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1
Health System Performance in Selected Nations: A Chartpack
Compiled by Katherine K. Shea, Alyssa L. Holmgren,Robin Osborn, and Cathy Schoen
May 2007
2
Outline
I. Quality of CareII. Access to CareIII. Efficiency of Health SystemIV. Equity of Health SystemV. Ability to Ensure Long, Healthy and
Productive LivesVI. Views of the Health Care System:
Physicians and PatientsVII. Country Rankings
3
Data Sources
• 2004 Commonwealth Fund International Health Policy Survey of Adults' Experiences with Primary Care (Random, representative samples of adults 18 and older)
• Sample sizes: 1,400 in Australia, 1,410 in Canada, 1,400 in New Zealand, 3,061 in U.K., and 1,401 in U.S.; total sample of 8,672 adults.
• 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults (Adults in six countries who met at least one of four criteria: rated their health as fair or poor; reported that they had a serious illness, injury, or disability that required intensive medical care in the past two years; or reported that in the past two years they had major surgery or had been hospitalized)
• Sample Size: 700–750 sicker adults in Australia, Canada, and New Zealand and 1,500 or more in the United Kingdom, United States, and Germany; total sample of 6,958 sicker adults.
• 2006 International Health Policy Survey of Primary Care Doctors (Primary care physicians)
• Sample Size: Australia: 1,003, Canada: 578, Germany: 1,006, Netherlands: 931, New Zealand: 503, UK: 1,063, US: 1,004; total sample of 5,157 primary care physicians
• OECD Health Data from 2004 and 2005
4
Data References• K. Davis, et al., Mirror, Mirror on the Wall: An Update on the Quality of
American Health Care Through the Patient's Lens, (New York:The Commonwealth Fund, May 2007)
• C. Schoen, R. Osborn, P. Trang Huynh, M. Doty, J. Peugh, K. Zapert, On The Front Lines of Care: Primary Care Doctors' Office Systems, Experiences, and Views in Seven Countries, Health Affairs Web Exclusive (Nov. 2, 2006):w555–w571
• C. Schoen, M.S., Robin Osborn, M.B.A., Phuong Trang Huynh, Ph.D., Michelle Doty, Ph.D., Kinga Zapert, Ph.D., Jordon Peugh, M.A., Karen Davis, Ph.D. Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries, Health Affairs Web Exclusive (November 3, 2005): W5-509–W5-525
• C. Schoen, M.S., Robin Osborn, M.B.A., Phuong Trang Huynh, Ph.D., Michelle Doty, Ph.D., Karen Davis, Ph.D., Kinga Zapert, Ph.D., and Jordon Peugh, M.A. Primary Care and Health System Performance: Adults' Experiences in Five Countries, Health Affairs Web Exclusive (October 28, 2004): W4-487–W4-503
• P. T. Huynh, C. Schoen, R. Osborn, and A. L. Holmgren, The U.S. Health Care Divide: Disparities in Primary Care Experiences by Income, (New York: The Commonwealth Fund, April 2006)
• J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, May 2007).
5
Quality: Right Care
6Patient Reports on Reminders forPreventive Care, 2004
37 3844
49 50
0
25
50
75
AUS CAN NZ UK US
Percent of adults receiving preventive care reminders
2004 Commonwealth Fund International Health Policy Survey
7
828
61
9383
18
14
3265
5
16
24
20
18
0
25
50
75
100
AUS CAN GER NET NZ UK US
Y es, using a manual systemY es, using a computerized system
Physicians Reporting Routinely Sending Patients Reminder Notice for Preventive or Follow-Up Care, 2006
Percent of physicians
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
8
Preventive Care, 2004
Percent received: AUS CAN NZ UK US
Pap in past 3 years, Women age 25-64 78 77 81 77 89
Mammogram in past 3 years, Women age 50-64 80 79 81 77 86
2004 Commonwealth Fund International Health Policy Survey
9Percentage of Population over Age 65 with Influenza Immunization in 2004
43.0%
48.0%49.2%
59.2%62.4%
64.6%68.0%
71.0%73.0%
79.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Australia Netherlands United
K ingdom
France United
States
Canada OECD
Median
New
Zealand
Germany J apan
aa aa
Source: J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
10
Prevalence of Chronic Conditions, 2004
47 48 50 51 52
0
25
50
75
NZ CAN AUS US UK
Percent of adults with at least one of six chronic conditions*
*Hypertension, heart disease, diabetes, arthritis, lung problems, and depression2004 Commonwealth Fund International Health Policy Survey
11
* Adult reported at least one of six conditions: hypertension, heart disease, diabetes, arthritis, lung problems (asthma, emphysema, etc.), or depression..Data: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults (Schoen et al. 2005a).
6558 56
5045
37
0
50
100
CAN US NZ AUS UK GER
Percent of sicker adults with chronic conditions* whose doctor gave plan to manage care at home
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 11
Sicker Adults with Chronic Conditions:Receipt of Self-Management Plan in Six Countries, 2005
12Received Recommended Carefor Chronic Condition, Sicker Adults, 2005
Percent received recommended care:
AUS CAN GER NZ UK US
Hypertension* 78 85 91 77 72 85
Diabetes** 41 38 55 40 58 56
* Blood pressure and cholesterol checked.
