Health & Society CSA-Europ Assistance Barometer 2013_synthesis

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Health & Society CSA-Europ Assistance Barometer 2013_synthesis

  1. 1. Health & Society Barometer - Europ Assistance / CSA CSA. 2013: 7th wave of the barometer Main learning points In October 2006, the Europ Assistance Group and the Cercle Santé Société, with the CSA Institute, launched an annual pan-European barometer on "the relationship and practices of European citizens with regard to their health systems". Set against the context of regular change within these systems, the objective of this barometer is to provide changes comparative enlightenment on the position of the citizens in the countries studied, in order that their opinions can feed into the major debates that are gripping the healthcare sector. In 2013, the barometer is being published at a time when Europ assistance is celebrating its 50th anniversary. 8 European countries, as well as the United States, are now included within the field of study of the barometer. Healthcare and, more broadly, the means of accessing care quality, including when travelling, within a professional context or via new technologies, are the main concerns of the citizens of all of these countries. This barometer not only allows us to evaluate their opinion and their expectations with regard to the preserv preservation of their healthcare systems, but also to study the manner in which the populations perceive the quality of their treatment. It thus contributes to gaining a better appreciation of the level of consciousness shown in public opinion regarding the iation new challenges associated with healthcare. 1
  2. 2. On the occasion of the 50th anniversary of the assistance service, established in France by Pierre Desnos, the founder of Europ Assistance, the Santé & Société Europ Assistance-CSA barometer focuses in its 2013 edition on CSA addressing the topic of healthcare and travel, assessing the benefits of repatriation for medical reasons. Also studied within the barometer are the changes in opinion regarding: • The evaluation of the healthcare system and the quality of trea treatments, taking into account not only the organisation of this system, but also the technical competence of the doctors and its development since 2010, the trust placed in the healthcare authorities in each country regarding the limiting of risks, an observ observation on the perception of the various future threats since 2009 and new sources of financing. • Social requirements, including the evaluation of equality when it comes to accessing treatments and the issue of the desired means of financing in order to stre strengthen this equality. • The cancellation or postponement of medical treatments what treatments? for treatments, whom? • The care for dependent elderly people is a measure of the change in opinion in each country since 2006, as regards the organisation and quality of this care provision, the adequacy of public support in financing home care and, more broadly, the recognition of the issue of dependency by public authorities. Furthermore, other than family, what types of organisations should be called on to provide this home care, what measures should be prioritised and to what equipment should preference be given, including technological devices? And finally, how can these services be financed? • Healthcare and new communication technologies, with the development of the technologies, viewing of healthcare information online since 2006, the sharing and exchanging of iewing opinion regarding healthcare on social networks and the Internet, the perception of the development of continual home monitoring by mobile telephone and the evolution of this perception since 2010, the possible use of webcams for a remote GP consultation. Finally, public awareness of genome mapping and the intention to use it, measured since 2011. • Healthcare and business, measuring the respective expectations of employees wit with regard to expatriation, depending on their country of origin, focussing on Healthcare, Safety, Schooling and Salary. • The final topic, Healthcare and economy addresses the manner in which the awareness of the various populations has developed with regard to the importance of their healthcare system and its impact on the economy. This barometer was established on the basis of a telephone survey conducted by the CSA in institute, with a sample of 500 individuals per country of study in Europe, as well as 1,000 individuals in the United States, representative of the population aged 18 years and older, distributed across nine countries - Germany, France, Great Britain, Italy Italy, Sweden (2006), Poland (2009), the United States, Austria (2010) and Spain (since 2011), between May and June nd 2013. 2
  3. 3. I- Evaluation of the healthcare system and of the quality of treatments Organisation: consolidation in the medium term 2013, Concerning the assessment of the public regarding the organisation of their healthcare system in 2013 clear differences of opinion are found between Austrians, who seem the most satisfied with an average score of 6.3/10, and the Polish who bring up the rear at 2.8, nonetheless reducing the gap between themselves and the Italians, for whom the average fell by half a point in relation to 2012, to 3.2. The Austrians also set themselves apart in that 47% of them consider their system to be very good or even excellent, far ahead of the British, of whom 29 are far 29% nonetheless of this opinion. Great Britain thus exceeds the average, with 5.2, followed by France (5.1), Germany (5.0), Spain and Sweden (4.8) and then the United States (4.5). In terms of changing opinions in the medium term, the general trend tends towards a structural balance if you term, compare the averages observed between 2006 and 2013. Only Germany experienced an upward variation of more than 1 point between these two dates, which can be explained by the generally positive financial situation of the generally Outer Rhine health insurance schemes. As for Sweden, the country has experienced a slight