The Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults in Six Countries...

The Commonwealth Fund 2005 International Health Policy Survey

of Sicker Adults in Six Countries

Cathy Schoen, Robin Osborn, Phuong Trang Huynh,Michelle M. Doty, and Jennifer A. Fenley

November 2005

THE COMMONWEALTH

FUND

Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff.

Additional copies of this and other Commonwealth Fund publications are available online at www.cmwf.org. To learn about new Fund publications when they appear, visit the Fund’s Web site and register to receive e-mail alerts.

Commonwealth Fund pub. no. 871.

THE COMMONWEALTH

FUND

Adults with Health Problems

2005 International Health Policy Survey

• Telephone survey of sicker adults ages 18 and older in Australia, Canada, Germany, New Zealand, the U.K., and the U.S. Adults met at least one of the following criteria:

– Self reported health status is fair or poor

– Serious illness in the past 2 years

– Hospitalized or had major surgery in the past 2 years

• One-fourth to one-third of adults net screened as sicker

• Final samples: 702 Australia, 751 Canada, 1,503 Germany,704 New Zealand, 1,770 United Kingdom, and 1,527 United States

• Conducted by Harris Interactive and subcontractors fromMarch 2005 to June 2005.

2005 Commonwealth Fund International Health Policy Survey

THE COMMONWEALTH

FUND


Characteristics of “Sicker Adults” in Survey

Percent who: AUS CAN GER NZ UK US

Rate health as fair or poor 50 46 58 33 56 59

Have any of 6 chronic illnesses, doctor diagnosis

72 72 73 62 67 73

Saw 4 or more doctors in the past 2 years

44 35 32 40 42 35

Use 4 or more prescriptions regularly

26 31 30 22 32 40

Hospitalized, other than normal pregnancy in past 2 years

48 44 50 54 40 41

Had major surgery in past 2 years

28 29 26 30 25 32


Hospital Stay andDischarge Experiences

THE COMMONWEALTH

FUND


Did Doctors and Nurses Involve You asMuch as You Wanted in Care Decisions?

2227

21 1922

16

0

25

50

AUS CAN GE R NZ UK US

Base: Hospitalized in past 2 years


Percent NOT involved as much as would like

THE COMMONWEALTH

FUND


Were Risks Explained Before a Hospital Procedure in an Understandable Way?

Percent said risks were NOT explained

141217 16

2118

0

25

50

AUS CAN GER NZ UK US



THE COMMONWEALTH

FUND


Failure to Discuss Medications UsedBefore Hospitalized on Discharge

2328

14

3127

33

0

25

50


Percent of patients with new prescription who saidprior medications were not reviewed at discharge


THE COMMONWEALTH

FUND


Deficiencies in Transition PlanningWhen Discharged from the Hospital

Percent who reportedwhen discharged:


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



THE COMMONWEALTH

FUND


Readmitted to a Hospital or Went to ER asa Result of Complications After Discharge

141715

1016

20

0

25

50



Percent readmitted or ER visit due to complications


Safety: Medication, Medical,and Diagnostic Test Errors

THE COMMONWEALTH

FUND


Developed Infection While in the Hospital

8 73

10 107

0

25

50



Percent


THE COMMONWEALTH

FUND


Medical Mistake or Medication Error in Past Two Years

19 19 19 18 1722

0

25

50


Percent reporting either mistake or medication error


THE COMMONWEALTH

FUND


Medical Mistake or Medication ErrorOccurred Outside the Hospital

63 60 63 63 6777

0

50

100


Percent saying error occurred outside the hospital


Base: Experienced medical mistake or medication error

THE COMMONWEALTH

FUND


Incorrect Lab/Diagnostic Test orDelay in Receiving Abnormal Test Results

1418

914

11

23

0

25

50


Percent reporting either lab test error in past two years


THE COMMONWEALTH

FUND


Any Error: Medical Mistake, Medication Error, or Test Error in Past Two Years

Percent


2730

23 2522

34

0

25

50


THE COMMONWEALTH

FUND


Patients Reporting Any Error by Numberof Doctors Seen in Past Two Years

Percent


12 15 14 14 12

22

37 40

3135

28

48

0

25

50

75


1 doctor 4 or more doctors

Access

THE COMMONWEALTH

FUND


Cost-Related Access Problems

Percent in past year due to cost:


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


THE COMMONWEALTH

FUND


Out-of-Pocket Medical Costs in the Past Year

1014

22

14

5 89 8

65

4

15

34

0

25

50

75

No out-of-pocket cost More than US $1,000

Percent


AUS CAN GER NZ UK US AUS CAN GER NZ UK US

THE COMMONWEALTH

FUND


Access to Doctor When Sickor Need Medical Attention

49

10

23

36

56

13

3

45

15

3023

58

0

25

50

75

Same-day appointment Wait of 6 days or more

Percent




THE COMMONWEALTH

FUND


Difficulty Getting Care on Nights, Weekends, Holidays Without Going to the ER

5954

25 28

38

61

0

25

50

75


Percent saying “very difficult” or “somewhat difficult”


THE COMMONWEALTH

FUND


Went to the ER for Condition that Could Have Been Treated by Regular Doctor if Available

15

21

69

12

26

0

25

50


Percent


THE COMMONWEALTH

FUND


Help Line Use

Percent who reported: AUS CAN GER NZ UK US

Called help line for medical advice in the past 2 years

10 28 5 10 32 13

Advice was definitely or somewhat helpful (Base: used help line)

