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Commonwealth Fund 2011 International Health Policy Survey of Sicker Adults in Eleven

Commonwealth Fund 2011 International Health Policy Survey of Sicker Adults in Eleven
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    2011 survey article_chartpack 2011 survey article_chartpack Presentation Transcript

    • THE COMMONWEALTH FUND The Commonwealth Fund2011 International Health Policy Survey of Sicker Adults in Eleven Countries Cathy Schoen and Robin Osborn The Commonwealth Fund November 2011
    • 22011 Commonwealth Fund International Health Policy Survey • Telephone survey of representative samples of sicker adults ages 18 and older conducted from March to June 2011. • Sicker adults screened in: fair or poor health; had surgery or been hospitalized in past two years; or received care for serious or chronic illness, injury, or disability in past year. • Final samples: Australia 1,500, Canada 3,958, France 1,001, Germany 1,200, Netherlands 1,000, New Zealand 750, Norway 753, Sweden 4,804, Switzerland 1,500, United Kingdom 1,001, and United States 1,200. • Conducted by Harris Interactive and country contractors. • Core topics: Affordability and access, care coordination and care transitions, patient safety, patient-centered care, doctor–patient relationship and patient activation, managing chronic conditions, medical homes, and U.S. experiences by age and insurance status. THE COMMONWEALTH FUND
    • 3 Health Spending per Capita, 2009 Adjusted for Differences in Cost of LivingDollars $7,960$8,000$7,000$6,000 $5,352 $5,144 $4,914$5,000 $4,218$4,363 $3,978$4,000 $3,722 $3,445$3,487 $2,983$3,000$2,000$1,000 $0 NZ (10.3%)(8.7%)* SWE (10.0%) GER (11.6%) NETH (12.0%) NOR (9.6%) AUS UK (9.8%) FR (11.8%) CAN (11.4%) SWIZ (11.4%) US (17.4%) % GDP THE COMMONWEALTH* 2008. FUNDSource: OECD Health Data 2011 (June 2011).
    • 4 2011 Survey Profile of Sicker AdultsPercent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USAge 50 or older 57 50 54 60 57 54 60 58 63 62 56Has two or morechronicconditions (out 44 41 34 42 34 34 35 26 37 45 53of eight)Health care usein past twoyears: Hospitalized 54 37 51 43 40 50 46 48 54 48 40 Surgery 43 37 36 37 39 46 38 35 46 41 38 Saw four or more doctors 32 21 23 36 24 26 19 23 6 16 21Taking four ormoreprescription 28 30 26 24 31 27 29 30 24 35 37medicationsregularly THE COMMONWEALTH FUNDSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults inEleven Countries.
    • 5Affordability and Access THE COMMONWEALTH FUND
    • 6 Cost-Related Access Problems in the Past YearPercent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USDid not fillprescription 16 15 11 14 8 12 7 7 9 4 30or skippeddosesHad a medicalproblem but 17 7 10 12 7 18 8 6 11 7 29did not visitdoctorSkipped test,treatment, or 19 7 9 13 8 15 7 4 11 4 31follow-upYes to atleast one of 30 20 19 22 15 26 14 11 18 11 42the aboveSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE COMMONWEALTHAdults in Eleven Countries. FUND
    • 7 Out-of-Pocket Spending and Problems Paying Medical Bills in Past Year More than US$1,000 in Serious problems paying or out-of-pocket costs unable to pay medical bills Percent 60 50 39 40 35 36 30 27 24 20 16 13 14 11 12 11 10 7 8 8 8 5 6 5 6 4 1 1 0 THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTHAdults in Eleven Countries. FUND
    • 8 Access to Doctor or Nurse When Sick or Needed Care Same- or next-day Waited six days or more appointmentPercent100 79 79 75 75 75 70 63 59 59 59 51 50 50 22 23 23 25 16 12 14 5 8 10 2 4 0Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THEAdults in Eleven Countries. COMMONWEALTH FUND
    • 9 After-Hours Care and Emergency Room Use Difficulty getting after-hours Used emergency room in past two care without going to the years emergency roomPercent100 75 63 56 58 52 55 55 50 47 48 49 50 40 40 39 40 40 34 35 31 32 33 26 25 21 0 THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTHAdults in Eleven Countries. FUND
    • 10 Waited Less Than a Month to See Specialist Percent 100 92 88 81 80 79 80 68 67 63 59 60 52 47 40 20 0 SWIZ US NETH UK GER NZ FR SWE AUS CAN NORBase: Saw or needed to see a specialist in the past two years. THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUNDAdults in Eleven Countries.