downward trend, falling from 5.3 in 2006 to 4.8 in 2013, and especially Italian opinion has significantly degraded since 2009 ( 1 2013, (point). France remains stable, as do Austria, Great Britain returning to its balanced trend following the peak in 2007. In the , United States, the opinions have remained stable since 2010, despite a little increase in 2012. Technical competence of doctors: a positive trend tors: Concerning the assessment made regarding the technical competence of the doctors, diagnostics and treatments, , the opinions in the various countries are relatively stable from the previous year, with only the United States falling by 0.3 points compared to 2012, yet still remaining the most positive (6.8) ahead of the Austrians (6.5), while the Polish replace the Italians in last place (4.7). If you consider the European countries together, the trend over two years is slightly positive and averages out at 5.6, following the considerable drop observed in all of the European countries between 2010 and 2011. between 3
  4. 4. Confidence in the healthcare authorities: stabilised opinions 72% of British state that they have confidence in the controls put in place by the healthcare authorities to limit the risks associated with the taking of medication and 81% for the risks associated with the use of medical prostheses, probe implants and endoscopic equipment. However, only 42 and 56 of the Polish express these 56% views respectively. However, the level of confidence among the same Polish survey participants with regard to the risks associated participants with the taking of medication increased considerably between 2012 and 2013 (42 vs. 35 (42% 35%), as did that of the British (72 vs. 61%), when it continued to fall in Spain (63 vs. 66%) and in Italy (51 vs. 55% and remained relatively %), stable from one year to the next in the other countries. Regarding the risks associated with the use of medical prostheses, probe implants and endoscopic equipment, only the Spanish declare themselves considerably less confident, fall falling from 69% in 2012 to 66 in 2013, while the 66% confidence of the British increases by 15 points (to 81 ), that of the Swedish by 10 points (to 76 and that of the 81%), 76%) Germans (increasing to 56%) and the Polish (to 56 by 8 points. ) 56%) Even the confidence of the French increases by 5 points, in spite of the legal proceedings regarding the Mediator , drug and breast implants recently making the news. Threats to the future: Europe relatively more calm than the United States With regard to the perception of threat to the future of the healthcare systems, 82% of British consider the risks threats of medical errors to be very important, ahead of Americans (78 ), followed by Italians (75 (78%), (75%), while only 37% of French and Austrians consider this risk to be very important. In terms of development, there is a very noticeable drop among Spanish with regard to this risk being taken into account (70% vs. 86%), but also to a lesser extent among Austrians (37% vs. 48 ) and Germans (45% vs. 54 ), 48%) 54%). On the other hand, a significant increase is to be observed among Polish and Americans, 66 of whom assessed the ase 66% risk of medical errors to be very significant in 2012, whereas 74 and 78% respectively consider this to be the case 74% in 2013. The waiting times before receiving treatment continue to concern the vast majority of Polish (87 (87%), but also 78% of Spanish, 75% of British and 72% of Italians. However, a very noticeable drop in the perception of this threat is to be observed among Spanish (-10 points), Swedish (59 vs. 68%) and, to a lesser extent, among Italians ( points). 10 (59% (-5 In the United States on the other hand, a significant increase is to be noted, with 66 of the population considering 66% waiting times a threat, compared to 57% one year prior to this. % At 76%, Spanish have the largest proportion to consider the increase in personal financing to be a very significant portion threat that their healthcare system must overcome, followed by Americans (74 ) and then Polish (70 (74%) (70%). It should be noted that, compared to 2012, this proportion decreases considerably in Spain (76 vs. 85 while it increases considerably 85%) considerably in the United States (74 vs. 68 Poland remains relatively stable. 68%). A very noticeable drop in this fear can be observed among Italians between 2012 (67 ) and 2013 (58 (67%) (58%), while the drop experienced in 2011 in Germany stabilises and an increase in the perception of this threat is evident in Austria (49 vs. 43%). financing, Spain, With regard to this issue of personal financing, a distinction can be drawn between two groups of countries: Sp the United States, Poland, Italy and Great Britain on the one hand, where an increase in this type of financing is considered a very significant threat by 50 of the population, and Sweden, Austria, Germany and France on the 50% other hand, where less than 50% of residents share this opinion. 4
  5. 5. In the long-term, the perception of a threat regarding the inequality of access to treatment appears to stabilise, even though a distinction continues to be drawn between a group of countries where the vast majority of the population is sensitive to this threat, and three countries; Germany (50 (50%), Austria (50% and France (53%) where %) opinions are more divided. Of the Spanish, 84 of whom felt this threat in 2012, only 73 do so in 2013, sharing 84% 73% top place with the British, ahead of the Polish (71 and the Americans (70%). ish, (71%) Sources of financing: in favour of a higher excess towards procedures? Concerning the opinion of citizens regarding the means of covering the increase in healthcare expenses, the Swedish (69%) remain the most favourable to the mandatory deductions, while half of British remain committed to this solution. A downward trend is to be observed among the French and the Americans, where only 30 of the 30% population is in favour of this method of financing. By contrast, a considerable increase is to be noted in the financing. number of people in support of the