People in developed countries feel that their health systems can only improve if they undergo 'fundamental changes', according to a seven-nation survey.

The Commonwealth Fund international health policy survey questioned more than 12,000 people from the UK, US, Australia, New Zealand, Canada, Germany and the Netherlands.

However, report authors Cathy Schoen, the fund's senior vice president, and Robin Ford, director of its international programme in health policy and practice, conclude that 'no country systematically leads' on performance and that variations in performance offer opportunities for cross-national learning.

Even where countries are considered to have a 'high-performance' health system, improvements are required in care co-ordination, patient safety, out-of-hours care and efficiency.

They stress primary care redesign and workforce strategy are critical to driving up performance.

Toward Higher-Performance Health Systems: adults' health care experiences in seven countries reveals that people in the UK feel personal cost is not a barrier to health. But despite massive investment in cutting waiting lists we still wait longer for elective surgery than other countries.

Some 15 per cent of UK respondents reported a wait of over six months compared with 14 per cent in Canada, 9 per cent in Australia, 4 per cent in New Zealand and the US, 3 per cent in Germany and 2 per cent in the Netherlands.

More than half of UK respondents did not have any personal health expenses last year, whereas just 10 per cent of US respondents, 9 per cent of Germans and 12 per cent of New Zealanders could say the same.

Nearly 20 per cent of US respondents reported serious problems paying health bills last year compared with just 1 per cent of people living in the UK.

But the UK lags behind on access when sick, with just 41 per cent of respondents saying they could get a same-day GP appointment compared with 55 per cent in Germany, 53 per cent in New Zealand and 49 per cent in the Netherlands.

The survey also shows that the UK is still consistently underperforming in areas of patient communications and decision-making compared with these other countries.

Stephen Thornton, chief executive of the Health Foundation, which has in the past sponsored Commonwealth Fund work, said the survey 'shows how thankful we should be that cost is not a major barrier to people accessing care in the UK'.

'Compared to the US we do staggeringly well.'

But he continued: 'The challenges for the UK from this important survey are clear.

'Even in waiting times for non-emergency surgery, an area where government has achieved the most in recent years, we still need to do more.'

To download the report, click here