Despite spending more on health care than other countries, an international survey from the Commonwealth Fund finds the United States lags behind on important measures of access, quality and use of health information technology (HIT). There are opportunities to learn as other countries move ahead to enhance the primary care foundations of their health care systems.

The authors surveyed more than 10,000 primary care physicians in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and the United States. Data were collected by mail, by telephone and over the Internet between February and July 2009.

Research shows that strong primary care is associated with good health outcomes and lower costs. It also can help meet the challenges presented by aging populations and the rising incidence of chronic disease. Across the globe, countries are working to redesign their primary care systems by investing in information technology, round-the-clock access, teamwork, integration and quality improvement. They also are working to reform delivery systems and payment policies. This study surveyed primary care physicians in 11 countries to find out what is happening on the front lines of health care.

Only 46 percent of U.S. doctors use electronic medical records, compared with more than 90 percent of doctors in Australia, Italy, the Netherlands, New Zealand, Norway, Sweden, and the United Kingdom.

The advanced health information technology and extensive use of quality incentives and care teams reported by Australian, Dutch and New Zealand doctors reflect national payment and information system policies focused on primary care. Lacking such policies, the U.S. lags far behind its peers in these areas--even as it spends far more on health care overall. In addition, insurance coverage restrictions make it difficult for many U.S. physicians to provide their patients with timely access to care.