system involving the payment of an excess per medical treatment, in France (40%), Germany (30%) and the United States (42 ) (42%). Only 29% of Germans opt for the use of optional insurance and mutuals, ahead of the Italians at 28 , although this remains the solution preferred by the majority of 28%, Austrians (39%) and Polish (41%). For 8 years, and since the launch of our barometer, there is mounting evidence to show that the traditional division between the systems is tending to fade, with public opinion changing - depending on the country and the target public - in favour of private insurance or payment of an excess towards the procedure, to the detriment of e compulsory contributions, with the notable and traditional exception of Sweden, and to a lesser extent Great , Britain, where people remain very committed to the National Health Service. To sum up, since the beginning of the barometer, in the long-term the opinions in the various countries have term balanced out with regard to the assessment of the healthcare system, in spite of short short-term fluctuations. With regard to the perception of threats, here too r relative structural balance has been observed, in spite of occasional alarming news, which confirms the general confidence expressed in the healthcare authorities and the competence of doctors. Finally, with regard to sources of financing, an increase in positive opinions about excess is noted, rces especially among younger generations and those who are active. Only in Sweden and Great Britain do the majority remain committed to increasing taxes or comp compulsory contributions. 5
  6. 6. II – Social requirements Access to treatments: consensus regarding the end, much less so regarding the means term, In the long-term, opinions appear relatively stable in all of the countries when assessing if the health system guarantees equality of access to treatment for every citizen. Only Italy fell from a 44% rate of positive opinion in % 2012, to 28% in 2013, dropping some way below its lowest level, observed in 2011 (33 ing (33%). The Spanish (67%) and the British (59%) seem relatively optimistic compared to the citizens of the other European countries, in which the ) proportion of positive opinions varies between 28 (Italy and Poland) and 48% (Austria), while the Americans 28% show a considerable increase from 34 to 41 41%. With regard to the need or otherwise to increase contributions or taxes in order to guarantee more equal access to treatment, the majority of Swedish (80%) and British (55%) are still in favour of the increase of contri contributions and taxes, while French return to the level observed three years ago (44%). In all of the other countries, this . increase in taxes or compulsory contributions is met with strong, or even very strong, opposition, with Italy (80 (80%) having the highest level of opposition, an increase of 5 points compared to 2012. Italy is closely followed by Spain, recording a 74% rate of negative opinion. A majority of Americans (59%) is unfavourable to an in increase of taxes and compulsory contributions, but not much more than Europeans on average (57%). Between Sweden, at one extreme with 80 of people in favour of increasing contributions or taxes, and Italy at the 80% other extreme, with the same proportion against such an increase, it would appear that opposition is culturally determined, with an evident distinction between the countries of the northern and southern Europe, with France, Austria, Germany and Poland occupying the middle ground between the two extremes. A more and more concerning postponement of treatments in France and Poland 18% of Europeans and 23% of Americans claim to have during the past year, postponed or declined medical have, treatment on account of financial difficulties. 39% of Polish stated that they had to make this choice, 33 of French compared with 27 the previous year, 24% 33% 27% of Germans compared to 30% in 2012, and 20 of Italians compared to 27% one year earlier. Great Britain, with a 20% 4% cancellation rate compared to 9% in 2012, outperforms Sweden at 6 6%. Observing the case of France in closer detail, which this year posted the greatest increase among all the countrie countries studied, it is evident that it is mainly women, those aged 18 18-39 and active individuals who decline or postpone, nd while in Germany it is mainly men, those aged 18 39 and active individuals. In the United States, 60 of people not 18-39 60% covered by insurance claim to have postponed or declined treatment, but so too do 44 of Medicaid recipients m 44% and 30% of those with personal insurance. Regarding the nature of treatments declined by individuals in the United States, dental treatments are postponed re in 14% of cases, however, routine treatments are mentioned spontaneously in 18 of cases. 18% In France, in 2013 dental treatments (25 remain the most affected, with a considerable increase compared to (25%) 2012, ahead of the purchase of glasses (17 (17%). Finally, if you consider the development over time regarding the various types of treatment, relative stability or er even a positive trend with regard to routine treatments can be noted, excluding in Poland and the United States. On the other hand, there is also a trend towards a increase in difficulties regarding intensive treatments with a an treatments, 6
