Americans are among the world's most dissatisfied people when itcomes to health care systems, but they are the least disposed to letgovernment try to solve the system's problems, according to athree-nation survey published today.
The survey also found that Canadians and Germans are increasinglydissatisfied with their health care systems.
The new findings suggest it is less likely than ever thatAmericans will soon look to other nations with government-led healthcare systems for answers to growing US problems with costs andgrowing numbers of uninsured citizens.
The survey, which involved nearly 4,000 adults in the threenations, found a sharp drop in recent years in the proportion ofCanadians and Germans who think their health systems work well. Theproportion of Canadians who were satisfied with their health systemplummeted from 56 percent in 1988 to 29 percent in 1994. In Germany,the drop in satisfaction was less drastic during the same period,from 41 percent to 30 percent.
In the United States, the proportion who said they were satisfiedwith the health system rose slightly, from 10 percent in 1988 to 18percent in 1994.
The rise in dissatisfaction, the authors said, reflects thosecountries' recent struggles to control health costs in the face ofnew technology and aging populations.
'There's no medical Shangri-La out there,' said Robert J. Blendon,chairman of health policy and management at the Harvard School ofPublic Health and principal author of the survey, which appears inthe journal Health Affairs. 'When you start to constrain costs,people don't necessarily want to abandon their health system, but thebloom is off the rose.'
That impression was ratified by Dr. Mimi Divinsky, a Torontogeneral practitioner who is active in efforts to keep Canada'sgovernment-financed health system intact.
'My sense is that people are really apprehensive about losing thesystem we've known since the 1960s,' Divinsky said in an interviewyesterday. 'My older patients, who remember the days beforeMedicare, are calling me and saying, `Maybe I should have my hipoperated on now, because perhaps in five years the system won't payfor it.' '
While Canada and Germany are cutting back drastically on healthcare spending, there is considerable evidence from the survey that,as Blendon put it, 'people in the other countries have fewer problemswith their health care' than Americans do.
For instance, one in eight Americans said in 1994 that theycouldn't get needed medical care in the previous year -- a measure ofthe millions of people who do not have health insurance here. Bycomparison, one in 13 Canadians and one in 17 Germans said theycouldn't get needed care.
Twenty percent of Americans said they had a problem paying doctoror hospital bills in 1994, versus only 6 percent of Canadians and 3percent of Germans. (The survey involved only people living in theformer West Germany, since the former East German states wererebuilding their health system.)
Americans didn't fare any better than Canadians in the length oftime they had to wait to see a doctor. About one in seven people inboth countries said they waited more than a week for an appointment,versus only one in 17 in Germany.
In one politically crucial measure, Americans stood out: Theirunwillingness to trust government health officials. Thirty-ninepercent of Americans said they have 'hardly any confidence' in suchofficials, versus 15 percent of Canadians and 9 percent of Germans.SIDEBARHEALTH CARE: WORLDWIDE UNEASINESSA new opinion survey in the United States, Canada, and Germany showswidespread disatisfaction