** Hemoglobin A1c and cholesterol checked, and feet and eyes examined.
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
13Sicker Adults with Hypertension or DiabetesWho Received Recommended Care by
Self-Management Plan or Nurse Involvement, 2005
6167
50
68 64
7974 78 77 81
8691
0
50
100
NZ AUS UK CAN US GER
Neither self-management plan or nurse Self-management plan and/or nurse
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Includes blood pressure and cholesterol for hypertension; Hemoglobin A1cand cholesterol checked, and feet and eyes examined for diabetes
Percent
14
Percent of Doctors Reporting Practice Is Well Prepared to Care for Chronic Diseases, 2006
Percent of physicians reporting “well prepared”:
AUS CAN GER NET NZ UK US
Patients with multiple chronic diseases
69 55 93 75 67 76 68
Patients with mental health problems
50 40 70 65 48 55 37
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
15Doctor’s Office Has a NurseRegularly Involved in Care Management, Sicker Adults, 2005
16 19
3641
4752
0
25
50
75
AUS CAN NZ US GER UK
Percent who have a nurse involved in case management
2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Adults with chronic disease
16Prescription Medication Advice Among Sicker Adults with Chronic Conditions, 2005
Percent saying doctor:* AUS CAN GER NZ UK US
Does NOT review all medications taking, including prescribed by other doctors
46 38 35 42 42 40
Does NOT explain side effects
36 40 47 33 48 49
2005 Commonwealth Fund International Health Policy Survey
* Doctor sometimes, rarely, or never.
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Adults with chronic disease who use prescription medications regularly
17Patients Did Not Receive Counseling About Exercise and Diet in Past Year, Sicker Adults, 2005
29 3136 36
4550
0
25
50
75
US CAN NZ AUS UK GER
2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Adults with chronic health condition
18Physician-Reported Use of Multi-Disciplinary Teams
and Non-Physicians, 2006
AUS CAN GER NET NZ UK US
Practice routinely uses multi-disciplinary teams:
Yes 32 32 49 50 30 81 29
Practice routinely uses clinicians other than doctors to:
Help manage patients with multiple chronic diseases
38 25 62 46 57 73 36
Non-physicians provide primary care services
38 22 56 33 51 70 39
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
19Capacity to Generate Patient Information, 2006
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
2637
81
63
80
68
92
25
37
55 59
72 74
88
0
25
50
75
100
CAN US GER NET NZ AUS UK
List of patients by diagnosis
List of patients' medications, including Rx by other doctors
Percent of primary care practices reporting very or somewhat easy to generate
20
Quality: Safe Care
21
Medical, Medication, and Lab Errors Among Sicker Adults, 2005
22 23 25 2730
34
0
25
50
75
UK GER NZ AUS CAN US
Percent reporting medical mistake, medication error, or lab error in past two years
Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005a.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 21
22Patients Reporting Any Error by Numberof Doctors Seen in Past Two Years, Sicker Adults, 2005
Percent
2005 Commonwealth Fund International Health Policy Survey
12 14 14 12 1522
28 3135 37 40
48
0
25
50
75
UK GER NZ AUS CAN US
1 doctor 4 or more doctors
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
23
2340
8093 87 91
6 6
10
3128
33
102
0
25
50
75
100
CAN US GER AUS NET NZ UK
Y es, using a manual systemY es, using a computerized system
Doctors Reporting Routinely Receiving Alerts about Potential Problem with Drug Dose/Interaction
Percent of physicians
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
24Incorrect Lab/Diagnostic Test orDelay in Receiving Abnormal Test Results, Sicker Adults,
2005
9 11 14 1418
23
0
25
50
75
GER UK NZ AUS CAN US
2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Percent reporting either lab test error in past two years
25Doctors Reporting Routinely Receiving Alerts to Provide
Patients with Test Results, 2006
Percent of physicians
6 15
51 5332
52
30
17
16
98
403714
0
25
50
75
100
NET CAN US NZ UK GER AUS
Yes, using a manual systemYes, using a computerized system
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
26Medical Mistake or Medication ErrorOccurred Outside the Hospital, Sicker Adults, 2005
60 63 63 63 6777
0
50
100
CAN AUS GER NZ UK US
Percent saying error occurred outside the hospital
2005 Commonwealth Fund International Health Policy Survey
Base: Experienced medical mistake or medication error
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
27Developed Infection While in the Hospital, Sicker Adults, 2005
37 7 8 10 10
0
25
50
GER CAN US AUS NZ UK
2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Hospitalized in past 2 years
Percent
28Deaths Due to Surgical or Medical Mishaps per 100,000 Population in 2004
0.7
0.6
0.5 0.5 0.5
0.4 0.4
0.2 0.2
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
United
States
Germany Canada France United
K ingdom
Australia OECD
Median
J apan Netherlands
a2003b2002
ab
b
bb
b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
29
Quality: Coordinated Care
30Length of Time with Regular Doctor, Sicker Adults, 2005
Percent: AUS CAN GER NZ UK US
Has regular doctor 92 92 97 94 96 84
Less than 2 years 16 12 6 19 14 17
5 years or more 56 60 76 57 66 42
No regular doctor 8 8 3 6 4 16
2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
31Patient Report of Care Coordination, Sicker Adults, 2005
Percent saying in the past 2 years:
AUS CAN GER NZ UK US
Test results or records not available at time of appointment
12 19 11 16 16 23
Duplicate tests: doctor ordered test that had already been done
11 10 20 9 6 18
Percent who experienced either coordination problem
19 24 26 21 19 33
2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
32
Doctors’ Reports of Care Coordination Problems, 2006
Percent saying their patients “often/ sometimes” experienced:
AUS CAN GER NET NZ UK US
Records or clinical information not available at time of appointment
28 42 11 16 28 36 40
Tests/procedures repeated because findings unavailable
10 20 5 7 14 27 16
Problems because care was not well coordinated across sites/providers
39 46 22 47 49 65 37
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
33Coordination Problems by Number of Doctors, Sicker
Adults, 2005Percent
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
15 1623
711
2227
31 30 3026
43
0
25
50
75
AUS CAN GER NZ UK US
1 doctor 4 or more doctors
* Either records/results did not reach doctors office in timefor appointment OR doctors ordered a duplicate medical test