  7. 7. major turn for the worse in the United States and a negative progression with regard to the purchasing of medication that is, generally speaking, more pronounced in 2013. The postponement of dental treatments also pronounced has a tendency to escalate, particularly in France with an increase of 6 points. Regarding glasses, purchasing is postponed by 17% of French, compared to 10 the previous year, ahead of Polish (12%) and Germans and 10% Americans (10%). In summary, a positive development and consolidation can be observed in terms of opinions regarding the capacity of the health system to guarantee equal medical treatment for all, although such opinion remains in the minority. With regard to resorting to increasing taxes to ensure more equal access, on the other hand, there is almost a form of reverse symmetry between the countries in the north and south of Europe regarding opposition, the former very much in favour of taxation, and the latter strongly opposing it. The level of decline or postponement of treatments remains low in Spain and in Great Britain, although it remains high in Poland, Germany, Italy and in France, where it has increased significantly. At present, this phenomenon appears to correlate more with the mechanisms of the health system rather than with the economic situation of the country. In the United States, which has an average rate slightly higher than in Europe, the rates of postponement vary significantly, depending on the health insurance system. This disparity is found on the other side of the Atlantic regarding the type of treatment concerned, in particular with huge numbers of postponement of routine with postponements treatments by those not insured nor covered by Medicaid. In Europe, the purchasing of medication is significantly affected by postponement decisions, even though at the same time it is dental treatments and the purchase of ions, glasses that people are increasingly likely to postpone in the majority of countries. 7
  8. 8. III – Care for elderly and dependent people are A negative general opinion and still high expectations below-average With the exception of Austrians (5.7/10), public opinions attribute a below average score to the organisation and quality of care to those that are elderly and dependent, within their respective countries. While 31% of Austrians go as far as to assess the organisation as very good or excellent, as do 24 of Americans 24% particularly those over 60 years of age, only 2 of Polish and Italians share this opinion. 2% quality In general, the manner in which the organisation and quality of care for elderly and dependent people are perceived continues to show sharp contrast from country to country country. In the long term, there is no sign of sign n significant variation of this negative evaluation, even though a rate of negative evaluation of 63% can be observed in Italy, posting an average score (2.2) that is considerably lower than in 2012 3% (2.9). Concerning Germany, with 4,1, this country comes back close to its level of 2011, which does not confirm on the long term the improvement observed in 2012. In Spain, the similar drop in the level that was observed (3.6 vs. 5) 2012. remains difficult to interpret. In the United States on the other hand, a consistent improvement in the evaluations is to be observed, with an average grade of 4.9 this year. Finally, France remains especially stable. nally, Public aid for home care: insufficient Compared to 2012, in 2013 Germans (27 vs. 40%) and Spanish (31 vs. 49%) appear significantly less satisfied with (27% ) public financial aid for home care for elderly or dependent people In Spain, this dissatisfaction is rooted in the people. calling into question of financing programmes to promote independence. As for Germany, it came in a little below the level for 2010 (31%). The level of satisfaction in the other countries rose considerably or remained more or less stable, at a particularly action low level such as in Italy (19%) and in Poland (14 which again occupy the bottom two places in this category. The ) (14%) average level of satisfaction of 58% in S Sweden rises to 67% among the over 60s, while Great Britain, at 56 on 56% average, sees this level climb to 62% among those aged 18 18-39. In Austria (52%), the best scores are observed in the ), rural communities (58%). France comes in below average with just 45% positive opinion. ). positive Public authorities and the issue of elderly people dependency a very negative dependency: perception With regard to the question of the awareness of public authorities regarding the issue of dependency, the same trends are appearing, with a considerable drop in positive opinions in Germany (17 vs. 28%) and the situation (17% stable in the other countries. A significant increase can even be seen in Great Britain (20 vs. 15%), in France (31% (20% vs. 26%) and in Austria (33% vs. 28%). The voluntary sector is highly favoured ctor With regard to knowing "Outside of their family, from which organisation can elderly and dependent people find the best home care support? ", the organisations in the voluntary sector or the private non non-profit sector are still 8
  9. 9. favoured by the majority of people in Germany (73 (73%), Austria (64%) Poland (54%), Great Britain (49 and France ), (49%) (43%). Public organisations are favoured by the majority in Sweden (59%) and in Spain (44 (44%), with the situation more balanced in Italy where private organisations come in first place with 37 of those surveyed in favour, vate 37% ahead of public organisations at 33% and the voluntary sector at 30 30%. In the United States, private organisations receive 39% of the votes, on an even par with the voluntary or private non-profit sector, and ahead of public organisations (23 profit (23%). If we now consider the preferences by age, it can be noted that public organisations are more highly favoured among those aged 60 years and above, while, depending on the country, those aged 18-39 have a tendency to feel 18affinity towards the private or voluntary sector. The home care widely approved With regard to the favoured means of solving the problems posed by the prolongation of life expectancy and the increase in the number of elderly and dependent people it is home care that remains preferred on the whole, with an average of 78% in Europe and 86 in the United States. 