Transcript THE COMMONWEALTH FUND The Commonwealth Fund 2013 International Health Policy Survey in Eleven Countries Robin Osborn and Cathy Schoen The Commonwealth Fund November 2013

THE
COMMONWEALTH
FUND
The Commonwealth Fund
2013 International Health Policy Survey
in Eleven Countries
Robin Osborn and Cathy Schoen
The Commonwealth Fund
November 2013
2
The Commonwealth Fund 2013 International
Health Policy Survey in Eleven Countries
• Survey of adults age 18 and older in eleven countries.
• Sample sizes: Australia (2,200), Canada (5,412), France (1,406),
Germany (1,125), Netherlands (1,000), New Zealand (1,000), Norway
(1,000), Sweden (2,400), Switzerland (1,500), United Kingdom (1,000),
United States (2,002).
• Survey in the field February to June 2013.
• Conducted by Social Science Research Solutions and country
contractors (by landline and cell phone).
• Presentation topics: affordability and cost-related access barriers;
access to primary care, emergency department, and specialist care;
complexity; and system views.
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Affordability and Cost-Related Access Barriers
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Health Spending per Capita, 2011
Adjusted for Differences in Cost of Living
$US
$9,000
$8,508
$8,000
$7,000
$6,000
$5,669 $5,643
$5,099
$5,000
$4,522 $4,495
$4,000
$4,118 $3,925
$3,800
$3,405 $3,182
$3,000
$2,000
$1,000
$0
% GDP
US
NOR
SWIZ NETH
CAN
GER
FR
SWE
AUS
UK
NZ
(17.7%) (9.3%) (11.0%) (11.9%) (11.2%) (11.3%) (11.6%) (9.5%) (8.9%)* (9.4%) (10.3%)
* 2010.
Source: OECD Health Data 2013.
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Key National Insurance Design and
Cost-Sharing Policies, 2013
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US*
Deductible
No
No
No
No
Yes
No
No
No
Yes
No
Yes
Caps on
out-of-pocket
spending
Yes
No
No
Yes
No
No
Yes
Yes
Yes
No
No
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
Core benefit
Drugs
Dental (adults)
✔
✔
* Before insurance market reforms take effect in 2014.
Source: S. Thomson, R. Osborn, D. Squires, and M. Jun, International Profiles of Health Care Systems, 2013,
The Commonwealth Fund, Nov. 2013.
✔
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Cost-Related Access Barriers and Out-of-Pocket Costs
in the Past Year
Percent
Experienced cost-related
access problem*
Spent US$1,000 or more
out-of-pocket
60
50
41
37
40
30
20
10
4 6
10
16 18
15
13 13
24 25
21 22
2
3
7
7
9 11
14
17
0
* Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.
Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Serious Problems Paying or Unable to Pay
Medical Bills in the Past Year
Percent
40
30
23
20
13
10
4
6
7
7
8
NOR
CAN
GER
AUS
9
10
10
NETH
NZ
SWIZ
1
0
UK
SWE
FR
US
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Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Gaps in Dental Care
Percent
75
Did not visit dentist/hygenist/dental clinic in past two years
Skipped dental care because of cost in past year
60
45
41
33
30
25
19 19
15
10 8
10 12 11
GER
SWE
23 21
22
27
26
27
28 29
32
20
11
6
0
NOR NETH SWIZ
CAN
UK
FR
US
AUS
NZ
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Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Cost and Access Problems in the Past Year for U.S. Adults,
by Insurance Status
Experienced costrelated access
problem
9
63
27
Serious problems/
unable to pay
medical bills
Uninsured
42
Insured all year
15
39
Spent $1,000 or more
out-of-pocket
42
0
20
40
60
Percent
Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
80
100
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Access: Primary Care, Emergency Department Use,
and Specialist Care
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Access to Doctor or Nurse When Sick or Needed Care
Same-day or next-day
appointment
11
Waited six days or more
for appointment
Percent
100
76
75
72
63
58 58 57
52 52
50
48
41
25
14 14 15 16 16
22
26 28
33
5
0
Note: Question asked differently in Switzerland.
Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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When Calling Regular Doctor with a Question,
Always or Often Hear Back on the Same Day
Percent
100
90
84
84
82
80
80
79
78
75
73
67
63
60
40
20
0
GER NETH SWE SWIZ
NZ
AUS
NOR
UK
US
CAN
FR
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Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Access to After-Hours Care
Adults, 2013
Easy getting after-hours care
without going to the ER
Primary care physicians, 2012
Practice has arrangement for
patients’ after-hours care
to see doctor or nurse
Percent
95 95
100
80
60
90 90
81 80 78
76
69
68
58 56 56 54
49 46
40
46
39 38 36 35
35
20
0
Base: Needed care after hours.
