The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries
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Transcript of The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries
THE COMMONWEALTH
FUND
The Commonwealth Fund
2010 International Health Policy Survey
in Eleven Countries
Cathy Schoen and Robin Osborn
The Commonwealth Fund
November 2010
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2010 Commonwealth Fund International Health Policy Survey• Telephone survey, conducted from March to June 2010, of
adults ages 18 and older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.
• Final samples: 3,552 Australia, 3,302 Canada, 1,402 France, 1,005 Germany, 1,001 Netherlands, 1,000 New Zealand, 1,058 Norway, 2,100 Sweden, 1,306 Switzerland, 1,511 United Kingdom, and 2,501 United States.
• Conducted by Harris Interactive subcontractors, and Dutch Scientific Institute for Quality of Healthcare, Haute Authorité de Santé (HAS), Swedish Ministry of Health, Swiss Federal Office of Public Health, and Norwegian Knowledge for the Health Services.
• Core topics: Affordability, access, insurance complexity, equity, and system views.
• Examined differences between above- and below-average (median) income respondents, controlling for age and health status.
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International Comparison of Spending on Health, 1980–2008
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1000
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6000
7000
8000
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United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand
Average spending on healthper capita ($US PPP)
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4
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16
1980
1981
1982
1983
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1987
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2008
United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia
Total expenditures on healthas percent of GDP
Source: OECD Health Data 2010 (June 2010).
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Confidence, Affordability, and Access
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Cost-Related Access Problems in the Past Year
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Did not fill prescription or skipped doses
12 10 7 6 3 7 6 7 4 2 21
Had a medical problem but did not visit doctor
13 4 6 16 2 9 6 5 6 2 22
Skipped test, treatment, or follow-up
14 5 6 10 3 8 5 4 4 3 22
Yes to at least one of the above
22 15 13 25 6 14 11 10 10 5 33
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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35
5147
41 39
61
33
50
20
76
31
0
25
50
75
100
AU
S
CA
N
FR
GE
RN
ETH N
Z
NO
R
SW
E
SW
IZ UK
US
Out-of-Pocket Medical Costs in the Past Year, in U.S. Dollars
Percent
2112
48 9 7
16
2
25
1
35
AU
S
CA
N
FR
GE
R
NE
T
NZ
NO
R
SW
E
SW
IZ UK
US
$200 or less $1,000 or more
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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86
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3 46 5 5 6
2
20
0
10
20
30
40
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Serious Problems Paying or Unable to Pay Medical Bills in the Past Year
Percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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76 7685 82
88 84
70 67
89 92
70
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25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Confident Will Receive Most-Effective Treatment if Sick
Percent responded, if they became seriously ill, confident/very confident they would get most-effective treatment, including drugs and diagnostic tests
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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64 6873 70
8175
69 7078
90
58
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25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Confident Will Be Able to Afford Needed Care
Percent responded, if they became seriously ill, confident/very confident they would be able to afford the care they needed
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Primary Care, Specialist, and After-Hours Access
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65
45
6266
7278
45
57
93
70
57
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25
50
75
100
AU
S
CA
N
FR
GE
RN
ETH N
Z
NO
R
SW
E
SW
IZ UK
US
Access to Doctor or Nurse When Sick or Needed Care
Percent*
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33
17 16
5 5
28 25
28
19A
US
CA
N
FR
GE
R
NE
TH NZ
NO
R
SW
E
SW
IZ UK
US
Same- or next-day appointment
Waited six days or more
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
* Base: Answered question.
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Difficulty Getting After-Hours Care Without Going to the Emergency Room
* Base: Needed care and answered question.
5965 63
57
3338
45
68
4338
63
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER*
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Emergency Room Use in the Past Two Years
33
44
2722
2629
26
35
2225
37
0
20
40
60
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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14Wait Times for Elective Surgery and
Specialist Appointments
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Specialist appointment*
Less than 4 weeks 54 41 53 83 70 61 50 45 82 72 80
2 months or more 28 41 28 7 16 22 34 31 5 19 9
Elective surgery**
Less than 1 month 53 35 46 78 59 54 44 34 55 59 68
4 months or more 18 25 7 0 5 8 21 22 7 21 7
* Base: Needed to see specialist in past 2 years.** Base: Needed elective surgery in past 2 years.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Coordination and Insurance Complexity
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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 time of appointment
11 11 7 8 8 9 10 9 7 9 15
Received conflicting information from different health professionals
20 20 16 17 15 18 24 18 16 10 23
Duplicate tests: doctors ordered test that had already been done
10 8 14 20 4 5 9 5 11 7 17
Yes to at least one of the above 28 28 28 29 21 23 31 23 24 19 37
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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2623
2823
19 19
27
1719
13
3129 31 29
42
25 26
38
2932 32
42
0
25
50
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
No chronic conditions2 or more chronic conditions
Percent experienced any of three coordination problems*
* Test results/records not available at time of appointment, received conflicting information from different health professionals, and/or doctors ordered test that had already been done.