86% A significant increase in those favouring this solution can even be noted in Italy (+ 8 points 90%), in Great Britain (+ points, 8 points) and in Germany (+11 points), and also in Sweden (+5 points) where the increase has been consistent and significant since 2009 (59% vs. 41% over 5 years). Home care: supplementary resources In order to enable the prolongation of home care, home carer jobs are approved by 96% of Europeans and 92% of % Americans, ahead of telemonitoring, which on average receives 83% of the European vote and 90 of the 90% American. Robotics does well with 69% of opinions favourable in Europe and 61 in the United States. It is in Austria (71 61% (71%) and in Germany (75%) that one finds the lowest level for telemonitoring. ) However, a very significant increase in favourable opinions towards this solution can be noted in all countries, and likewise with regard to home carer jobs. . Still relatively unpopular in Austria (28 (28%), Sweden (41%) and Germany (42%), robotics continues to increase in popularity in Great Britain, Italy and Poland, countries in which it receives scores equal to or greater than 75 pularity 75%. French have a drop of 5 points to 50%, appearing still to have mixed feelings on the subject. The significant scores , achieved by these solutions emphasize the complementarity between technical solutions and the assistance of a s lutions person at home. The rise of remote monitoring technologies In response to the question, "Are you prepared to equip your elderly relatives with remote monitoring systems such as an electronic bracelet, a fall detector or continual blood pressure monitoring in order to make their home life safer? ", 85% of Europeans responded positively, with Spanish in the top place with 93 and Germans in the last ans 93% place with 77%, and favourable opinions increasing in all countries in a significant, or even very significant manner, , such as in Spain (+ 19 points) or in Germany (+ 20 points). 9
  10. 10. The European preference for taxation and public financing rence In response to the question: "In your opinion, who should pay for the services and support that enable the daily needs of elderly and dependent people to be met? ", it is evident that the majority are in favour of public financing by the local government with taxes or compulsory contributions or mixed financing with an emphasis on public financing. These basic public financing solutions, particularly popular among those aged 60 and over and those who are inactive, appeal to an average of 70% of Europeans. French are the exception with just 47 preferring them in 47% 2013, compared to 56% in 2012. They now favour mixed financing by both public government and the people concerned. On the whole, 23% of Americans advocate the individual solution and 27% mixed financing by both public government and the people concerned. Only 12% declare themselves in favour of public financing, but with regard to this choice, a very significant disparity can be noted between recipients of Medicaid and Medicare on the one edicaid hand, 24% and 22% of whom respectively favour this solution, and the recipients of an employer employer-based plan on the other hand, at 9%. In summary, the issue of the provision of care to elderly and dependent people remains a central issue in public opinion, with people desiring that it be paid greater attention by the public authorities. The manner in which the quality of this provision is perceived matches the assessment made by the populations regarding their healthcare systems in general. This is particularly the case in Italy and Poland, where the scores are the lowest. It is in the United States and in Austria that the most positive results are recorded. With regard to the means of implementation, home care is preferred by the majority in all countries. This is now a general underlying trend. In order to ensure this support, the majority of people in all countries prefer public or voluntary organisations, with the notable exception of Swedish, the vast majority of whom prefer public ganisations, organisations, with Spanish also favouring this solution, but to a lesser extent, while Italians share their vote between the three types of organisation. In the United States, the choice in this area remains highly influenced by the type of social security cover held by the population. 10
  11. 11. IV- Healthcare and economy Healthcare: an economic sector in its own 74% of Europeans and 60% of Americans believe that the healthcare sector contributes to economic growth. This is the consensus in all countries, with very high scores in Italy and Spain (85 ), in Sweden (83 (85%), (83%), Great Britain (81%) and Austria (76%). However, these were the result of an increase between 2012 and 2013, with the exception of France, which sets 2012 itself apart through its relative stability (59 vs. 57%) and Austria which remains stable - by no means the norm: +24 points in Spain, +21 points in Great Britain, +18 points in Italy, +14 points in Sw Sweden. Against this background, Germany increased by 6 points (66 and Poland by 5 points (58 (66%), (58%). It should be noted that positive opinions see a slight drop in the United States, where the debate on healthcare expenses remains unresolved. 11
  12. 12. Focus for 2013 Healthcare and travel The repatriation for medical reasons perceived first to save lives Regarding the issue of mobility, those surveyed were required to respond to the question: "For each of the following trends concerning healthcare and travel, would you say that for yourself or people like you, repatriation for medical reasons in the event of accidents or serious illnesses suffered while travelling abroad, has represented an improvement or not? " ng 66% Among the benefits identified, "saving lives" comes in first place in most countries, achieving an average of 66 for Europeans and 76% for Americans. British (81%), followed by Swedish (80%) are the most sensit sensitive to this criterion, while Polish (37%) and French (54 are not as convinced. (54%) "Travelling as a family" is the second most frequently selected suggestion among those surveyed. British and Americans (76%) have the greatest number select this criterion, far ahead of Spanish (53 ) (53%). Germans (50%), Polish (26%) and French (39%) had the fewest number of people choose it. ewest Finally, 74% of Americans select the notion of "discovering distant and lesser known countries" to represent an improvement, followed by British (60%), while this benefit is only mentioned by 21 of Polish and 29 of French. ), 21% 29% Varying levels