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The document summarizes key findings from a 2011 survey of sicker adults in 11 countries that assessed access, affordability, quality of care and health system performance. Some of the main results presented include: 1) Out-of-pocket costs and problems paying medical bills were highest in the U.S. compared to other countries; 2) Access to same-day doctor appointments was best in Norway, Sweden and the UK, and worst in the U.S.; 3) Difficulty obtaining after-hours care without going to the emergency room was also greatest in the U.S.

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THE COMMONWEALTH FUND The Commonwealth Fund 2011 International Health Policy Survey of Sicker Adults in Eleven Countries Cathy Schoen and Robin Osborn The Commonwealth Fund November 2011
2 2011 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 Living Dollars $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. FUND Source: OECD Health Data 2011 (June 2011).
4 2011 Survey Profile of Sicker Adults Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Age 50 or older 57 50 54 60 57 54 60 58 63 62 56 Has two or more chronic conditions (out 44 41 34 42 34 34 35 26 37 45 53 of eight) Health care use in past two years: 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 21 Taking four or more prescription 28 30 26 24 31 27 29 30 24 35 37 medications regularly THE COMMONWEALTH FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
5 Affordability and Access THE COMMONWEALTH FUND
6 Cost-Related Access Problems in the Past Year Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Did not fill prescription 16 15 11 14 8 12 7 7 9 4 30 or skipped doses Had a medical problem but 17 7 10 12 7 18 8 6 11 7 29 did not visit doctor Skipped test, treatment, or 19 7 9 13 8 15 7 4 11 4 31 follow-up Yes to at least one of 30 20 19 22 15 26 14 11 18 11 42 the above Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE COMMONWEALTH Adults 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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults in Eleven Countries. FUND
8 Access to Doctor or Nurse When Sick or Needed Care Same- or next-day Waited six days or more appointment Percent 100 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 0 Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE Adults 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 room Percent 100 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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults 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 NOR Base: Saw or needed to see a specialist in the past two years. THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUND Adults in Eleven Countries.
11 Care Coordination and Care Transitions THE COMMONWEALTH FUND
12 Coordination Problems in the Past Two Years Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Test results/ records not available at appointment 19 25 20 16 18 15 22 16 11 13 27 and/or duplicate tests ordered Providers failed to share important 12 14 13 23 15 12 19 18 10 7 17 information with each other Specialist did not have information about medical history and/or 19 18 37 35 17 12 25 20 9 6 18 regular doctor not informed about specialist care THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUND Adults 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 test that had already been done, providers failed to share important information with each other, specialist did not have information about medical history, and/or regular doctor not informed about specialist care. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUND in Eleven Countries.
14 Gaps in Hospital or Surgery Discharge in Past Two Years Percent did NOT AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Receive instructions about symptoms 16 16 33 23 22 17 29 27 13 11 7 and when to seek further care Know who to contact for questions about 12 11 20 9 9 10 13 16 9 5 6 condition or treatment Receive written plan for care 30 27 33 26 44 31 44 46 28 19 7 after discharge Have arrangements made for follow- 31 26 47 47 22 31 38 36 32 12 16 up visits Receive clear instructions about what 15 11 27 15 20 11 19 14 14 9 5 medicines to be taking THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults 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 and when to seek further care; 2) know who to contact for questions about condition or treatment; 3) receive written plan for care after discharge; 4) have arrangements made for follow-up visits; and/or 5) receive very clear instructions THE about what medicines you should be taking. COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven FUND Countries.
