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The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries Presented by Cathy Schoen and Robin Osborn Commonwealth.

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Presentation on theme: "The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries Presented by Cathy Schoen and Robin Osborn Commonwealth."— Presentation transcript:

1 The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries Presented by Cathy Schoen and Robin Osborn Commonwealth Fund International Symposium October 28, 2004 THE COMMONWEALTH FUND Embargoed for release: 9:00 a.m. ET, Thursday, October 28, 2004

2 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND 2004 International Health Policy Survey Topics: System Views, Access, Doctor-Patient Communication, Coordination, Emergency Room Care, Prescription Drugs, Preventive Care, and Chronic Illness Management Telephone survey of 1,400 adults ages 18 and older in Australia, Canada, New Zealand, the United States, with an expanded sample of 3,061 in the United Kingdom (funded by The Health Foundation) Conducted by Harris Interactive and subcontractors March 29 to May 17, 2004. Margin of error + or - 3 percentage points for differences between countries and + or - 2% for country averages

3 Views of the Health Care System

4 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Views of The Health Care System in Five Nations - 1998 to 2004 Percent saying:AUSCANNZUKUS Only Minor Changes Needed 2004 21 192616 2001 2521182118 1998 192092517 Rebuild Completely 2004 2314191333 2001 1918201828 1998 3023321433

5 Access to Care

6 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Length of Time with Regular Doctor/Place of Care Percent:AUSCANNZUKUS Has Regular Doctor/Place 9495979991 2 years or less 2220211829 3-5 years 2221201725 More than 5 years 5053566337 No regular doctor/place 55319

7 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Access to Doctor When Sick or Need Medical Attention Percent AUS CAN NZ UK US

8 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Difficulty Getting Care on Nights, Weekends, Holidays Without Going to The ER Percent Saying Very or Somewhat Difficult

9 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Called Help Line for Medical Advice in the Past 2 Years Percent

10 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Out-of-Pocket Medical Costs in the Past Year Percent AUS CAN NZ UK US

11 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Cost-Related Access Problems Percent in the past year who due to cost: AUSCANNZUKUS Did not fill prescription or skipped doses 12911422 Had a medical problem but did not visit doctor 17628429 Skipped test, treatment or follow-up 18820227 Percent who said yes to at least one of the above 291734940

12 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Going without Needed Care Due to Costs, Total and Low Income AUS CAN NZ UK US Percent went without care due to cost AUS CAN NZ UK US

13 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Satisfaction in Amount of Choice You Have in Doctors You See Percent:AUSCANNZUKUS Very satisfied 4030484439 Somewhat satisfied 40 373539 Not very or not at all satisfied 1727121820

14 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Wanted Information on Quality of Care Doctor Provides When Had to See a New Doctor Percent saying Yes

15 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Access to Own Medical Records Percent:AUSCANNZUKUS Currently have access 4034452851 Do not have access: Would like access 4048354237 Dont want access 1715 2510

16 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Email Communication with Doctor Base: Have regular doctor/place Percent:AUSCANNZUKUS Currently can email doctor 1610221320 Have internet, cannot currently email doctor: Would like to be able to email 1528182725 Would not like to be able to email 4339403733 Do not have access to internet 24211921

17 Emergency Room Use and Experiences

18 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Emergency Room Use in the Past 2 Years Percent with any visits

19 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Went to the ER for a Condition That Could Have Been Treated by Regular Doctor if Available Percent

20 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Waited 2 Hours or More in ER Before Being Treated Percent Base: Adults with ER visit in past 2 years

21 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND ER Staff Did Everything They Could to Help Control Pain Base: Adults with ER visit in the past 2 years and in pain Percent

22 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Rated Overall Quality of Emergency Care Services as Fair or Poor Percent Base: Adults with ER visit in the past 2 years

23 Doctor-Patient Relationship and Communication

24 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Doctor-Patient Relationship Percent saying doctor:AUSCANNZUKUS Always listens carefully 7166746858 Always explains things so you can understand 7370736958 Always spends enough time with you 6355665844