Coordination Problems in the Past Two Years, by Number of Chronic Conditions
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Problems with Health Insurance
Percent reported in the past year:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Spent a lot of time on paperwork or disputes over medical bills
6 6 11 16 8 4 8 3 6 3 17
Health insurance denied payment or did not pay as much as expected
11 12 18 11 15 4 2 2 10 2 25
Yes to either 14 15 23 23 20 6 9 4 13 5 31
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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1319
16
34
1016 17
106
48
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50
75
AUS CAN FR GER NETH NZ NOR SWE UK US
2009 Survey: Primary Care Doctors Say Insurance Restrictions on Care Are a Major Time Concern
Percent saying amount of time physician or staff spend getting patients needed medications or treatment because of coverage restrictions is a major problem
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Experiences by Income
Slides 21 to 26: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
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Confident Will Receive Most-Effective Treatment if Sick, by Income
79 8088
8288 87
72 70
91 95
8273 71
8578 81 78
6358
8692
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25
50
75
100
AUS* CAN* FR GER NETH* NZ* NOR* SWE* SWIZ* UK US*
Above-average income Below-average income(Adjusted) percent confident/very confident
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
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Cost-Related Access Problems in the Past Year, by Income
126 8
17
38
4 5 7 4
202218 17
27
13 1521
14 12
4
39
0
25
50
75
AUS* CAN* FR* GER* NETH* NZ* NOR* SWE* SWIZ* UK US*
Above-average income Below-average income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent experienced at least one of three problems**
** Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
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Out-of-Pocket Spending of $1,000 or More in the Past Year, by Income
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
31
17
510 11 11
16
2
34
0
45
1612
5 5 7 6
15
2
20
0
29
0
15
30
45
60
AUS* CAN* FR GER* NETH NZ* NOR SWE SWIZ* UK US*
Above-average income Below-average income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent
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52 2 1 2 2 1 2 2 2
910 9
13
711
610 9 9
3
24
0
10
20
30
40
AUS* CAN* FR* GER* NETH* NZ* NOR* SWE* SWIZ* UK US*
Above-average income Below-average income
Serious Problems Paying or Unable to Pay Medical Bills in the Past Year, by Income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
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60 6459 56
31 3440
67
43
31
5563
7267
55
4437
52
70
4247
68
0
25
50
75
100
AUS CAN* FR* GER NETH* NZ NOR* SWE SWIZ UK* US*
Above-average income Below-average income
Difficulty Getting After-Hours Care, by Income
(Adjusted) percent reported somewhat/very difficult
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. Base: Needed care and answered question.
* Indicates significant within-country differences with below-average income (p < 0.05).
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Waited Two Months or Longer for Specialist Appointment, by Income
26
40
29
815 14
3532
7
18
7
31
45
30
9
24 26
3531
3
28
10
0
25
50
75
AUS* CAN FR GER NETH* NZ* NOR SWE SWIZ* UK US
Above-average income Below-average income(Adjusted) percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. Base: Needed to see specialist in past two years.
* Indicates significant within-country differences with below-average income (p < 0.05).
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27
19
46
7
32
46
33
31
36
69
35
47
0 25 50 75 100
Insured all year,above-averageincome
Insured all year,below-averageincome
Uninsured
Percent
U.S. Adults Under Age 65, by Insurance and Income
Went without care because of cost
$1,000 or more out-of-pocket costs
Serious problem or unable to pay bill
Insurance difficulty
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Overall Views of Health Care System, 2010
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Only minor changes needed
24 38 42 38 51 37 40 44 46 62 29
Fundamental changes needed
55 51 47 48 41 51 46 45 44 34 41
Rebuild completely 20 10 11 14 7 11 12 8 8 3 27
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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Cross-Cutting Themes and Implications for U.S. Reform
• United States stands out
– Access problems because of costs, difficulty paying medical bills, insurance complexity, and disparities by income
• Insurance benefit design matters for access, protection, and simplicity
– Income-related cost-sharing and limits on out-of-pocket spending promote access and enable ability to pay
– Special provisions necessary to protect low- and modest-income people who are often sicker and least able to afford care if not well-insured
• Symptoms of weaker primary care in U.S., Canada, and Sweden
• German, Swiss, U.S., Dutch, and U.K. rapid access to specialists
– Swiss notable for rapid access to primary and specialized care
• U.S. health reforms will make a difference—includes many elements seen internationally
– Premium assistance for low- and modest-income people; Medicaid expansion
– Benefit standards with limits on out-of-pocket spending
– Insurance exchanges and standards to reduce complexity
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Acknowledgments and Cofunders
• Australia: Commission on Safety and Quality in Health Care, Bureau of Health Information
• Canada: Health Council of Canada, Ontario Quality Council, Quebec Health Commission
• France: Haute Authorité de Santé (HAS), Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (CNAMTS)
• Germany: Institute for Quality and Efficiency in Health Care (IQWiG)
• Netherlands: Dutch Ministry of Health, Welfare and Sport, and IQ Health, Radboud University Nijmegen
• Norway: Norwegian Knowledge Centre for the Health Services
• Sweden: Swedish Ministry of Health
• Switzerland: Federal Office of Public Health
• United Kingdom: Health Foundation
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 by Health Affairs as: “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries,” Web First, November 18, 2010.