16 Patient Safety THE COMMONWEALTH FUND
17 Medical, Medication, or Lab Test Errors in Past Two Years Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US reported: Wrong medication 4 5 6 8 6 7 8 5 2 2 8 or dose Medical mistake in 10 11 6 8 11 13 17 11 4 4 11 treatment Incorrect diagnostic/ lab test 4 5 3 2 6 5 4 3 3 2 5 results* Delays in abnormal 7 11 3 5 5 8 10 9 5 4 10 test results* Any medical, medication, or 19 21 13 16 20 22 25 20 9 8 22 lab errors * Base: Had blood test, x-rays, or other tests in past two years. THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUND Adults 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 NOR Base: Taking two or more prescriptions. Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries. THE COMMONWEALTH FUND
19 Doctor–Patient Relationship and Patient Activation THE COMMONWEALTH FUND
20 Doctor–Patient Relationship and Communication Percent reported AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US regular doctor always/often: Spends enough 85 77 82 86 87 87 71 70 88 87 81 time with you Encourages you to ask questions and explains 69 59 53 64 54 67 31 41 77 77 71 things in a way that is easy to understand Always/often 66 54 50 61 52 65 27 37 73 72 65 to both Base: Has a regular doctor/place of care. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults 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 about recommended treatment; 2) Tells you about treatment choices; and 3) Involves you as much as you want in decisions about your care. THE Base: Seen specialist in past two years. COMMONWEALTH FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
22 Managing Chronic Conditions THE COMMONWEALTH FUND
23 Patient Engagement in Care Management for Chronic Condition Percent reported AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US professional in past year has: Discussed your main goals/ 63 67 42 59 67 62 51 36 81 78 76 priorities Helped make treatment plan you could 61 63 53 49 52 58 41 40 74 80 71 carry out in daily life Given clear instructions on symptoms 66 66 56 64 64 63 44 49 84 80 75 and when to seek care Yes to all 48 49 30 41 42 45 23 22 67 69 58 three Base: Has chronic condition. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults 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 going Percent advice 100 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 0 Base: Has chronic condition. Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE COMMONWEALTH Adults 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 UK Base: Has heart disease, hypertension, and/or diabetes and blood pressure checked in past year. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults in Eleven Countries.
26 Medical Homes THE COMMONWEALTH FUND
27 Medical Homes Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Has a regular doctor or 97 96 99 97 100 99 99 95 99 99 91 place of care . . . . . . who is accessible . . 79 70 91 85 89 91 80 83 89 90 80 . . . . knows 84 80 88 91 79 89 76 66 96 94 84 you . . . . . . and helps 66 71 60 56 59 72 67 42 80 83 71 coordinate your care Has a medical 51 49 52 48 48 65 53 33 70 74 56 home* * 1) Has a regular doctor/place; 2) able to get appointment same/next day last time sick and/or regular place of care always/often calls back the same day to answer question; 3) someone at regular place of care always/often knows important information about medical history; and 4) regular practice always/often helps coordinate and arrange care from other doctors/places and/or one person responsible for all care received for chronic condition. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUND Eleven 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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults 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 ask questions, and explains things in a way that is easy to understand. THE Base: Has a regular doctor/place of care. COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUND Eleven 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 test that had already been done, providers failed to share important information with each other, specialist did not have information about medical history, and/or regular doctor not informed about specialist care. THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in COMMONWEALTH FUND Eleven Countries.
31 Hospital or Surgery Discharge Gap in Past Two Years, by Medical Home Percent * 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 about symptoms and when to seek further care; 2) know who to contact for questions about condition or treatment; 3) receive written plan for care after discharge; 4) have arrangements made for follow-up visits; and/or 5) receive very clear instructions about what medicines you should be taking. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUND Eleven Countries.
32 Medical, Medication, or Lab Test Errors in Past Two Years, by Medical Home Percent * 40 Medical home No medical home 30 29 29 29 27 23 23 22 22 20 18 19 16 16 17 15 15 15 15 15 14 10 10 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 in past two years. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUND in 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 in care for condition; 2) helped make treatment plan you could carry out in daily life; and 3) given clear instructions on symptoms and when to seek care. THE COMMONWEALTH Base: Has chronic condition. FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven 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 US Base: Has heart disease, hypertension, and/or diabetes and blood pressure checked THE in past year. COMMONWEALTH FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
35 Rated 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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults in Eleven Countries. FUND
36 U.S. Sicker Adults, by Age and Insurance Status THE COMMONWEALTH FUND
37 Affordability, Access, and Coordination Experiences in the Past Year, by Age and Insurance Among U.S. Adults 19 Access problems because of costs 38 76 Serious problems 6 paying 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 Experienced coordination gap 43 52 72 Has a medical home 57 35 0 25 50 75 100 Percent THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUND in 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 Cofunders Thanks to coauthors David Squires, Michelle M. Doty, Roz Pierson, and Sandra Applebaum, and to Harris Interactive, Inc., and contractors for conducting the survey. Published in Health Affairs as: “New 2011 Survey of Patients with Complex Care Needs in Eleven Countries Finds That Care Is 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

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2011 survey article_chartpack

  • 1.
    THE COMMONWEALTH FUND The Commonwealth Fund 2011 International Health Policy Survey of Sicker Adults in Eleven Countries Cathy Schoen and Robin Osborn The Commonwealth Fund November 2011
  • 2.
    2 2011 Commonwealth FundInternational 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.
    3 Health Spending per Capita, 2009 Adjusted for Differences in Cost of Living Dollars $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. FUND Source: OECD Health Data 2011 (June 2011).
