German patients seem less easily satisfied

There is currently no industrial nation in the world whose health care system has not been repeatedly reformed in the past years. However, patients in other countries possibly deal with the ongoing discussions and constant changes in a more relaxed manner than do German patients. This conclusion is implied by an international comparative survey coordinated by the Commonwealth Fund, a private US foundation. Although the experiences of German patients are largely by no means negative, they judge the health care system more critically than patients in other countries. The German part of the survey was supervised by the Institute for Quality and Efficiency in Health Care (IQWiG). The results reflecting the German point of view have recently been published in "Deutsches Ärzteblatt", the journal of the German Medical Association.

About 10,000 randomly selected patients from the following countries participated in the survey in May 2008: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, France, and the United States. Adults were interviewed who reported a fair or poor health status and/or reported that in the past 2 years they had suffered serious illness or disability, had been hospitalized, or had undergone major surgery. The survey therefore included patients who were in particularly close contact to doctors and hospitals.

Half of the German respondents see fundamental need for reform

"Overall the survey shows that patients generally have had good experiences with the health care system. However, in all countries they report things that are not optimal," says Peter Sawicki, IQWiG's Director. "For example, this includes coordination problems both between specialists and GPs and between hospitals and GPs."

Although patients in different countries had quite similar experiences, satisfaction with the national health care system differed greatly from country to country: 53 % of respondents in Germany classified the quality of health care as "good,” but only 34% awarded the grade "very good” or "excellent”. In other countries (e.g. the United Kingdom, Canada or Australia) this proportion of very satisfied patients was nearly twice as high.

Even though 87% of German respondents rated the quality of treatment as "good" or better, 50% still thought that fundamental changes in the health care system were necessary, and a further 25% thought that a complete reform was required. This proportion was greater only in the United States. This discrepancy, i.e. that the great majority of German patients think they receive good to very good treatment, but still see a considerable need for reform, had already been observed in a previous survey in 2005.

"Our data do not indicate that treatment outcomes in Germany are actually worse than those in other countries," says Sawicki. "It is possible that patients in Germany simply have higher expectations than patients in other countries. The way we publicly discuss our health care system in Germany also possibly contributes to this dissatisfaction. Such surveys can therefore help us to view the quality of the German health care system more objectively within an international context. Subjective satisfaction with treatment seems to be a result of expectations and reality."