THE
COMMONWEALTH
FUND
The Commonwealth Fund
2012 International Health Policy Survey
of Primary Care Physicians
2012 INTERNATIONAL SYMPOSIUM ON HEALTH CARE POLICY
Cathy Schoen and Robin Osborn
The Commonwealth Fund
November 2012
2012 Commonwealth Fund International Health Policy Survey
2
• Mail and phone survey of primary care physicians in Australia,
Canada, France, Germany, Netherlands, New Zealand, Norway,
Sweden, Switzerland, United Kingdom, and United States
• Samples: Australia (500), Canada (2,124), France (501), Germany
(909), Netherlands (522), New Zealand (500), Norway (869), Sweden
(1,314), Switzerland (1,025), United Kingdom (500), and United
States (1,012)
• Survey in the field March to July 2012
• Conducted by Harris Interactive and country contractors
• Core topics: Health information technology; access; care
coordination; financial incentives for quality improvement;
assessment and feedback of practice performance; system views
and physician satisfaction
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COMMONWEALTH
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Health Information Technology
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Doctors’ Use of Electronic Medical Records
in Their Practice, 2009 and 2012
Percent
100
99 98 97 98 97 97
96 97 95
92 94
2009
2012
88
82
80
72
69 68 67
56
60
46
37
40
41
20
0
NETH NOR
NZ
UK
AUS
SWE
GER
US
FR
CAN
SWIZ
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COMMONWEALTH
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Source: 2009 and 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
5
Doctors with Electronic Medical Records and
Multifunctional Health IT Capacity
Percent
Uses EMR
100
97
Uses EMR with multifunctional HIT capacity
98
97
92
98
88
80
69
68
60
60
82
67
59
56
41
40
33
27
20
12
11
10
7
6
4
CAN
GER
FR
NOR
0
UK
AUS
NZ
NETH
US
SWE
SWIZ
Note: Multifunctional health IT capacity—uses electronic medical record and at least two electronic functions: for order
entry management, generating patient information, generating panel information, and routine clinical decision support.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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COMMONWEALTH
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Doctor Routinely Receives Electronic Prompts About
Potential Problems with Rx Dose or Interaction
Percent
100
93
89
88
85
80
70
58
60
41
40
30
26
25
GER
SWIZ
22
20
0
NET
NZ
AUS
UK
SWE
US
FRA
CAN
NOR
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
7
Doctor Can Electronically Exchange Patient Summaries
and Test Results with Doctors Outside their Practice
Percent
100
80
60
55
52
49
49
45
39
40
38
31
27
22
20
14
0
NZ
SWE
NET
SWIZ
NOR
FRA
UK
US
AUS
GER
CAN
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
8
Access and Barriers to Care
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COMMONWEALTH
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Doctors’ Perception of Patient Access Barriers
Percent
reporting
their patients
OFTEN have:
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Difficulty paying
out-of-pocket
costs
25
26
29
21
42
26
4
6
16
13
59
Difficulty getting
diagnostic tests
16
38
41
27
7
59
10
15
3
14
23
Long waits to
see a specialist
60
73
59
68
21
75
60
49
10
28
28
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
10
Practice Has Arrangement for Patients’ After-Hours Care
to See Doctor or Nurse
Percent
100
95
94
90
89
81
80
80
78
76
67
60
45
40
34
20
0
UK
NETH
NZ
GER
AUS
NOR* SWIZ
FR
SWE
CAN
* In Norway, respondents were asked whether there practice has arrangements or if there are regional arrangements.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
US
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COMMONWEALTH
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Almost All Patients Can Get Same- or Next-Day Appointment
Percent of doctors responding almost all patients (>80%) can get a
same- or next-day appointment when one is requested
100
86
80
62
61
60
59
56
55
47
42
40
38
28
22
20
0
FR
SWIZ NETH
NZ
GER
UK
US
NOR
AUS
SWE
CAN
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
12
Electronic Access for Patients
Percent