34Receive Information Back after Referrals of Patients
to Other Doctors/Specialists, 2006
Percent of physicians reporting receive for “almost all” referrals (80% or more)
827675
686261
37
0
25
50
75
100
US NET CAN GER UK AUS NZ
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
35Deficiencies in Transition PlanningWhen Discharged from the Hospital, Sicker Adults, 2005
Percent who reportedwhen discharged:
AUS CAN GER NZ UK US
Did NOT receive instructions about symptoms to watch and when to seek further care
18 17 23 14 26 11
Did NOT know who to contact with questions about condition or treatment
9 12 12 9 12 8
Hospital did NOT make arrangements for follow-up visits
23 30 50 23 19 27
% any of the above 36 41 60 33 37 33
Base: Hospitalized in past 2 years
2005 Commonwealth Fund International Health Policy Survey 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
36Doctors’ Reports of Length of Time to Receive a Full
Hospital Discharge Report, 2006
1723
28
4852 53
58
0
25
50
75
100
NZ US AUS NET UK GER CAN
Percent of physicians saying 15 days or more or rarely receive a full report
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
37
86
7773 72
69 67
0
50
100
GER AUS UK CAN NZ US
Percent of hospitalized patients with new prescription who reported prior medications were reviewed at discharge
Medications Reviewed When Discharged from the Hospital,Among Sicker Adults in Six Countries, 2005
Data: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults (Schoen et al. 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 37
38
Quality: Patient-Centered Care
39
Patient Reports about Doctor-Patient Relationship, 2004
Percent saying doctor: AUS CAN NZ UK US
Always listens carefully 71 66 74 68 58
Always explains things so you can understand
73 70 73 69 58
Always spends enough time with you
63 55 66 58 44
2004 Commonwealth Fund International Health Policy Survey
40Missed Opportunities toEngage Patient in Care, Sicker Adults, 2005
Percent saying doctor:* AUS CAN GER NZ UK US
Does NOT give you clear instructions
19 24 18 15 27 27
Does NOT make goals and plans clear
19 19 21 16 27 25
Does NOT tell you about treatment choices or ask your opinions
45 38 39 38 51 49
* Doctor only sometimes, rarely, or never.
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Adults with chronic disease
41Were Risks Explained Before a Hospital Procedure
in an Understandable Way?, Sicker Adults, 2005
Percent who said risks were NOT explained
2116 17 18
1412
0
25
50
GER US UK NZ AUS CAN
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Hospitalized in past 2 years
42Did Doctors and Nurses Involve You asMuch as You Wanted in Care Decisions? , Sicker Adults, 2005
1619 21 22 22
27
0
25
50
US NZ GER AUS UK CAN
Base: Hospitalized in past 2 years
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Percent NOT involved as much as would like
43Top Two Most Important Types ofInformation About Surgeons, Sicker Adults, 2005
Percent: AUS CAN GER NZ UK US
Experience with specific conditions
68 59 59 67 59 55
Outcomes of specific surgery or treatment
52 53 47 49 43 55
Patient satisfaction ratings
36 36 33 36 43 41
Training 23 32 36 26 19 34
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Had major surgery in the past 2 years
44Missed Opportunity to Engage Patientson Choice and Quality, Sicker Adults, 2005
Percent who said: AUS CAN GER NZ UK US
Did NOT have a choice of surgeons
34 36 23 38 44 23
Did NOT have any quality information about the surgeon
63 48 53 54 65 53
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Had major surgery in the past 2 years
45
Quality: Quality Improvement Efforts
46Physician Participation in Activities to Improve Quality
of Care, 2006
AUS CAN GER NET NZ UK US
Percent of physicians in past 2 years who:
Participated in collaborative QI efforts
58 48 76 70 78 58 49
Conducted clinical audit of patient care
76 45 69 46 82 96 70
Percent reporting their practice:
Sets formal targets for clinical performance
26 27 70 35 41 70 50
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
47
Physicians’ Reports on Availability of Data on Clinical Outcomes or Performance, 2006
Percent of physicians reporting yes:
AUS CAN GER NET NZ UK US
Patients’ clinical outcomes
36 24 71 37 54 78 43
Surveys of patient satisfaction and experiences
29 11 27 16 33 89 48
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
48Primary Care Doctor’s Practice Has Documented Process for Follow-Up/Analysis of Adverse Events,
2006
AUS CAN GER NET NZ UK US
Yes, for all adverse events
35 20 32 7 41 79 37
Yes, for adverse drug reactions only
21 19 26 10 19 8 19
Do Not have a process
44 58 42 82 40 13 41
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
49Primary Care Doctors’ Reports of Financial Incentives For Quality of Care Improvement, 2006
Percent of physicians who receive financial incentive:*
AUS CAN GER NET NZ UK US
Achieving certain clinical care targets
33 10 9 6 43 92 23
High ratings for patient satisfaction
5 - 5 1 2 52 20
Managing patients with chronic disease/ complex needs
62 37 24 47 68 79 8
Enhanced preventive care activities
53 13 28 18 42 72 12
Participating in quality improvement activities
35 7 21 28 47 82 19
*Receive or have the potential to receive
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
50
95
7972
58
43 41
30
0
25
50
75
100
UK NZ AUS NET GER CAN US
Percent of physicians reporting any financial incentive*
Primary Care Doctors’ Reports of Any Financial Incentives for Quality of Care Improvement, 2006
*Receive of have potential to receive payment for: clinical care targets, high patient ratings, managing chronic disease/complex needs, preventive care, or QI activities
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
51
Access to Care
52Cost-Related Access Problems, Sicker Adults, 2005
Percent in past year due to cost:
AUS CAN GER NZ UK US
Did not fill prescription or skipped doses
22 20 14 19 8 40
Had a medical problem but did not visit doctor
18 7 15 29 4 34
Skipped test, treatment or follow-up
20 12 14 21 5 33
Percent who said yes to at leastone of the above
34 26 28 38 13 51
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
53Americans Spend More Out-of-Pocket on Health Care Expenses, 2004
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$0 $100 $200 $300 $400 $500 $600 $700 $800 $900
a2003b2003 Total Health Care Spending, 2002 OOP Spending
ba
United States
OECD Median
New Zealand
Netherlands
Japan
GermanyFrance CanadaAustralia
a
Source: The Commonwealth Fund, calculated from OECD Health Data 2006.