90 86 75 86 88 80


THE COMMONWEALTH

FUND


Waited More than Four Weeksto See a Specialist Doctor

46

57

22

40

60

23

0

25

50

75


Percent


Base: Saw or needed to see a specialist

THE COMMONWEALTH

FUND


Waiting Time for Elective or Non-Emergency Surgery

Percent


Base: Needed non-emergency or elective surgery

48

1915

33

59

6

32

2025

41

53

8

0

25

50

75

Less than 1 Month More than 4 Months AUS CAN GER NZ UK US AUS CAN GER NZ UK US

Patient–Doctor Communication,Care Coordination, Patient Choice

THE COMMONWEALTH

FUND


Length of Time with Regular Doctor

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


THE COMMONWEALTH

FUND


Care Coordination

Percent saying in the past 2 years:


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


THE COMMONWEALTH

FUND


Coordination Problems by Number of Doctors

Percent


15 1623

711

2227

31 30 3026

43

0

25

50

75


1 doctor 4 or more doctors

* Either records/results did not reach doctors office in timefor appointment OR doctors ordered a duplicate medical test

THE COMMONWEALTH

FUND


Missed Opportunity to Engage Patientson Choice and Quality

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


Base: Had major surgery in the past 2 years

THE COMMONWEALTH

FUND


Top Two Most Important Types ofInformation About Surgeons

Percent: AUS CAN GER NZ UK US

Experience with specific conditions

68 59 59 67 59 55

Outcomes of specific surgeryor treatment

52 53 47 49 43 55

Patient satisfaction ratings

36 36 33 36 43 41

Training 23 32 36 26 19 34


Base: Had major surgery in the past 2 years

Chronic Illness andAppropriateness of Care

THE COMMONWEALTH

FUND


Did Not Receive Counseling AboutExercise and Diet in Past Year

3631

50

36

45

29

0

25

50

75



Base: Adults with chronic health condition

THE COMMONWEALTH

FUND


Missed Opportunities toEngage Patient in Care

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.


Base: Adults with chronic disease

THE COMMONWEALTH

FUND


Prescription Medications

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


Base: Adults with chronic disease on regular medications

* Doctor only sometimes, rarely, or never.

THE COMMONWEALTH

FUND


Doctor Gives You Plan for Self-Management

50

65

37

56

45

58

0

25

50

75



Percent given self-management plan


THE COMMONWEALTH

FUND


Doctor’s Office Has a NurseRegularly Involved in Care Management

16 19

47

36

52

41

0

25

50

75



Percent have nurse involved


THE COMMONWEALTH

FUND


Received Recommended Carefor Chronic Condition

Percent received recommended care:


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.


THE COMMONWEALTH

FUND


7078

85

66

54

7483

8895

82 8189

0

25

50

75

100


Neither self-management plan or nurse Self-management plan and/or nurse

Adults with Hypertension Who Received Recommended Care, by Self-Management Plan

and/or Nurse Involvement

Includes blood pressure and cholesterol checked


Percent

THE COMMONWEALTH

FUND


41

25 27

61 65 64

0

50

100

GER UK US


Adults with Diabetes Who Received Recommended Care, by Self-Management Plan

or Nurse Involvement

Includes Hemoglobin A1c and cholesterol checked,and feet and eyes examined


* Sample size too small for subgroups for Australia, Canada, and New Zealand.

Percent

THE COMMONWEALTH

FUND


Adults with Hypertension or DiabetesWho Received Recommended Care by

Self-Management Plan or Nurse Involvement

67 6879

6150

64

78 8191

74 7786

0

50

100




Includes blood pressure and cholesterol for hypertension; Hemoglobin A1cand cholesterol checked, and feet and eyes examined for diabetes

Percent

Overall Views of theHealth Care System

THE COMMONWEALTH

FUND


Views of the Health Care Systemin Six Nations

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


THE COMMONWEALTH

FUND


Care Experiences Reported by Adultswith Positive or Negative System Views

Percent


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

Summary and Implications

• Medical Errors: High rates in multiple areas– Majority occur outside the hospital– Highest rates with complex care

• Coordination: Failures to coordinate and integrate care across sites of care put patients at risk

• Chronic Care: Gaps in engaging patients and use of teams to help manage care

• Choice: Lack of information undermines choice as a driver of quality

• Access: Wide variations across countries– Lack of timely access affects quality and efficiency– U.S. an outlier on cost barriers– Germany overall positive access experiences THE

COMMONWEALTH FUND

Potential of Cross-National Exchange

• Opportunities to learn from country initiatives– Similar approaches in different systems– Different approaches to similar problems

Multiple examples• Models for managing chronic illnesses • Use of IT and adoption of EHRs• Primary care reforms • Incentives to improve quality

• Distinct country patterns often reflect insurance and unique system designs – and their impact– Cross-national comparisons of positive as well as

negative experiences can inform policy

• Patient experiences offer unique perspectiveTHE

COMMONWEALTH FUND

Acknowledgments

With appreciation to:

• Harris Interactive Co-Authors: Kinga Zapert and Jordan Peugh

• Survey Development and Field Work: Harris Interactive and Affiliates

• Co-Funders: The Health Foundation and the German Institute for Quality and Efficiency in Health Care

THE COMMONWEALTH

FUND

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