25 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Missed Opportunities to Engage Patient in Care Percent saying doctor:* AUSCANNZUKUS Does NOT give you clear instructions 1012813 Does NOT make goals and plans clear 1415131920 Does NOT tell you about treatment choices or ask your opinions 35 305044 * Doctor only sometimes, rarely or never

26 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Left Doctors Office Without Getting Important Questions Answered Percent unanswered questions in past two years

27 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Have NOT Followed Doctors Advice or Treatment Plan in Past 2 Years Percent

28 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Areas of Patient Non-Adherence Percent who: AUSCANNZUKUS Did NOT take medicines as prescribed 3835494835 Did NOT follow advice on diet, smoking, drinking or other lifestyle changes 334024 37 Did NOT get follow-up appointment or see specialist 10 14713 Did NOT get diagnostic test or have recommended surgery or procedure 11779 Base: Respondents who have not followed doctors advice

29 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Main Reasons for Non-Adherence Percent saying: AUSCANNZUKUS Disagreed with recommendation 3521374330 Too difficult to do 3228 2634 Cost too much 81114118 Condition improved 815484 Concerned about risks/side effects 32635 Did not understand what to do 210252 Base: Respondents who have not followed doctors advice

30 Coordination

31 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Care Coordination Percent saying in the past 2 years: AUSCANNZUKUS Test results or records not available at time of appointment 121413 17 Duplicate tests: doctor ordered test that had already been done 767414 Received conflicting information from different doctors 1814 18 Percent who experienced at least one of the above 2826252431 Base: Have seen a doctor in past 2 years

32 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Prescription Drugs Percent saying in the past 2 years doctor: AUSCANNZUKUS Has NOT reviewed the medications you take 2925313725 Has NOT explained the side effects of medications 2528273930 % who said doctor has not done one of the above 4239425541 Base: Adults taking prescriptions regularly

33 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Did Not Receive Lab Tests/X-Ray Results or Results Not Clearly Explained Percent Base: Have seen a doctor in past 2 years

34 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Given Incorrect Test Results or Delays in Being Notified about Abnormal Results Percent Base: Adults with test in past 2 years

35 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Lack of Hospital and ER Coordination Percent saying regular doctor: AUSCANNZUKUS Was NOT well informed about plans for follow-up care after hospital 192123 13 Was NOT well informed about the care you received in the ER 3036283230 Base: Have regular doctor/place and hospitalized or used ER in past 2 years

36 Preventive Care

37 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Do NOT Receive Reminders for Preventive Care Percent

38 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Missed Opportunities to Promote Health Percent said in past 2 years doctor: AUSCANNZUKUS Has NOT provided advice on weight, nutrition or exercise 6255677248 Has NOT asked if any emotional issues may be affecting your health 6762717263 Base: Have regular doctor/place of care

39 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Adults with Chronic Condition: Doctor Did NOT Give Plan for Self-Management Base: Adults with chronic disease Percent

40 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Preventive Care Percent received:AUSCANNZUKUS Pap in past 3 years, age 25-64 7877817789 Mammogram in past 3 years, age 50-64 8079817786 Flu shot in past year, age 65+ 7766677472

41 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Summary and Implications Primary care shortfalls in all countries. –Gaps in patient-centered care, access, safety and coordination of care. Access concerns in all countries, but notable country variations on wait to see doctor and cost. –Lack of prompt access to doctor linked to higher ER use in U.S. and Canada. –Cost sharing can undermine timely care. Safety and risks in ambulatory care a challenge. –Includes prescription drugs reviews and diagnostic tests. Missed opportunities for preventive care. Issues amenable to policy action.

42 2004 Commonwealth Fund International Health Policy Survey THE COMMONWEALTH FUND Country Initiatives 24/7 Access to Care –NHS Direct (U.K.) –After-hours Primary Medical Care Program (Australia) –Primary Care Transition Fund (Canada) Incentives for Quality and Primary Care –GP Contract (U.K.) –Primary Health Organizations (New Zealand) –CMS Doctors Office Quality, P4P, Leapfrog (U.S.) –Collaboratives Information Technology (EMR+) –National Programme for IT (U.K.) –Canada Health Infoway

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