Total health care spending per capita
Out-of-pocket spending per capita
54Out-of-Pocket Medical Costs in the Past Year, Sicker Adults, 2005
Percent with out of pocket expenses for medical bills more than $1000, US In the past year
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
48 8
14 14
34
0
25
50
75
UK NZ GER AUS CAN US
55
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
713 15
23 24 27
51
0
25
50
75
NET UK AUS GER CAN NZ US
Percent of physicians
Physicians’ Perception of Patient Access: Patients Often Have Difficulty Paying for Medications,
2006
56
58 5649 45
3023
2313
1716
17
13
0
50
100
NZ GER AUS UK US CAN
Next day
Same day
Percent of adults
310 13 15
23
36
NZ AUS GER UK US CAN
Waiting Time to See Doctor When Sick or Need Medical Attention, Sicker Adults in Six Countries, 2005
Data: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults (Schoen et al. 2005a).
Last time you were sick or needed medical attention,how quickly could you get an appointment to see a doctor?
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 56
Percent of adults reporting 6 days or more
57Difficulty Getting Care on Nights, Weekends, Holidays WithoutGoing to the ER, Among Sicker Adults in Six Countries, 2005
2528
38
5459 61
0
50
100
GER NZ UK CAN AUS US
Percent of adults who sought care reporting “very” or “somewhat” difficult
GER=Germany; NZ=New Zealand; UK=United Kingdom; CAN=Canada; AUS=Australia; US=United States.Data: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults (Schoen et al. 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 57
58Doctor’s Reports on Whether Practice Has Arrangement for Patients’
After-Hours Care to See Nurse/Doctor, 2006
9590 87
8176
4740
0
25
50
75
100
NET NZ UK AUS GER CAN US
Percent of physicians reporting “yes”
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
59
Help Line Use, Sicker Adults, 2005
Percent who reported: AUS CAN GER NZ UK US
Called help line for medical advice in the past 2 years
1028
5 10 32 13
Advice was definitely or somewhat helpful (Base: used help line)
90 86 75 86 88 80
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
60Waited More than Four Weeksto See a Specialist Doctor, Sicker Adults, 2005
22 23
4046
57 60
0
25
50
75
100
GER US NZ AUS CAN UK
Percent
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Saw or needed to see a specialist
61
Patients Often Experience Long Waits for Diagnostic Tests, 2006
6 8 9
26 28
5157
0
25
50
75
AUS GER US NET NZ CAN UK
Physicians’ Perception of Patient Access:
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
Percent of physicians
62Waiting Time for Elective or Non-Emergency Surgery, Sicker Adults, 2005
Percent experienced wait time of 4 month or more
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Base: Needed non-emergency or elective surgery
6 8
19 20
33
41
0
25
50
75
GER US AUS NZ CAN UK
63
Efficiency
64
69
1215
21
26
0
25
50
GER NZ UK AUS CAN US
Went to ER for Condition That Could Have Been Treatedby Regular Doctor, Among Sicker Adults, 2005
Percent of adults who went to ER in past two years for condition that could have been treatedby regular doctor if available
Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005a.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 64
65Readmitted to a Hospital or Went to ER asa Result of Complications After Discharge,
Sicker Adults, 2005
14171510
1620
0
25
50
75
AUS CAN GER NZ UK US
Base: Hospitalized in past 2 years
Percent readmitted or ER visit due to complications
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
66
69 10 11
1820
0
25
50
UK NZ CAN AUS US GER
Duplicate Medical Tests, Sicker Adults, 2005
Percent reporting that doctor ordered test that had already been done in past two years
Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005a.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 66
67
11 12
16 1619
23
0
25
50
GER AUS NZ UK CAN US
Percent reporting test results/records not available at time of appointment in past two years
Test Results or Medical Record Not Available atTime of Appointment, Among Sicker Adults, 2005
Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005a.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 67
68Primary Care Doctors Use of Electronic Patient Medical Records, 2006
9892 89
79
42
2823
0
25
50
75
100
NET NZ UK AUS GER US CAN
Percent of physicians
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
69Primary Care Doctors’ Access to Electronic Medical Record System Access, 2006
Percent with capability to:
AUS CAN GER NET NZ UK US
Share records electronically with clinicians outside your practice
10 6 9 45 17 15 12
Access records from outside the office
19 11 16 32 36 22 22
Provide patients with easy access to their records
36 6 15 8 32 50 10
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
70
Practice Use of Electronic Technology, 2006
Percent reporting routine use of:
AUS CAN GER NET NZ UK US
Electronic ordering of tests
65 8 27 5 62 20 22
Electronic prescribing of medication
81 11 59 85 78 55 20
Electronic access to patients’ test results
76 27 34 78 90 84 48
Electronic access to patients’ hospital records
12 15 7 11 44 19 40
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
71Primary Care Practices with Advanced Information Capacity, 2006
*Count of 14: EMR, EMR access other doctors, outside office, patient; routine use electronic ordering tests, prescriptions, access test results, access hospital records; computer for reminders, Rx alerts, prompt tests results; easy to list diagnosis, medications, patients due for care.