    • 11Care Coordination and Care Transitions THE COMMONWEALTH FUND
    • 12 Coordination Problems in the Past Two YearsPercent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USTest results/records notavailable atappointment 19 25 20 16 18 15 22 16 11 13 27and/or duplicatetests orderedProvidersfailed to shareimportant 12 14 13 23 15 12 19 18 10 7 17informationwith each otherSpecialist didnot haveinformationabout medicalhistory and/or 19 18 37 35 17 12 25 20 9 6 18regular doctornot informedabout specialistcare THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUNDAdults in Eleven Countries.
    • 13 Experienced Coordination Gaps in Past Two Years Percent 80 60 56 53 42 43 39 40 40 36 37 30 23 20 20 0 UK SWIZ NZ AUS NETH SWE CAN US NOR FR GER* Test results/records not available at time of appointment, doctors ordered testthat had already been done, providers failed to share important information witheach other, specialist did not have information about medical history, and/orregular doctor not informed about specialist care. THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUNDin Eleven Countries.
    • 14 Gaps in Hospital or Surgery Discharge in Past Two YearsPercent did NOT AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USReceiveinstructionsabout symptoms 16 16 33 23 22 17 29 27 13 11 7and when to seekfurther careKnow who tocontact forquestions about 12 11 20 9 9 10 13 16 9 5 6condition ortreatmentReceive writtenplan for care 30 27 33 26 44 31 44 46 28 19 7after dischargeHave arrangementsmade for follow- 31 26 47 47 22 31 38 36 32 12 16up visitsReceive clearinstructionsabout what 15 11 27 15 20 11 19 14 14 9 5medicines to betaking THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUNDAdults in Eleven Countries.
    • 15 Any Gaps in Hospital or Surgery Discharge in Past Two Years Percent 100 80 73 71 66 67 61 60 55 48 50 51 40 26 29 20 0 UK US SWIZ CAN NZ AUS GER NETH SWE NOR FR* Last time hospitalized or had surgery, did NOT: 1) receive instructions about symptoms andwhen to seek further care;2) know who to contact for questions about condition or treatment; 3) receive written plan forcare after discharge;4) have arrangements made for follow-up visits; and/or 5) receive very clear instructions THEabout what medicines you should be taking. COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven FUNDCountries.
    • 16Patient Safety THE COMMONWEALTH FUND
    • 17 Medical, Medication, or Lab Test Errors in Past Two YearsPercent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USreported:Wrongmedication 4 5 6 8 6 7 8 5 2 2 8or doseMedicalmistake in 10 11 6 8 11 13 17 11 4 4 11treatmentIncorrectdiagnostic/lab test 4 5 3 2 6 5 4 3 3 2 5results*Delays inabnormal 7 11 3 5 5 8 10 9 5 4 10test results*Any medical,medication, or 19 21 13 16 20 22 25 20 9 8 22lab errors* Base: Had blood test, x-rays, or other tests in past two years. THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUNDAdults in Eleven Countries.
    • 18 Pharmacist or Doctor Did Not Review and Discuss Prescriptions in Past Year Percent 100 80 62 60 55 58 41 40 34 28 28 29 31 25 20 16 0 UK SWIZ CAN US GER NZ AUS NETH SWE FR NORBase: Taking two or more prescriptions.Source: 2011 Commonwealth Fund International Health Policy Survey of SickerAdults in Eleven Countries. THE COMMONWEALTH FUND
    • 19Doctor–Patient Relationship and Patient Activation THE COMMONWEALTH FUND
    • 20 Doctor–Patient Relationship and CommunicationPercentreported AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USregular doctoralways/often:Spends enough 85 77 82 86 87 87 71 70 88 87 81time with youEncourages youto askquestions andexplains 69 59 53 64 54 67 31 41 77 77 71things in away that iseasy tounderstandAlways/often 66 54 50 61 52 65 27 37 73 72 65to bothBase: Has a regular doctor/place of care. THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUNDAdults in Eleven Countries.
