Via a survey of primary care doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States completed in 2009, Cathy Schoen, from The Commonwealth Fund (New York, USA), and colleagues found  wide differences in practice systems, incentives, perceptions of access to care, use of health information technology, and programs to improve quality. In the United States:  50% of primary doctors polled report their patients have frequent difficulty paying for their treatment and medications; half report having to deal with restrictions on care placed by insurance companies; more than 2/3 said their practices are unable to handle patients after-hours, raising the burden on hospital emergency departments; and less than half use computerized medical records. The researchers encourage that: “We believe that opportunities exist for cross-national learning in disease management, use of teams, and performance feedback to improve primary care globally.”