* In Norway, doctors asked whether their practice had
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arrangements or there were regional arrangements. COMMONWEALTH
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Source: 2012 and 2013 Commonwealth Fund International Health Policy Surveys.
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Used the Emergency Department in Past Two Years
Percent
75
48
50
39
25
27
28
AUS GER NETH UK
NZ
22
22
24
28
28
31
32
FR
SWE
41
0
NOR SWIZ
US
CAN US
Uninsured
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Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Patients’ Email Access to Regular Practice
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
24
10
9
19
32
16
22
20
29
25
28
9
2
2
3
20
5
6
9
15
13
6
21
11
39
45
47
39
27
44
68
35
35
Adults, 2013
Can email
practice with
questions
Have emailed
practice in
past two years
Primary care
doctors, 2012
Patients can
email practices
with questions
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Source: 2012 and 2013 Commonwealth Fund International Health Policy Surveys.
Wait Times for Specialist Appointment
Less than four weeks
16
Two months or more
Percent
100
80 80
75
76 75
72
59
50
54 51 51
46
39
26 29
17 18 18 19
25
3
3
6
7 10
0
Base: Needed to see specialist in the past two years.
Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Complexity
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Spending on Health Insurance Administration per Capita, 2011
Adjusted for Differences in Cost of Living
$US
$700
$606
$600
$500
$400
$300
$199
$200
$100
$237
$266 $277
$128 $148
$35
$55
$70
SWE
AUS
$0
NOR
* 2010.
Source: OECD Health Data 2013.
NZ
CAN
NETH
GER
SWIZ
FR
US
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Insurance Complexity and Restrictions Create Concerns
for Patients and Doctors
Adults, 2013
Insurance did not cover as
expected/spent a lot of time on
Percent paperwork in past year*
19
Primary care physicians, 2012
Insurance coverage restrictions
pose major time concern**
75
54
50
41
32
25
19
15 16 17
8
4 4 7
23 25
10 11 12 12
23 24
20
18
28
0
* Adults spent a lot of time on paperwork or disputes over medical bills and/or insurance denied payment
or did not pay as much as expected in the past year.
** Amount of time doctor or staff spend getting patients needed medications/treatments because of coverage
restrictions is a major problem.
Source: 2012 and 2013 Commonwealth Fund International Health Policy Surveys.
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Overall Views of Health Care System, 2013
Works well, only minor changes
Fundamental changes
63
UK
33
54
51
48
47
46
44
42
42
40
SWIZ
NETH
AUS
NZ
NOR
SWE
GER
CAN
FR
0%
48
20%
4
7
5
9
8
12
10
10
8
11
40
44
43
45
42
46
48
50
49
25
US
Completely rebuild
40%
27
60%
80%
100%
Percent
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Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Insights from Global and Domestic Perspectives
• Insurance coverage and insurance design matter for ensuring
access and affordability
• Insurance and payment policies targeted at primary care can
strengthen access, including after-hours care
• Complexity can pose significant health system costs
o U.S. provides a cautionary example
• Controlling costs while safeguarding access will require vigilance
regarding the impact of insurance design changes
o Especially for those vulnerable because of chronic disease or
limited incomes
• Varying country insurance approaches provide rich insights
looking forward
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Acknowledgments and Country Partners
Thanks to coauthors David Squires and Michelle M. Doty, and to
Robyn Rapoport, Eran Ben-Porath, Social Science Research Solutions,
and country contractors for conducting the survey.
Cofunded by:
•
Australia: New South Wales Bureau of Health Information
•
Canada: Health Council of Canada, Health Quality Ontario, Commissaire à
la Santé et au Bien–être du Québec, Health Quality Council of Alberta
•
France: Haute Autorité de Santé (HAS), Caisse Nationale de l’Assurance
Maladie des Travailleurs Salariés (CNAMTS)
•
Germany: Federal Ministry of Health, BQS Institute for Quality and
Patient Safety
•
Netherlands: Dutch Ministry of Health, Welfare and Sport, and Scientific
Institute for Quality of Healthcare (IQ Healthcare)
•
Norway: Norwegian Knowledge Centre for the Health Services
•
Sweden: Swedish Ministry of Health and Social Affairs
•
Switzerland: Federal Office of Public Health
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