  • 4.
    4 2011 Survey Profile of Sicker Adults Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Age 50 or older 57 50 54 60 57 54 60 58 63 62 56 Has two or more chronic conditions (out 44 41 34 42 34 34 35 26 37 45 53 of eight) Health care use in past two years: 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 21 Taking four or more prescription 28 30 26 24 31 27 29 30 24 35 37 medications regularly THE COMMONWEALTH FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
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    5 Affordability and Access THE COMMONWEALTH FUND
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    6 Cost-Related Access Problems in the Past Year Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Did not fill prescription 16 15 11 14 8 12 7 7 9 4 30 or skipped doses Had a medical problem but 17 7 10 12 7 18 8 6 11 7 29 did not visit doctor Skipped test, treatment, or 19 7 9 13 8 15 7 4 11 4 31 follow-up Yes to at least one of 30 20 19 22 15 26 14 11 18 11 42 the above Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE COMMONWEALTH Adults in Eleven Countries. FUND
  • 7.
    7 Out-of-Pocket Spendingand 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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults in Eleven Countries. FUND
  • 8.
    8 Access to Doctor or Nurse When Sick or Needed Care Same- or next-day Waited six days or more appointment Percent 100 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 0 Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE Adults in Eleven Countries. COMMONWEALTH FUND
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    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 room Percent 100 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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults in Eleven Countries. FUND
  • 10.
    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 NOR Base: Saw or needed to see a specialist in the past two years. THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUND Adults in Eleven Countries.
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    11 Care Coordination andCare Transitions THE COMMONWEALTH FUND
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    12 Coordination Problems in the Past Two Years Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Test results/ records not available at appointment 19 25 20 16 18 15 22 16 11 13 27 and/or duplicate tests ordered Providers failed to share important 12 14 13 23 15 12 19 18 10 7 17 information with each other Specialist did not have information about medical history and/or 19 18 37 35 17 12 25 20 9 6 18 regular doctor not informed about specialist care THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUND Adults in Eleven Countries.
  • 13.
    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 test that had already been done, providers failed to share important information with each other, specialist did not have information about medical history, and/or regular doctor not informed about specialist care. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUND in Eleven Countries.
  • 14.
    14 Gapsin Hospital or Surgery Discharge in Past Two Years Percent did NOT AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Receive instructions about symptoms 16 16 33 23 22 17 29 27 13 11 7 and when to seek further care Know who to contact for questions about 12 11 20 9 9 10 13 16 9 5 6 condition or treatment Receive written plan for care 30 27 33 26 44 31 44 46 28 19 7 after discharge Have arrangements made for follow- 31 26 47 47 22 31 38 36 32 12 16 up visits Receive clear instructions about what 15 11 27 15 20 11 19 14 14 9 5 medicines to be taking THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults in Eleven Countries.
  • 15.
    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 and when to seek further care; 2) know who to contact for questions about condition or treatment; 3) receive written plan for care after discharge; 4) have arrangements made for follow-up visits; and/or 5) receive very clear instructions THE about what medicines you should be taking. COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven FUND Countries.
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    16 Patient Safety THE COMMONWEALTH FUND
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    17 Medical, Medication,or Lab Test Errors in Past Two Years Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US reported: Wrong medication 4 5 6 8 6 7 8 5 2 2 8 or dose Medical mistake in 10 11 6 8 11 13 17 11 4 4 11 treatment Incorrect diagnostic/ lab test 4 5 3 2 6 5 4 3 3 2 5 results* Delays in abnormal 7 11 3 5 5 8 10 9 5 4 10 test results* Any medical, medication, or 19 21 13 16 20 22 25 20 9 8 22 lab errors * Base: Had blood test, x-rays, or other tests in past two years. THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH FUND Adults in Eleven Countries.
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    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 NOR Base: Taking two or more prescriptions. Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries. THE COMMONWEALTH FUND
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    19 Doctor–Patient Relationship and Patient Activation THE COMMONWEALTH FUND
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    20 Doctor–Patient Relationship and Communication Percent reported AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US regular doctor always/often: Spends enough 85 77 82 86 87 87 71 70 88 87 81 time with you Encourages you to ask questions and explains 69 59 53 64 54 67 31 41 77 77 71 things in a way that is easy to understand Always/often 66 54 50 61 52 65 27 37 73 72 65 to both Base: Has a regular doctor/place of care. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults in Eleven Countries.
  • 21.