reporting their
practice allows
patients to:
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Request
appointments or
referrals online
8
7
17
22
13
13
51
66
30
40
30
Request refills
for prescriptions
online
7
6
15
26
63
25
53
88
48
56
36
E-mail about
medical
question
20
11
39
45
46
38
26
41
68
35
34
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
13
Care Coordination
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COMMONWEALTH
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Practice Uses Nurse Case Managers or Navigators
for Patients with Serious Chronic Conditions
Percent
100
80
78
73
68
68
59
60
51
44
43
41
40
20
20
0
UK
NETH
NZ
SWIZ
AUS
NOR
CAN
US
Note: Question asked differently in France.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
SWE
GER
THE
COMMONWEALTH
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Primary Care Doctors’ Receipt of Information from Specialists
Percent said after
their patient visits
a specialist they
always receive:
15
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Report with all
relevant health
information
32
26
51
13
13
41
26
12
59
36
19
Information
about changes to
patient’s drugs or
care plan
30
24
47
12
5
44
22
13
44
41
16
Information that
is timely and
available when
needed
13
11
26
4
1
15
4
8
27
18
11
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
After Hospital Discharge, Primary Care Doctor Receives Needed
Information to Manage the Patient Within 48 Hours
16
Percent
100
80
67
56
60
45
42
40
40
36
21
21
20
15
14
CAN
NOR
10
0
GER
NZ
US
NET
SWIZ
AUS
UK
SWE
FRA
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
17
Financial Incentives or Support
for Quality Improvement
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Financial Incentives and Targeted Support
Percent can
receive financial
incentives* for:
AUS
CAN
FR
GER
NET
NZ
NOR
SWE
SWIZ
UK
US
Managing patients
w/ chronic disease
or complex needs
75
70
37
60
77
83
15
49
4
50
21
Enhanced
preventive care
activities**
42
42
12
23
28
40
17
55
5
37
14
Adding
nonphysician
clinicians to
practice
53
33
3
5
60
36
9
33
4
17
10
Making home
visits
57
53
16
51
50
36
45
49
32
20
9
* Including special payments, higher fees, or reimbursements.
** Including patient counseling or group visits.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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COMMONWEALTH
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Assessment and Feedback
of Practice Performance
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COMMONWEALTH
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Practice Routinely Receives and Reviews Data on Patient Care
Percent
routinely
receives and
reviews data on:
20
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Clinical
outcomes
42
23
14
54
81
64
24
78
12
84
47
Patient
satisfaction
56
15
1
35
39
51
7
90
15
84
60
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
21
Doctor Reviews Clinical Performance Against Targets
at Least Annually
Percent
100
96
83
80
67
57
60
53
47
43
43
41
40
37
22
20
0
UK
NZ
US
SWE
AUS
NET
FRA
GER
CAN
SWIZ
NOR
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
22
Doctor Routinely Receives Data Comparing Practice’s
Clinical Performance to Other Practices
Percent
100
80
78
60
55
55
45
40
35
34
32
25
25
20
15
5
0
UK
NZ
SWE
FR
SWIZ
US
NETH
AUS
GER
CAN
NOR
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Practice Routinely Receives and Reviews Data on Resource Use
23
Percent
routinely
receives and
reviews data on:
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Hospital
admissions and
ED use
39
30
9
24
21
43
33
28
32
82
55
Frequency of
ordering tests
33
16
7
17
16
56
18
43
20
56
32
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
24
System Views and Physician Satisfaction
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COMMONWEALTH
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Physician Views of the Health System, 2009 and 2012:
“System Works Well, Only Minor Changes Needed”
Percent
100
2009
2012
80
60
60
45
40
33
54
18
20
56
46 47 46
42
40 41 37
23
53
61
37 39
22
17 15
0
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Physician Views of Whether the Quality of Care in the Health Care