Percent reporting 7 or more out of 14 functions*
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
8783
72
59
32
19
8
0
25
50
75
100
NZ UK AUS NET GER US CAN
72Public Investment per Capita in Health Information Technology (HIT) as of 2005
$192.79
$31.85$21.20
$4.93 $0.43$0
$50
$100
$150
$200
United K ingdom Canada Germany Australia United States
Source: The Commonwealth Fund, calculated from Anderson, G.F., Frogner, B., Johns, R.A., and Reinhardt, U. “Health Care Spending and Use of Information Technology in OECD Countries,” Health Affairs, 2006.
73
International Comparison of Spending on Health, 1980–2004
Data: OECD Health Data 2005 and 2006.
Average spending on healthper capita ($US PPP)
Total expenditures on healthas percent of GDP
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
EFFICIENCY
73
0
1000
2000
3000
4000
5000
6000
7000
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
United StatesGermanyCanadaFranceAustraliaUnited Kingdom
0
2
4
6
8
10
12
14
16
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
United StatesGermanyCanadaFranceAustraliaUnited Kingdom
74Health Care Spending per Capita in 2004Adjusted for Differences in Cost of Living
$2,083$2,249
$2,546$2,571
$2,876$3,005$3,041$3,159$3,165
$6,102
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
United
States
Canada France Netherlands Germany Australia OECD
Median
United
K ingdom
J apan New
Zealand
aa
a2003
a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
75Average Annual Growth Rate of Real Health Care Spending per Capita, 1994–2004
2.4%
2.8%2.8%
3.2%3.3%
3.4%
3.7%3.8%
4.2%4.3%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
Australia United
K ingdom
OECD
Median
United
States
New
Zealand
Netherlands France J apan Canada Germany
A1994–2003
a a a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
76Percentage of Gross Domestic Product Spent on Health Care in 2004
8.0%8.3%8.4%8.7%
9.2%9.2%9.9%10.5%10.9%
16.0%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
United
States
Germany France Canada Netherlands Australia OECD
Median
New
Zealand
United
K ingdom
J apana a
a2003b2004c2004 number for US from C. Smith et al., “National Health Spending in 2004: Recent Slowdown Led by Prescription Drug Spending,” Health Affairs, Jan./Feb. 2006 25(1):186–96.
a b b b bbc
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
77Health Care Expenditure per Capitaby Source of Funding in 2004
Adjusted for Differences in Cost of Living
$803
$472 $313$582 $396 $389
$359
$2,572
$483 $342 $354
$1,611$1,832$1,917$2,176$1,940$2,350
$1,894$2,475$2,210
$2727
$238
$239$370 $28
$113
$444
$906$148
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
United
States
Canada France Netherlands Germany Australia United
K ingdom
OECD
Median
J apan New
Zealand
Private Spending
Out-of-Pocket Spending
Public Spending
a b
a2003b2002 (Out-of-Pocket)
aa
$6,102
$3,165 $3,158 $3,038 $3,005 $2,876$2,546 $2,461 $2,249
$2,083
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
78Inpatient Hospital Spending per Capita in 2004Adjusted for Differences in Cost of Living
$879$914$914
$1,015$1,043$1,044$1,069
$1,636
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
United
States
France Germany Netherlands Australia OECD
Median
Canada J apana b
a2003b2002
b a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
79Hospital Spending per Inpatient Acute Care Day in 2004
Adjusted for Differences in Cost of Living
$419$549
$793$862
$1,015$1,069
$2,337
$0
$500
$1,000
$1,500
$2,000
$2,500
United
States
France Australia Canada OECD
Median
Germany J apan
a2003b2002
a a ab
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
80Average Annual Hospital Inpatient Acute Care Days per Capita in 2004
0.7
1.01.01.01.01.1
1.8
2.1
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2.2
J apan Germany United
K ingdom
France Australia OECD
Median
Canada United
Statesa2003
a a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
Days
81Number of Acute Care Hospital Beds per 1,000 Population in 2004
2.82.83.0
3.63.63.73.8
6.4
8.4
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
J apan Germany France OECD
Median
United
K ingdom
Australia Canada Netherlands United
Statesa2003
aa a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
82Average Length of Stay for Acute Care in 2004
5.55.66.16.66.6
7.3
8.7
20.2
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
22.0
J apan Germany Canada OECD
Median
United
K ingdom
Australia United
States
France
Da
ys
a2003
aa
a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
83
$88
$183
$310$313
$392$396$402$409
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
Canada Netherlands Germany United
States
OECD
Median
J apan Australia France
Long-Term Institutional Care Spendingper Capita in 2004
Adjusted for Differences in Cost of Living
a
a2003b2002
ba
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
84Number of Long-Term Care Beds per 1,000 Population over Age 65 in 2004
2126
41
49
62
69
99
0
10
20
30
40
50
60
70
80
90
100
110
Canada France OECD
Median
United
States
Australia J apan United
K ingdomaa
a2003
a a a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
85Home Health Care Spending per Capita in 2004Adjusted for Differences in Cost of Living
$10$14
$46
$60
$97
$147
$157
$0
$20
$40
$60
$80
$100
$120
$140
$160
Germany United
States
Netherlands Canada OECD
Median
France J apana
a2003b2002
a b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
86Average Annual Growth Rate of Home Health Care Spending per Capita, 1994–2004
32.0%
13.4%
5.5%3.7%
2.1%
-5.0%
-10.0%
-5.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
J apan Germany France Canada United States Netherlands
a1995–2003 b1994–2003 c1994–2002