    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 about recommended treatment; 2) Tells you about treatment choices; and 3) Involves you as much as you want in decisions about your care. THE Base: Seen specialist in past two years. COMMONWEALTH FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
  • 22.
    22 Managing Chronic Conditions THE COMMONWEALTH FUND
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    23 Patient Engagement in Care Management for Chronic Condition Percent reported AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US professional in past year has: Discussed your main goals/ 63 67 42 59 67 62 51 36 81 78 76 priorities Helped make treatment plan you could 61 63 53 49 52 58 41 40 74 80 71 carry out in daily life Given clear instructions on symptoms 66 66 56 64 64 63 44 49 84 80 75 and when to seek care Yes to all 48 49 30 41 42 45 23 22 67 69 58 three Base: Has chronic condition. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults in Eleven Countries.
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    24 Between DoctorVisits, Has a Health Care Professional Who . . . You can easily call to Contacts you to see how ask a question or get things are going Percent advice 100 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 0 Base: Has chronic condition. Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker THE COMMONWEALTH Adults in Eleven Countries. FUND
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    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 UK Base: Has heart disease, hypertension, and/or diabetes and blood pressure checked in past year. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker FUND Adults in Eleven Countries.
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    26 Medical Homes THE COMMONWEALTH FUND
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    27 Medical Homes Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Has a regular doctor or 97 96 99 97 100 99 99 95 99 99 91 place of care . . . . . . who is accessible . . 79 70 91 85 89 91 80 83 89 90 80 . . . . knows 84 80 88 91 79 89 76 66 96 94 84 you . . . . . . and helps 66 71 60 56 59 72 67 42 80 83 71 coordinate your care Has a medical 51 49 52 48 48 65 53 33 70 74 56 home* * 1) Has a regular doctor/place; 2) able to get appointment same/next day last time sick and/or regular place of care always/often calls back the same day to answer question; 3) someone at regular place of care always/often knows important information about medical history; and 4) regular practice always/often helps coordinate and arrange care from other doctors/places and/or one person responsible for all care received for chronic condition. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUND Eleven Countries.
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    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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults in Eleven Countries. FUND
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    29 Doctor–Patient Relationshipand 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 ask questions, and explains things in a way that is easy to understand. THE Base: Has a regular doctor/place of care. COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUND Eleven Countries.
  • 30.
    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 test that had already been done, providers failed to share important information with each other, specialist did not have information about medical history, and/or regular doctor not informed about specialist care. THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in COMMONWEALTH FUND Eleven Countries.
  • 31.
    31 Hospitalor Surgery Discharge Gap in Past Two Years, by Medical Home Percent * 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 about symptoms and when to seek further care; 2) know who to contact for questions about condition or treatment; 3) receive written plan for care after discharge; 4) have arrangements made for follow-up visits; and/or 5) receive very clear instructions about what medicines you should be taking. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in FUND Eleven Countries.
  • 32.
    32 Medical, Medication, orLab Test Errors in Past Two Years, by Medical Home Percent * 40 Medical home No medical home 30 29 29 29 27 23 23 22 22 20 18 19 16 16 17 15 15 15 15 15 14 10 10 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 in past two years. THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUND in Eleven Countries.
  • 33.
    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 in care for condition; 2) helped make treatment plan you could carry out in daily life; and 3) given clear instructions on symptoms and when to seek care. THE COMMONWEALTH Base: Has chronic condition. FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
  • 34.
    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 US Base: Has heart disease, hypertension, and/or diabetes and blood pressure checked THE in past year. COMMONWEALTH FUND Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries.
  • 35.
    35 Rated Quality ofCare 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 THE Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker COMMONWEALTH Adults in Eleven Countries. FUND
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    36 U.S. Sicker Adults, by Age and Insurance Status THE COMMONWEALTH FUND
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    37 Affordability, Access, andCoordination Experiences in the Past Year, by Age and Insurance Among U.S. Adults 19 Access problems because of costs 38 76 Serious problems 6 paying 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 Experienced coordination gap 43 52 72 Has a medical home 57 35 0 25 50 75 100 Percent THE COMMONWEALTH Source: 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults FUND in Eleven Countries.
  • 38.
    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.
    39 Acknowledgments and Cofunders Thanks to coauthors David Squires, Michelle M. Doty, Roz Pierson, and Sandra Applebaum, and to Harris Interactive, Inc., and contractors for conducting the survey. Published in Health Affairs as: “New 2011 Survey of Patients with Complex Care Needs in Eleven Countries Finds That Care Is 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