The U.S. spends far more per person on health care than any other country but lags far behind peers in several important aspects of office care. That’s according to a survey of primary-care practices in seven developed countries released in November 2006 by the Commonwealth Fund, a private, nonprofit health-policy foundation based in New York City. Some of those aspects:

Electronic medical records. Computer-based record-keeping is considered a major step toward improving the quality and efficiency of medical care. But only about one-quarter of Canadian and U.S. doctors surveyed currently use electronic records, compared with 8 out of 10 or more in Australia, the Netherlands, New Zealand, and the United Kingdom. (Germany, also in the study, falls in the middle.)

In our own survey of family-care doctors, 55 percent said they still maintained patient records exclusively on paper, while only 13 percent had all-electronic records systems. U.S. electronic-records advocates say problems holding up adoption include high up-front costs that neither health plans nor the government will subsidize and the continuing inability of computer systems in hospitals, doctor’s offices, and pharmacies to “talk” to one another.

To make the switch to computerized records, Philadelphia internist Richard J. Baron, M.D., and his three partners spent $140,000 and had to cut their patient load in half for three weeks. But the new system has enabled the doctors to reduce the number of prescribing errors and more closely monitor patients with chronic diseases such as diabetes. “The improved ability to meet patients’ needs is incredible,” Baron said.

After-hours access. Only 40 percent of U.S. doctors and half of Canadian doctors have arrangements for patients who need care outside of normal office hours, leaving patients to the mercies of the local emergency room or walk-in medical clinic. In contrast, at least three-quarters of physicians in the other countries had some after-hours arrangement such as a nurse or on-call physician.

Paying for drugs. Half of U.S. doctors said their patients often have trouble affording medications; comparable numbers in the other surveyed countries ranged from a low of 7 percent in the Netherlands to a high of 27 percent in New Zealand.

One advantage of the U.S. system: Doctors report few problems with long waits for diagnostic tests and elective surgery compared with doctors in Canada, the U.K., the Netherlands, and New Zealand.