The US healthcare system lags behind in terms of access, quality and health information technology compared to ten other countries despite spending more, according to a new survey.

The US private health policy group The Commonwealth Fund studied more than 10,000 primary care physicians in 11 countries including the UK, Germany and the US.

More than half of US physicians surveyed said their patients often had difficulty paying for medication and care and 50% said they spend substantial time dealing with the restrictions insurance companies place on patients’ care.

Only 29% of US doctors said their practice had arrangements for after-hours care to avoid a hospital emergency room visit, while almost all Dutch, New Zealand, and UK doctors said they had after-hours care arrangements.

Only 46% of US physicians use electronic medical records compared with over 90% of doctors in Australia, Italy and the Netherlands.