System Has Improved in the Past Three Years, 2012
Percent
responding
quality of care
has:
26
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Improved
30
26
9
12
38
33
28
24
11
35
21
Stayed the same
50
54
52
54
40
49
60
43
66
44
53
Gotten worse
20
19
37
34
20
19
11
32
21
21
25
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
27
Insurance Restrictions on Medication or Treatment
for Patients Pose Major Time Concerns for Doctors
Percent saying amount of time physician or staff spend getting patients needed
medications or treatment because of coverage restrictions is a MAJOR PROBLEM
100
80
60
52
37
40
20
9
10
10
11
UK
SWE
AUS
NOR
17
17
FR
NZ
21
23
26
0
CAN
SWIZ NETH
GER
US
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
28
Physician Satisfaction with Practicing Medicine
Percent
Very satisfied/satisfied
Somewhat/very dissatisfied
100
11
12
16
16
18
18
20
23
24
80
31
45
60
40
88
87
84
84
82
82
80
76
75
68
54
20
0
NETH NOR
SWIZ
UK
CAN
NZ
AUS
FR
SWE
US
GER
THE
COMMONWEALTH
FUND
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
29
Dissatisfaction with Income and Time with Patients
Percent
somewhat/
very dissatisfied
with:
AUS
CAN
FR
GER
NETH
NZ
NOR
SWE
SWIZ
UK
US
Income from
medical practice
25
20
63
33
20
25
16
28
42
21
32
Time to spend
per patient
40
40
47
48
47
44
37
54
31
59
44
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
30
U.S. Primary Care Reports, by Practice Size
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COMMONWEALTH
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U.S. Primary Care Doctors: Access, Information Capacity,
and Administrative Burden by Practice Size
2 or fewer FTE physicians
27
Has after-hours care
arrangements
5 or more FTE physicians
41
49
Uses electronic
medical records
83
Routinely reviews
data on clinical
outcomes
33
58
Insurance restrictions
on medications/
treatments pose
major time concern
63
48
0
25
50
75
Percent
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
100
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COMMONWEALTH
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Cross-Cutting Themes and Implications
• National policies make a difference for primary care practices
• Insurance design
• Support for practice infrastructure and information feedback
• Health IT is spreading, but differentially across countries
• Information exchange and alerts slowest to spread
• Feedback on performance is not yet routine in any country
• Opportunities to learn within and across countries
• Access varies widely: after hours, waits, and cost barriers
• New technology and shared after-hour services enable multiple
points of access
• Opportunities to learn as these evolve
• Gaps in communication across sites of care in all countries
undermines care coordination and integration
• Primary care workforce with expanded team-work, including nurses,
key to a high performing health system
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COMMONWEALTH
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Acknowledgments and Cofunders
Thanks to coauthors David Squires, Michelle M. Doty, Petra Rasmussen,
Roz Pierson, and Sandra Applebaum, and to Harris Interactive, Inc., and
contractors for conducting the survey. Published in Health Affairs as:
“A Survey of Primary Care Doctors in Ten Countries Shows Progress in
Use of Health Information Technology, Less in Other Areas,” Web First,
Nov. 15, 2012.
•
Canada: Health Council of Canada, Health Quality Ontario, Quebec Health
Commission, Health Quality Council of Alberta, Canada Health Infoway
•
France: Haute Authorité de Santé (HAS), Caisse Nationale de l’Assurance
Maladie des Travailleurs Salariés (CNAMTS)
•
Germany: Federal Ministry of Health, German National Institute for
Quality Measurement in Health Care
•
Netherlands: Dutch Ministry of Health, Welfare and Sport, and Scientific
Institute for Quality of Healthcare, Radboud University Nijmegen
•
Norway: Norwegian Knowledge Centre for the Health Services
•
Sweden: Swedish Ministry of Health and Social Affairs
•
Switzerland: Federal Office of Public Health, Swiss Medical
Association
THE
COMMONWEALTH
FUND