b ca
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
87Spending on Physician Services per Capita in 2004Adjusted for Differences in Cost of Living
$307$319$371$436
$482$563
$1,362
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
United
States
J apan OECD
Median
Australia France Canada Germanya
a2003b2002
ab
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
88Average Annual Growth Rate of Practicing Physicians per 1,000 Population, 1994–2004
3.1%
1.3% 1.3%1.3%
1.1% 1.1%0.9%
0.6%
0.0%0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
United
Kingdom
United
States
OECD
Median
Germany J apan New
Zealand
Australia France Canada
a1994–2003
a
a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
89Number of Practicing Physicians per 1,000 Population in 2004
3.63.4 3.4
3.2
2.62.4
2.32.2
2.12.0
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Netherlands France Germany OECD
Median
Australia United
States
United
K ingdom
New
Zealand
Canada J apana
a2003
a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
90Average Annual Number of Physician Visits per Capita in 2004
13.8
6.76.1 6.1 6.0
5.3 5.3
3.93.2
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
J apan France Canada OECD
Median
Australia Netherlands United
K ingdom
United
States
New
Zealand
a
a
aa
a2003
a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
91Pharmaceutical Spending per Capita in 2004Adjusted for Differences in Cost of Living
$318
$377$383
$425$438
$559
$599
$752
$0
$100
$200
$300
$400
$500
$600
$700
$800
United
States
France Canada Germany J apan Australia OECD Median Netherlands
a2003b2002
aa b b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
92Average Annual Growth Rate of Real Spendingper Capita on Pharmaceuticals, 1994–2004
1.6%
3.7%4.1%4.2%4.2%
5.9%
7.5%7.7%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
Australia United
States
Canada OECD
Median
Netherlands France Germany J apanb a
a1994–2003b1994–2002
b a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
93Percentage of Total Health Care Spending on Health Administration and Insurance in 2004
7.6% 7.5%
5.6%
4.4%4.1%
3.0% 3.0%
2.3%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
United
States
France Germany Netherlands Canada Australia OECD Median J apan
a2003b2002
b aa
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
94
Equity
95Health Status by Income, 2004
Percent: AUS CAN NZ UK US
Fair/Poor Health:
Below Average 22* 19* 22* 24* 30*
Above Average 7 7 6 8 6
Any of 6 Chronic Illnesses:^
Below Average 63* 58* 62* 64* 62*
Above Average 41 42 40 39 42
^ Chronic illnesses include: hypertension, heart disease, diabetes, arthritis, lung problems, and depression.* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
96Insurance and Cost-Sharing Policiesin Four Countries with Universal Public Coverage
AUS CAN NZ UK
Private insurancefor services covered by public
Permitted only for hospital services
Prohibited for core services in most provinces
Permitted Permitted
Percent with private coverage 49%
79.9%
(to cover benefits excluded from ‘free-of charge’ public
plan)
33% 12%
Public Plan Patient Cost-SharingVariable depending on
service type and providerNone for core services
Copayments for many services
None for basic services (except Rx and optical)
Prescription Drugs CoveredPublicly covered for social
assistance beneficiaries and in most provinces for seniors
Covered Covered
Source: B. K. Frogner and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2005(New York: The Commonwealth Fund, Apr. 2006).
97Private Insurance in Four Countrieswith Universal Coverage, 2004
3036
1911
63
81
57
35
0
25
50
75
100
Australia Canada New Zealand United
K ingdom
Below average income Above average income
Percent who have private insurance in addition to public
**
*
* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
*
98Spent More than US$1,000 Out-of-Pocketfor Medical Care in Past Year, by Income, 2004
8 104 2
2421
126 5
32
0
25
50
75
Australia Canada New
Zealand
United
K ingdom
United
States
Below average income Above average income
**
*
Percent
* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
99
3526
44
12
57
25
6
29
12
24
0
25
50
75
Australia Canada New
Zealand
United
K ingdom
United
States
Below average income Above average income
Cost-Related Access Problems, by Income, 2004
Percent reporting any of three access problems because of costs^
^ Access problems include: Had a medical problem but did not visit a doctor; skipped a medical test, treatment, or follow-up recommended by a doctor; or did not fill a prescription because of cost.* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
*
*
*
*
*
100
73
14
24 25
5 3
12 13
24
0
25
50
75
Australia New
Zealand
United
K ingdom
United
States
Canada
Below average income Above average income
Access to Doctor When Sick orNeed Medical Attention, by Income, 2004
Percent waited six days or more for appointment when sick
* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
*
101
6 612
19 21
5 6 9 11 14
0
25
50
75
United
K ingdom
New
Zealand
Australia United
States
Canada
Below average income Above average income
ER Visit for Condition a Primary CareDoctor Could Have Treated if Available, by Income, 2004
Percent
Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
102Difficulty Getting Care on Nights, Weekends, Holidays Without Going to ER, 2004
Percent saying “very” or “somewhat difficult”
5360
3242
70
56 59
3244
60
0
25
50
75
100
Australia Canada New
Zealand
United
K ingdom
United
States
Below average income Above average income
•Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
*
103Care Coordination, by Income, 2004
26 29 27 26
3628 25 23 24 27
0
25
50
75