    • 21 Shared Decision-Making with Specialists Percent reporting positive shared decision-making experiences with specialists* 100 80 79 80 72 67 67 64 61 60 50 48 40 37 40 20 0 SWIZ UK NZ NETH US AUS CAN GER SWE NOR FR* Reported specialist always/often: 1) Gives opportunities to ask questions aboutrecommended treatment; 2) Tells you about treatment choices; and 3) Involves youas much as you want in decisions about your care. THEBase: Seen specialist in past two years. COMMONWEALTH FUNDSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adultsin Eleven Countries.
    • 22Managing Chronic Conditions THE COMMONWEALTH FUND
    • 23 Patient Engagement in Care Management for Chronic ConditionPercentreported AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USprofessional inpast year has:Discussed yourmain goals/ 63 67 42 59 67 62 51 36 81 78 76prioritiesHelped maketreatment planyou could 61 63 53 49 52 58 41 40 74 80 71carry out indaily lifeGiven clearinstructionson symptoms 66 66 56 64 64 63 44 49 84 80 75and when toseek careYes to all 48 49 30 41 42 45 23 22 67 69 58threeBase: Has chronic condition. THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUNDAdults in Eleven Countries.
    • 24 Between Doctor Visits, Has a Health Care Professional Who . . . You can easily call to Contacts you to see how ask a question or get things are goingPercent advice100 81 77 75 73 71 70 68 63 62 59 55 54 50 31 29 24 22 22 22 25 16 16 14 12 9 0Base: Has chronic condition.Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE COMMONWEALTHAdults in Eleven Countries. FUND
    • 25 Blood Pressure Under Control Last Time Checked Has Heart Disease, Hypertension, and/or Diabetes Percent yes, under control 100 85 85 85 84 84 83 79 78 80 74 69 69 60 40 20 0 CAN NOR US NZ SWE FR AUS GER NETH SWIZ UKBase: Has heart disease, hypertension, and/or diabetes and blood pressurechecked in past year. THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUNDAdults in Eleven Countries.
    • 26Medical Homes THE COMMONWEALTH FUND
    • 27 Medical HomesPercent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USHas a regulardoctor or 97 96 99 97 100 99 99 95 99 99 91place of care. . .. . . who isaccessible . . 79 70 91 85 89 91 80 83 89 90 80.. . . knows 84 80 88 91 79 89 76 66 96 94 84you . . .. . . andhelps 66 71 60 56 59 72 67 42 80 83 71coordinateyour careHas a medical 51 49 52 48 48 65 53 33 70 74 56home** 1) Has a regular doctor/place; 2) able to get appointment same/next day last timesick and/or regular place of care always/often calls back the same day to answerquestion; 3) someone at regular place of care always/often knows important informationabout medical history; and 4) regular practice always/often helps coordinate andarrange care from other doctors/places and/or one person responsible for all carereceived for chronic condition. THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUNDEleven Countries.
    • 28 Patients with a Regular Doctor versus a Medical Home Has a regular doctor or place Percent of care 99 99 99 99 99 97 97 100 100 96 95 91 80 74 70 65 60 56 53 52 51 49 48 48 40 33 20 0 UK SWIZ NZ US NOR FR AUS CAN GER NETH SWE Patients with a medical home have a regular practice who is accessible, knows them, and helps coordinate their care THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTHAdults in Eleven Countries. FUND
    • 29 Doctor–Patient Relationship and Communication, by Medical Home Percent reporting positive doctor–patient relationship and communication* Medical home No medical home 100 79 82 79 80 80 76 70 72 65 59 60 52 55 54 50 51 45 38 40 40 41 40 36 28 20 18 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US* Regular doctor always/often: spends enough time with you, encourages you to askquestions, and explains things in a way that is easy to understand. THEBase: Has a regular doctor/place of care. COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUNDEleven Countries.
    • 30 Experienced Coordination Gaps in Past Two Years, by Medical Home Percent * 100 Medical home No medical home 80 57 59 60 53 54 49 49 51 41 42 41 42 40 36 33 33 31 30 32 32 30 25 20 20 15 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US* Test results/records not available at time of appointment, doctors ordered testthat had already been done, providers failed to share important information with eachother, specialist did not have information about medical history, and/or regulardoctor not informed about specialist care. THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in COMMONWEALTH FUNDEleven Countries.