of maturity With regard to achieving a qualitative measurement of the significance of each of these improvements for the people surveyed, it can be noted that 81 of British attach considerable importance to the criteria "Saving lives", 81% with a score of 88% among the over 60s. 80% of Swedish are of the same opinion, with a high of 88 among holders of private individual insurance. In 88% contrast, 16% of Polish do not believe that this represents an improvement. In Germany it is inte interesting to note that with the average standing at 60% of people rating it as "very significant", 99 of those aged 18 99% 18-39 give this assessment. In France, with an average of 54 it is those aged 60+ (64%) and those who are inactive (62 who 54%, ) (62%) attribute greater value to this criterion. The improvement to "travelling as a family judged to be very important by 76% of British on average, achieves a travelling family" score of 85% among those aged 60 and over. In Poland, 33 of those aged 60 and over are of this opinion, whil 33% while 20% of Polish do not think that this is an improvement. In Italy, it is again those aged 60 and over (52 who (52%) attribute major significance to this criterion, the average standing at 43 43%. Finally, "discovering distant and lesser known countries motivates, in particular, British aged 60 years and over discovering countries" es, (68%), Germans aged 18-39 (89%). In Italy (39 women (44%) and those aged 60 and over (46 are particularly ). (39%) ) (46%) motivated while in Spain (44%) it is men (49 ) and holders of supplementary individual health co ) (49%) cover (72%). 12
  13. 13. In summary, over the years, travellers have come to consider repatriation for health reasons to be synonymous with rescue in the event of danger, an accident or serious illness occurring while abroad. This sentiment, shared by the majority in all countries, will, depending on the case, be more pronounced among certain categories of the population, both among those aged 60 and over and among the younger generation. Repatriation also represents an asset when travelling as a family and when venturing into "exotic" countries, whether young or not so young. venturing 13
  14. 14. Healthcare and business Professional mobility: priority given to quality treatment Among the most important criteria to be taken into account when deciding whether to accept an expatriation proposal from your employer, "access and the provision of quality treatment to you and your family in the destination country" is far in the lead, in every country. This criterion achieves an average of 85 in Europe and 85% 71% in the United States. susceptible British, at 76%, are relatively less susceptibl to this factor, whereas 71% of them express a preference for "a healthy living environment and comfortable accommodation", a factor selected by an average of 60 of , 60% Europeans. 65% of the latter require "the education of children in a school offering a good quality of teaching" the most teaching", demanding in this respect being Germans (77 followed by Swedish (76%) and Spanish (68 (77%), (68%). "An increase in pay" interests 80% of Polish, but only motivates 50% of Europeans on average, and 58 of 58% Americans. The least interested by this factor are Germans (32%). nterested Finally, the issue of an "overall prevention, information, warning and evacuation system protecting you and your family from local geopolitical and climate climate-related risks" only motivates 40% of Europeans, compared to 57 of 57% Americans. 51% of French are attracted b this proposal, followed by Austrians (49%) and Swedish (48%). by ) Prevention of occupational illnesses: in first place - back pain and the prevention of stress With regard to the nature of the healthcare programmes that they would require within the context of their workplace, those surveyed attributed particular priority to back pain and stress management mentioned by more management, than 50% of survey participants in the majority of countries, with the exception of the United States (40 and 45 45%). Swedish appear to be particularly concerned by back pain (75%) and stress (65%). Polish are very concerned by back pain (77%), in particular women (83 ), (83%), stress (71%) (women 78%) and serious illnesses (65%). On average, French indicate a higher level of requirement in these three areas. Swedish claim to be the most concerned by the prevention of risks associated with the consumption of tobacco, alcohol or drugs (48%), but also by obesity (47%), whereas only 30 and 36% of Americans are concerned by these problems respectively. Germans (17 and 22%) and British (23 and 22%) do not seem motivated by programs for the prevention of obesity ) and various addictions either. high-quality care are essential decision-making criteria for employees who To sum up, access to and provision of high are offered a position abroad, whatever their nationality, far ahead of any other consideration. On the other hand, the more global mechanisms for the prevention of risks are only of concern to a minority of Europeans, while prevention Americans appear more familiar with these solutions. As for prevention of occupational illnesses, while employees appear concerned by back pain, stress and se serious illnesses, they seem less interested by the battle against obesity and addition, with the exception of the Swedish. 14