Australia Canada New
Zealand
United
K ingdom
United
States
Below average income Above average income
^ Coordination problems include: Test results or medical records not available at time of appointment, received conflicting information from different doctors, or doctor ordered duplicate medical test.* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
Percent reporting any of three care coordination problems^
Base: Have seen a doctor in past two years
*
104
9 11 9 12
22
7 84
117
0
25
50
75
Australia Canada New
Zealand
United
K ingdom
United
States
Below average income Above average income
Percent of adults
* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
Rated Doctor Fair or Poor, by Income, 2004
*
*
105Had Blood Pressure Check in Past Year,by Income, 2004
85
72777983
91
6170
8279
0
25
50
75
100
Australia Canada New
Zealand
United
K ingdom
United
States
Below average income Above average incomePercent of adults
**
*
* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
106Had Pap Test in Past Three Years,by Income, 2004
8673716975
84 84 84 8293
0
25
50
75
100
Australia Canada New
Zealand
United
K ingdom
United
States
Below average income Above average income
Base: Women ages 25–64
* Significant difference between below and above average income groups within country at p<.05.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
Percent
* * * **
107Under 65: ER Use—Comparisons with U.S. Insured and Uninsured, 2004
26 29 30
3934
27
46
0
25
50
75
NZ AUS UK CAN Total Insured Uninsured
Percent under 65 with ER visit in past two years
United States
* Significantly different from U.S. insured at p<.05.Uninsured = uninsured at time of survey or any time during the year.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
**
108Under 65: Coordination Problem— Comparisons with U.S. Insured and Uninsured, 2004
26 26 2630 33
28
44
0
25
50
75
CAN NZ UK AUS Total Insured Uninsured
Percent under 65 with at least one of three coordination problems^
United States
^ Coordination problems include: Test results or medical records not available at time of appointment, received conflicting information from different doctors, or doctor ordered duplicate medical test.* Significantly different from U.S. insured at p<.05.Uninsured = uninsured at time of survey or any time during the year.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
*
109Under 65: Lab Test Errors—Comparisons with U.S. Insured and Uninsured, 2004
9 9 12 15 16 13
27
0
25
50
75
AUS UK CAN NZ Total Insured Uninsured
Percent given wrong result or delay in receiving abnormal test result
United States
Base: Under 65 who have had lab tests in past two years
**
*
* Significantly different from U.S. insured at p<.05.Uninsured = uninsured at time of survey or any time during the year.Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
110
Long, Healthy, and Productive Lives
111Mortality Amenable to Health Care
97 97 99106 107 109 109
115 115
129 130 132
7584 88 88 88
8192
0
50
100
150
Fran
ceJa
pan
Spain
Swed
en Italy
Aus
tral
iaC
anad
aN
orw
ayN
ethe
rland
sG
reec
eG
erm
any
Aus
tria
New
Zea
land
Den
mar
k
Uni
ted
State
sFi
nland
Irela
nd
Uni
ted
Kin
gdom
Portu
gal
Deaths per 100,000 population*
110
8490
103
119
134
U.S.avg
10th 25th Med-ian
75th 90th
Percentiles
Internationalvariation, 1998
State variation,2002
* Countries’ age-standardized death rates, ages 0–74; includes ischemic heart disease.See Technical Appendix for list of conditions considered amenable to health care in the analysis.Data: International estimates—World Health Organization, WHO mortality database (Nolte and McKee 2003);State estimates—K. Hempstead, Rutgers University using Nolte and McKee methodology.
Mortality from causes considered amenable to health care is deaths before age 75 that are potentially preventable with timely and appropriate medical care
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
112
7.0
5.3
6.0
7.1
8.1
9.1
U.S.avg
10th 25th Med-ian
75th 90th
Infant Mortality Rate, 2002
* 2001.Data: International estimates—OECD Health Data 2005;State estimates—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2005a).
2.2
3.0 3.03.3 3.5
4.1 4.1 4.1 4.2 4.2 4.4 4.4 4.5 4.55.0 5.0 5.0 5.0 5.1 5.2 5.4 5.6
7.0
0
5
10
Icel
and
Japa
nFi
nlan
dSw
eden
Norw
aySpa
inFr
ance
Austri
a
Czech
Rep
ublic
Ger
man
yBel
gium
Denm
ark
Italy
Switz
erla
ndNet
herla
nds
Austra
liaPor
tuga
lIre
land
Gre
ece
Unite
d Kin
gdom
Canad
a
New Z
eala
nd*
Unite
d Sta
tes
Infant deaths per 1,000 live births
Percentiles
International variation State variation
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 112
113Healthy Life Expectancy at Age 60, 2002
2220 20 20 20 20 19 19 19 19 19 19 19 19 18 18 18 18 18 18 18 17 1718 17 17 16 17 17 16 16 16 16 16 16
1816 16 16 16 16 15 15 15 15
14
0
10
20
30
Japan
Switzer
land
France
Spain
Sweden
Austra
lia
Italy
Austri
a
Canad
a
Belgiu
m
Germ
any
Norway
Icel
and
Finla
nd
Nether
lands
New Z
eala
nd
Greec
e
Unite
d Kin
gdom
Unite
d Sta
tes
Portu
gal
Irela
nd
Denm
ark
Czech
Rep
ublic
Women Men
Years
Data: The World Health Report 2003 (WHO 2003, Annex Table 4).
Developed by the World Health Organization, healthy life expectancy is based on life expectancy adjusted for time spent in poor health due to disease and/or injury
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
114Acute Myocardial Infarction Deaths per 100,000 Population
58.8
53.0
48.3 48.1 47.9 46.343.9
25.7
19.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
United
K ingdom
Australia Germany OECD
Median
United
States
Canada Netherlands France J apan
a2003b2002
b b a
b
b
b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006(New York: The Commonwealth Fund, Apr. 2007).
