Commonwealth Fund, New York City, NY, USA.
Health Aff (Millwood). 2012 Dec;31(12):2805-16. doi: 10.1377/hlthaff.2012.0884. Epub 2012 Nov 15.
Health reforms in high-income countries increasingly aim to redesign primary care to improve the health of the population and the quality of health care services, and to address rising costs. Primary care improvements aim to provide patients with better access to care and develop more-integrated care systems through better communication and teamwork across sites of care, supported by health information technology and feedback to physicians on their performance. Our international survey of primary care doctors in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the United Kingdom, and the United States found progress in the use of health information technology in health care practices, particularly in the United States. Yet a high percentage of primary care physicians in all ten countries reported that they did not routinely receive timely information from specialists or hospitals. Countries also varied notably in the extent to which physicians received information on their own performance. In terms of access, US doctors were the most likely to report that they spent substantial time grappling with insurance restrictions and that their patients often went without care because of costs. Signaling the need for reforms, the vast majority of US doctors surveyed said that the health care system needs fundamental change.
高收入国家的医疗改革越来越旨在重新设计初级保健，以改善人口健康和医疗服务质量，并应对不断上升的成本。改善初级保健的目标是通过更好的沟通和跨护理场所的团队合作，为患者提供更好的护理机会，并发展更综合的护理系统，同时辅以医疗信息技术，并向医生提供有关其绩效的反馈。我们对澳大利亚、加拿大、法国、德国、荷兰、新西兰、挪威、瑞士、英国和美国的初级保健医生进行的国际调查发现，医疗实践中医疗信息技术的使用取得了进展，尤其是在美国。然而，所有十个国家的大多数初级保健医生都报告说，他们没有定期从专家或医院收到及时的信息。各国在医生收到自身绩效信息的程度上也存在显著差异。在获取医疗服务方面，美国医生最有可能报告说，他们花费大量时间来处理保险限制，并且由于费用问题，他们的患者经常得不到护理。调查中的绝大多数美国医生表示，医疗保健系统需要根本性的变革，这表明需要进行改革。
