areas including quicker access to doctors and assuring that medical records aren't lost as a patient moves from doctor to doctor, so tests aren't repeated or the wrong drugs prescribed.

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The findings were released Thursday by the New York-based Commonwealth Fund at its health policy symposium in Washington, D.C.

"While the consistently high error rates and lack of coordination are disturbing, the findings also highlight the potential of each country to improve," said Commonwealth Fund President Karen Davis.

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She said the survey especially points to the need for health officials to build electronic medical recordkeeping into their systems, to address the exploding demand for quality chronic care for an aging population, and to more actively engage the patient in his or her own treatment decisions.

Specifically, the survey found that 34 percent of Americans polled reported at least one of four types of medical errors, including mistakes in treatment or care, incorrect drug or dose, lab/test result error or delay in notification of abnormal results. The next-highest error rate was in Canada at 30 percent, while Britain had the lowest mistake rate at 22 percent.

However, Carolyn Clancy, director of the U.S. Agency for Healthcare Research and Quality, told United Press International that America's poor marks for medical mix-ups should be put into context.

Many incidents chalked up to "medical error" are actually lab mistakes where test results are lost and then reordered, rather than the more serious drug mistakes, when a patient is given the wrong drug or dose, she said.

Predictably, the U.S. error rate is especially a problem with patients seeing multiple doctors, the survey showed, with 48 percent of such patients reporting a slip-up. Out-of-pocket healthcare spending per person (adjusted for differences in cost of living) for 2003 was highest in the United States at $793 and lowest in New Zealand at $296, the study showed.

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The Americans also got the lowest marks for medical records being unavailable at the time of the patient's appointment, but Germany had the worst track record with duplicate tests.

Health officials at the conference from the countries targeted by the study weighed in on what was ailing their own healthcare systems and what the survey said about how to fix the problems.

The survey underscored that high costs and sluggish bureaucracies are shared concerns among all of the countries covered by the survey, said AHRQ's Clancy. A key challenge that transcends national borders is to improve healthcare delivery to patients with multiple conditions, since these patients are typically seen by a series of specialists who each have their own records on a patient.

"The real question is how we can develop positive solutions to (coordinating patient information) while protecting the patient's privacy," mainly through electronic medical records, "so the information follows the patient as he goes from one setting to another," Clancy said, adding that the "next frontier" stateside will be in the area of outpatient care, which in the United States usually involves smaller practice centers that are particularly vulnerable to medical errors.

Liam Donaldson, Britain's chief medical officer, agreed that the patient's move from primary to specialized care is the area ripest for medical mistake, as a patient's records are lost or misinterpreted.

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Philip Davies, with Australia's Department of Health and Aging, said the survey highlights the dilemma of the harried, overworked physician. "Physicians are under stress," he said. "They're focusing on their curing role and have less time for counseling the patient and explaining treatment. The message here is that these activities that physicians see as discretionary are the first to be sacrificed."

Britain's Donaldson noted that his country is attacking the problem by cutting healthcare providers' work hours as one way to cut down on mistakes, but he added that the new hours alone won't be enough to fix the problem without high-tech measures like electronic records.

He also noted that medical jargon should be more understandable to the patient, and the patient should be given a more active role in his or her treatment. "That whole area of dignity, respect and communication is vital to the patient, so why aren't we using it?" Donaldson asked.

The comparative study's statistics also had a more emotional undercurrent: the simmering debate over which healthcare system contributes more to the problems identified in the survey, the U.S. market-based scenario or the government-run systems favored in other countries.

The U.S. system is criticized for having skyrocketing prices for drugs and medical services, while nationally based systems such as Canada's are blasted for being inefficient, making patients wait months for vital tests.

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However, Ian Shugart, Health Canada's senior assistant deputy minister, told United Press International that the image of Canadians scrambling over the U.S. border for faster medical tests like magnetic resonance imaging is misguided.

"We've recently had a tremendous infusion of (new tests such as MRIs). I'm not saying there aren't wait times, but the perception of Canadians flooding over the border for medical services is just a perception."

So do patients in countries like Canada have a more accessible, more affordable healthcare system? "I would say look at the price of drug marketing in the United States. The overall policy for drugs in the United States is unregulated and direct-to-consumer advertising is allowed," Shugart said.

In contrast, Canada and other countries impose price controls on brand drugs, which holds down costs.

Clancy told UPI that the United States undoubtedly has more capacity for medical services including MRIs and that often, "Canada takes advantage of that," since it's cheaper to send a patient over the border for a particular test rather than open a new facility.

But in any case, she conceded that Canada does a better job with same-day access to a physician, while U.S. doctors are more likely to send overflow patients to the emergency room, where care is more costly and where medical errors are more likely since ER doctors will be less familiar with patient's medical history.

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