115Bronchitis, Asthma, and Emphysema Deaths per 100,000 Population
6.46.0
5.04.7
4.44.0
3.73.4
3.0
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
J apan United
States
Australia Netherlands OECD
Median
United
K ingdom
Germany France Canada
a2003b2002
b
b a
bb
b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
116Potential Years of Life Lost Due to Malignant Neoplasms per 100,000 Population in 2004
1059
952 912 895 885 867 847800
725
0
200
400
600
800
1000
1200
France Netherlands United
K ingdom
United
States
OECD
Median
Germany Canada Australia J apan
a2003b2002
abb
bb
b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
117Potential Years of Life Lost Due to Diseases of the Circulatory System per 100,000 Population in 2004
825
635
557 550
472 464 437419 411
0
100
200
300
400
500
600
700
800
900
United
States
United
K ingdom
Germany OECD
Median
Netherlands J apan Canada Australia Francea
a2003b2002
bbb
bb
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
118Potential Years of Life Lost Due to Diabetes per 100,000 Population in 2004
101
59
4239 39 39
30 2925
0
20
40
60
80
100
120
United
States
Canada Netherlands Australia Germany OECD
Median
United
K ingdom
France J apan
a2003b2002
ab
b
bb
b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
119Potential Years of Life Lost Due to Diseases of the Respiratory System in 2004
190
172
119114
10594 93 89
80
0
20
40
60
80
100
120
140
160
180
200
United
States
United
K ingdom
J apan OECD
Median
Australia Netherlands Germany Canada France
a2003b2002
a
b b
b bb
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
120Percentage of Adults Who Reported Being Daily Smokers in 2004
30.0% 29.4%
25.5% 25.0%24.3% 23.0%
22.0%
17.7% 17.0%15.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Netherlands J apan OECD
Median
United
K ingdom
Germany France New
Zealand
Australia United
States
Canada
a2003
a
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006(New York: The Commonwealth Fund, Apr. 2007).
121Obesity (BMI>30) Prevalence in 2004
30.6%
23.0%22.4%
20.9%
13.0% 12.9%10.9%
9.5%
3.2%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
United
States
United
K ingdom
Canada New
Zealand
OECD
Median
Germany Netherlands France J apana
a
a2003b2002
a
b
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006(New York: The Commonwealth Fund, Apr. 2007).
122
Health Care System Views
123Views of the Health Care System in Five Nations, 1998 to 2004
Percent saying: AUS CAN NZ UK US
Only Minor Changes Needed
2004 21 21 19 26 16
2001 25 21 18 21 18
199819 20 9 25 17
Rebuild Completely
2004 23 14 19 13 33
2001 19 18 20 18 28
1998 30 23 32 14 33
Source: 2004, 2001 and 1998 Commonwealth Fund International Health Policy Surveys
124Sicker Adults Views of the Health Care Systemin Six Nations, 2005
Percent saying: AUS CAN GER NZ UK US
Only minor changes needed
23 21 16 27 30 23
Fundamental changes needed
48 61 54 52 52 44
Rebuild completely 26 17 31 20 14 30
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
125Care Experiences Reported by Adultswith Positive or Negative System Views, Sicker Adults,
2005Percent
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
2016 18
11
36 35
47
24
0
25
50
75 Minor Change Rebuild
Any medical, medication,or lab error
Coordination problems
Access problem
due to cost
Waited 6 days or more for
appointment
126
Physician Views of the Health System, 2006
Percent saying: AUS CAN GER NET NZ UK US
Only Minor Changes Needed
38 23 4 52 34 23 13
Fundamental Changes Needed
56 71 54 42 62 68 69
Rebuild Completely
5 3 42 3 4 9 16
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
127Physician Dissatisfaction with Medical Practice, 2006
Percent very or somewhat dissatisfied with:
AUS CAN GER NET NZ UK US
Freedom to make clinical decisions
8 12 74 10 26 24 31
Time to spend per patient
33 36 50 35 33 51 42
Income from medical practice
36 40 53 23 44 18 47
Overall experience with medical practice
14 16 19 9 23 14 23
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
128
A Six Country Ranking of Healthcare Quality, Access, Efficiency, Equity and Mortality
129
Overall Ranking
AUSTRALIA CANADA GERMANYNEW
ZEALANDUNITED
KINGDOMUNITEDSTATES
OVERALL RANKING (2007) 3.5 5 2 3.5 1 6
Quality Care 4 6 2.5 2.5 1 5
Right Care 5 6 3 4 2 1
Safe Care 4 5 1 3 2 6
Coordinated Care 3 6 4 2 1 5
Patient-Centered Care 3 6 2 1 4 5
Access 3 5 1 2 4 6
Efficiency 4 5 3 2 1 6
Equity 2 5 4 3 1 6
Long, Healthy, and Productive Lives 1 3 2 4.5 4.5 6
Health Expenditures per Capita, 2004 $2,876* $3,165 $3,005* $2,083 $2,546 $6,102
1.0-2.66
2.67-4.33
4.34-6.0
Country Rankings
* 2003 dataSource: Calculated by Commonwealth Fund based on the Commonwealth Fund 2004 International Health Policy Survey, the Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults, the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, and the Commonwealth Fund Commission on a High Performance Health System National Scorecard.
130
A Three Year View of Overall Ranking
1.0-2.66
2.67-4.33
4.34-6.0
Country Rankings
* 2003 dataSource: Calculated by Commonwealth Fund based on the Commonwealth Fund 2004 International Health Policy Survey, the Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults, the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians; the Commonwealth Fund Commission on a High Performance Health System National Scorecard; K. Davis, C. Schoen, S.C. Schoenbaum, A.J. Audet, M.M. Doty, and K. Tenney, Mirror, Mirror on the Wall: Looking at the Quality of American Health Care through the Patient's Lens (New York: The Commonwealth Fund, Jan. 2004); and K. Davis, C. Schoen, S. C. Schoenbaum, A. J. Audet, M. M. Doty, A. L. Holmgren, and J. L. Kriss, Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens (New York: The Commonwealth Fund, Apr. 2006).
AUSTRALIA CANADA GERMANYNEW
ZEALANDUNITED
KINGDOMUNITEDSTATES
OVERALL RANKING (2007 Edition) 3.5 5 2 3.5 1 6
OVERALL RANKING (2006 Edition) 4 5 1 2 3 6
OVERALL RANKING (2004 Edition) 2 4 n/a 1 3 6
Health Expenditures per Capita, 2004 $2,876* $3,165 $3,005* $2,083 $2,546 $6,102