    • 31 Hospital or Surgery Discharge Gap in Past Two Years, by Medical HomePercent*100 Medical home No medical home 82 80 78 74 68 70 67 63 66 64 57 60 63 59 59 60 53 49 46 43 42 41 40 17 19 20 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US* Last time hospitalized or had surgery, did NOT: 1) receive instructions aboutsymptoms and when to seek further care; 2) know who to contact for questions aboutcondition or treatment; 3) receive written plan for care after discharge; 4) havearrangements made for follow-up visits; and/or 5) receive very clear instructionsabout what medicines you should be taking. THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUNDEleven Countries.
    • 32Medical, Medication, or Lab Test Errors in Past Two Years, by Medical HomePercent*40 Medical home No medical home30 29 29 29 27 23 23 22 2220 18 19 16 16 17 15 15 15 15 15 14 1010 6 6 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US* Reported medical mistake, medication error, and/or lab test error or delay inpast two years. THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUNDin Eleven Countries.
    • 33 Patient Engagement in Care Management for Chronic Condition, by Medical Home Percent reporting positive patient engagement in managing chronic condition* Medical home No medical home 100 80 73 76 67 56 59 60 54 51 51 47 46 45 40 38 38 34 33 32 29 27 29 24 20 16 15 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US* Health care professional in past year has: 1) discussed your main goals/priorities incare for condition; 2) helped make treatment plan you could carry out in daily life; and3) given clear instructions on symptoms and when to seek care. THE COMMONWEALTHBase: Has chronic condition. FUNDSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults inEleven Countries.
    • 34 Blood Pressure Under Control Last Time Checked, by Medical Home Has Heart Disease, Hypertension, and/or Diabetes Percent Medical home No medical home 100 88 88 90 85 86 82 84 82 84 83 80 82 79 78 80 75 76 71 73 70 70 65 60 58 40 20 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK USBase: Has heart disease, hypertension, and/or diabetes and blood pressure checked THEin past year. COMMONWEALTH FUNDSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adultsin Eleven Countries.
    • 35Rated Quality of Care in Past Year as “Excellent” or “Very Good,” Percent by Medical Home 100 Medical home No medical home 88 83 79 77 80 72 72 65 62 60 59 57 60 56 49 46 44 44 43 40 38 35 34 27 26 20 0 AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US THESource: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTHAdults in Eleven Countries. FUND
    • 36 U.S. Sicker Adults,by Age and Insurance Status THE COMMONWEALTH FUND
    • 37Affordability, Access, and Coordination Experiences in the Past Year, by Age and Insurance Among U.S. Adults 19Access problemsbecause of costs 38 76Serious problems 6paying or unable to pay medical 25 bills 57 Age 65+ Out-of-pocket 27 spending: more 40 Under 65: insured all than $1,000 41 year 33 Experiencedcoordination gap 43 52 72 Has a medical home 57 35 0 25 50 75 100 Percent THE COMMONWEALTHSource: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUNDin Eleven Countries.
    • 38 Cross-Cutting Themes and Implications• Room for improvement in all countries – Improving care coordination and system integration – Engaging patients in care and self-management• No single health system model stands out – U.K. and Switzerland often lead but have very different systems• U.S. is an outlier on access and affordability – Cost-sharing and benefit design matters• Strong primary care “medical homes” make a difference in all countries THE COMMONWEALTH FUND
    • 39 Acknowledgments and CofundersThanks to coauthors David Squires, Michelle M. Doty, Roz Pierson, andSandra Applebaum, and to Harris Interactive, Inc., and contractors forconducting the survey. Published in Health Affairs as: “New 2011 Surveyof Patients with Complex Care Needs in Eleven Countries Finds That CareIs Often Poorly Coordinated,” Web First, November 9, 2011. • Australia: Bureau of Health Information • Canada: Health Council of Canada, Ontario Quality Council, Quebec Health Commission, Health Quality Council of Alberta • France: Haute Authorité de Santé (HAS), Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (CNAMTS) • Germany: German National Institute for Quality Measurement in Health Care • Netherlands: Dutch Ministry of Health, Welfare and Sport, and Scientific Institute for Quality of Healthcare, Radboud University Nijmegen • Norway: Norwegian Knowledge Centre for the Health Services • Sweden: Swedish Ministry of Health and Social Affairs • Switzerland: Federal Office of Public Health THE COMMONWEALTH • United Kingdom: Health Foundation FUND