  15. 15. Healthcare and new communication technologies The Internet generation Sweden (82%) remains the country where the consultation of health-related information on the Internet is the ) related most common, followed by the United States (75 and then Poland (63%). Spain (41% and France (45%) remain (75%) %) the countries with the fewest users. A slight drop in online consultation can even be observed in France ( 4 points), Spain (-2 points) and Italy (-2 (-4 points), while all other countries continue to increase; Germany (62 ) by 8 points in comparison with its level in (62%) 2012, and Sweden also reporting a considerable increase (+ 5 points). On the whole, Europe increased by 5 points. Unsurprisingly, it is those aged 18-39 and active individuals, in many 39 cases those living in a major city, who use the Internet for healthcare the most. Web 2.0 Healthcare: still in its infancy The consultation of healthcare information on the Internet has increased regularly to reach 82% among the Swedish, with France and Spain in the bottom positions with level of consultation of 45% and 41% respectively in 2013. But what is the situation regarding the exchange of information, opinions and comments re regarding health with other people? Practices are considerably less developed: 26 of Swedish and Germans claim to do it regularly or 26% occasionally, followed by 21% of Americans and 16 % of Austrians. Only 10% of French have adopt these adopted practices, ahead of British at 7%. The profile of the most frequent users is the same as that for the consultation of healthcare information on the Internet: young people, active people or residents of major cities. Mobile telephone: renewed interest In response to the question "are your more for or against the development of means of continual medical monitoring via telephone", an increase of interest for this medium is to be observed in all countries, with a spectacular increase in Germany to a level of 60% positive responses in 2013 compared with 46 in 2012, the 46% country seeming to catch up with the others. At the top, Swedish (80%) increase by a further 8 points. Austria increase from 55% in 2012 to 62% in 2013, ) increases % French making a slight climb to 61%, positioning themselves towards the back of the pack, yet still chased by , Germans. If you compare the results of 2010 with those of 2013, there is no spectacular change of opinions regarding the use of the mobile phone, but rather one can see evidence of a gradual increase in the awareness of its potential. Remote consultation: a still limited support in many countries Regarding the issue of remote GP consultations via Internet using a webcam Swedish come top (62 webcam, (62%), followed by Spanish(52%), with a very noticeable increase in the number of favourable responses in these two countries, increasing by + 13 points and +10 points resp respectively. In third place are Polish (50%) followed by Americans (48%). ) 15
  16. 16. In contrast, 85% of Austrians, 75% of Germans and 69 of French are not in favour of this. With a spectacular 69% increase of 16 points regarding the number of positive opinions, Italians (42%) catch up with British, the majority of umber ) whom also remain opposed to this solution, with only 39 in favour. 39% In summary, new technologies in the area of healthcare are on the rise in all countries, as people are becoming , more familiar with their use. While consulting medical information on the Internet has become commonplace, exchanging opinions on healthcare is not yet an established habit. Likewise, the idea of using one's mobile phone has been accepted on principle, but users are yet to familiarise themselves with the new applications. Regarding remote consultation, it is to be observed that usage is developing more slowly than the technologies themselves, slowly and cultural resistance varies from one country to the next. 16
  17. 17. To sum up… A dynamic barometer Since its creation in 2006, the annual pan pan-European barometer on "the relationship and practices of European citizens with regard to their health systems" has evolved considerably, for at least three reasons. The first is that, over the years, the barometer quickly expanded to include in its observations the United States, and as many as eight European countries - some of which, such as Poland, have made the transition from ich, communism to capitalism. Contrasts were thus particularly evident between the countries that maintain strong and specific policies, with somewhat uneven levels of economic development, distinct social trad traditions and varying systems of healthcare coverage. Having been able to observe this diversity with a view to gaining a better understanding of it is one of the major strengths of this barometer, the evolution of which has tracked that of the fields of investigation themselves. The second reason for this development comes as the result of the emergence of new parameters over the years, which must be taken into consideration in order to acquire an up date perspective of the relationships and up-to-date practices of citizens in a system that is seeking to modernise, in particular with the introduction of new technologies. The third reason is that the world itself has continued to experience rapid development, with situations arising such as economic, social and even moral crises. In these changing circumstances, the barometer also serves to help ven maintain our course by using the same benchmarks in order to continue making progress and to benefit from a more long-term vision; a more global understanding of significant changes. Today this development in time and term significant space enables us to take stock, so as to embrace a global, more long term perspective, looking beyond long-term epiphenomena. A consolidated vision Over a period of 3, 5 or 7 years depending on each country, it can be noted that the assessments made by those e surveyed in each country regarding the organisation of their healthcare system ultimately return more or less to a median level, the ratings differing from one country to the next but remaining coherent within eac individual each country. The reading of curves over a period of several years thus enables us to disregard the characteristics unique to each population, but also to verify whether the often abrupt variations are the consequence of measures, announcements or events, the impact of which will fade in time. r Let's take, for example, the case of Germany, and the opinion of its population with regard to its healthcare system, its curve having climbed the most between 2006 and 2013, increasing from 3.9 to 5, wit a peak of 5.5 in with 2012. This variation is remarkable compared to those experienced in the other countries observed over a long period. As such, the opinion curve of French, by comparison, paints the picture of a long and tranquil river! 17
  18. 18. Convergent ends and divergent means While, with the notable exception of Germany, national opinions regarding healthcare systems show signs of consolidation over time, opinions vary more greatly when one touches upon other subjects. Admittedly, there is consensus regarding the competence of doctors or the confidence placed in the healthcare authorities in general. egarding It is reassuring to note, for example, that in spite of the healthcare scandals that regularly crop up here and there, confidence in the institutions and also in the technical aspects of healthcare remains intact. But while everyone is in agreement in demanding improved equality of access to treatment, while still observing improvement, major division is evident when it comes to the question as to the means of implementation and the means of financing healthcare expenses. Here again, the observations made by the barometer since 2006 have much to teach us. Models in the process of becoming uniform? In reality, everything is happening as if, little by little, the models on the basis of which the various countries have built their social security system, and more broadly their healthcare system, have been falling into disuse. Thus, the beveridgian and bismarckian systems from which we drew influence in the initial studies seem to have lost their relevance in light of the changing mentalities, the arrival of new generations, more global models arising from the globalisation of practices and even new form of individualism… forms It is thus noted that the use of taxation to finance the increase in healthcare expenses receives fewer and fewer votes, including in countries in which it was traditionally preferred, and this phenomenon is particularly notable among young people, who, unlike their elders, did not experience the golden years following the Second World War and did not taste the fruit of this period like those over 60 years of age. The crisis and the cancellation of treatments The crisis of 2008 no doubt contributed to expanding the generational gap, and all analyses converge in ubt demonstrating that the austerity policies implemented since then penalise a growing number of families and individuals. In particular, the study reveals this in its analysis of the threats perceived by those surveyed in each country. It is most revealing, for example, to note the increase in the postponement or decision not to spend money on healthcare for needs as vital as routine treatment and medication, not to mention dental treatments and the purchasing of glasses, which often require supplementary insurance in order to be eligible for reimbursement. These postponements must have underlying reasons linked to changes in regulations relating to the organisation of treatments and reimbursement for certain services. However, nowadays, in the context of an economic crisis, nowadays, financial reasons take precedence and those who do not benefit from comprehensive care are the first to be sacrificed. cularly The case of the United States is particularly revealing when reading the results of the study, on account of the different types of social cover from which individuals benefit - or not as the case may be - on the other side of the Atlantic. 18
  19. 19. A reluctance to new mandatory deductions Paradoxically, in the European countries, where the social security systems still ensure a minimum level of cover, cally, the acceptance of the use of individual insurance solutions that work on the basis of an excess payment - personal financing - is evident. Within a context whereby financial resources are scarce, the use of taxation to ensure equality of access to treatment is being met with an increasingly negative response by those who are in a position to pay it, that is, mainly those who are active and younger peo people. The issues of dependency The other major debate concerns the provision of care to the elderly. The average score awarded to the quality of care for the elderly has not changed since 2012. For the European countries it stands at 3.7, a long way off the American average of 4.9. In Europe, this remains some way below the assessment of the healthcare sy system, which is given the grade 4.7. Expectations therefore remain high in this area, even though improvements have already been perceived, to a greater or lesser degree depending on the country, as a result of solutions already implemented. Among these solutions, the provision of home care for dependent people remains the preferred solution throughout, by some olutions, margin. However the envisaged methods of financing in order to provide this support continue to vary considerably depending on the country, as does the choice of organisations to provide this service - public or private, voluntary or otherwise. Pragmatic solutions Aside from Swedish who are huge supporters of public financing, the solutions that are increasingly preferred are mixed solutions with varying levels of financing, either public, private or personal. Ultimately, a homogeneous solution does not appear to be emerging, whether between the European countries or between Europe and the emerging, United States, where solutions also vary depending on the different types of social insurance. New technologies in the phase between acquisition and effective use Consensus is beginning to be reached in the majority of countries regarding new technologies and their desired use in prolonging home care. Therefore telemonitoring, but also robotics are being met with substantially more positive opinions. While telemonitoring has become commonplace, as has the use of the Internet to consult information relating to monplace, healthcare, the sharing of information and personal opinions regarding healthcare via the web is far from being common practice. Likewise, mobile telephone technology is awaiting applications that would be used on a massive applications scale, but that are as of yet only used marginally. CSA contact: helene.chevalier@csa.eu 19

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