1
Health System Performance in
Selected Nations: A Chartpack
Compiled by Katherine K. Shea, Alyssa L. Holmgren,
Robin Osborn, and Cathy Schoen
May 2007
Outline
I.
II.
III.
IV.
V.
Quality of Care
Access to Care
Efficiency of Health System
Equity of Health System
Ability to Ensure Long, Healthy
and Productive Lives
VI. Views of the Health Care System:
Physicians and Patients
VII. Country Rankings
2
Data Sources
•
2004 Commonwealth Fund International Health Policy
Survey of Adults' Experiences with Primary Care
(Random, representative samples of adults 18 and older)
•
•
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 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.
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
3
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).
4
5
Quality: Right Care
Patient Reports on Reminders for
Preventive Care, 2004
6
Percent of adults receiving preventive care reminders
75
50
37
38
AUS
CAN
44
49
50
UK
US
25
0
NZ
2004 Commonwealth Fund International Health Policy Survey
Physicians Reporting Routinely Sending Patients 7
Reminder Notice for Preventive or Follow-Up Care,
2006
Percent of
physicians
Yes, using a manual system
Yes, using a computerized system
100
75
5
18
16
50
25
24
65
20
8
0
AUS
14
CAN
93
83
61
28
GER
32
18
NET
NZ
UK
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
US
8
Preventive Care, 2004
Percent received:
Pap in past 3
years, Women
age 25-64
Mammogram in
past 3 years,
Women age 50-64
AUS
CAN
NZ
UK
US
78
77
81
77
89
80
79
81
77
86
2004 Commonwealth Fund International Health Policy Survey
Percentage of Population over Age 65
with Influenza Immunization in 2004
80.0%
9
79.1%
73.0%
71.0%
70.0%
68.0%
64.6%
62.4%
60.0%
59.2%
49.2%
50.0%
48.0%
43.0%
40.0%
30.0%
20.0%
10.0%
0.0%
a
Australia Netherlands
a
United
Kingdom
France
United
States
Canada
a
OECD
New
Median
Zealand
Germany
Source: J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The
Commonwealth Fund, Apr. 2007).
a
Japan
Prevalence of Chronic Conditions, 2004
Percent of adults with at least one of six chronic conditions*
75
50
47
48
50
NZ
CAN
AUS
51
52
US
UK
25
0
*Hypertension, heart disease, diabetes, arthritis, lung problems, and depression
2004 Commonwealth Fund International Health Policy Survey
10
11
Sicker Adults with Chronic Conditions:
Receipt of Self-Management Plan in Six Countries, 2005
Percent of sicker adults with chronic conditions* whose doctor gave plan to manage care at
home
100
65
58
56
50
45
50
37
0
CAN
US
NZ
AUS
UK
GER
* 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).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
11
Received Recommended Care
for Chronic Condition, Sicker Adults, 2005
Percent received
recommended care:
12
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
Sicker Adults with Hypertension or Diabetes 13
Who Received Recommended Care by
Self-Management Plan or Nurse Involvement, 2005
Includes blood pressure and cholesterol for hypertension; Hemoglobin A1c
and cholesterol checked, and feet and eyes examined for diabetes
Neither self-management plan or nurse
Self-management plan and/or nurse
Percent
100
74
61
78
77
67
86
81
68
91
79
64
50
50
0
NZ
AUS
UK
CAN
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
US
GER
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
15
Doctor’s Office Has a Nurse
Regularly Involved in Care Management, Sicker Adults, 2005
Base: Adults with chronic disease
Percent who have a nurse involved
in case management
75
50
25
36
16
41
47
52
19
0
AUS
CAN
NZ
US
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
GER
UK
16
Prescription Medication Advice Among Sicker Adults
with Chronic Conditions, 2005
Base: Adults with chronic disease who use prescription medications regularly
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
* Doctor sometimes, rarely, or never.
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Patients Did Not Receive Counseling About
Exercise and Diet in Past Year, Sicker Adults,
2005
Base: Adults with chronic health condition
75
45
50
29
31
US
CAN
36
36
NZ
AUS
50
25
0
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
UK
GER
17
18
Physician-Reported Use of Multi-Disciplinary Teams
and Non-Physicians, 2006
AUS
CAN
GER
NET
NZ
UK
US
30
81
29
Practice routinely uses multi-disciplinary teams:
Yes
32
32
49
50
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
Capacity to Generate Patient Information, 2006
19
Percent of primary care practices reporting very or somewhat easy
to generate
List of patients by diagnosis
List of patients' medications, including Rx by other doctors
100
81
80
75
55
50
25
63
92 88
72
59
68
74
37 37
26 25
0
CAN
US
GER
NET
NZ
AUS
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
UK
20
Quality: Safe Care
21
Medical, Medication, and Lab Errors Among Sicker Adults, 2005
Percent reporting medical mistake, medication error, or lab error
in past two years
75
50
25
22
23
25
UK
GER
NZ
27
AUS
30
34
0
CAN
US
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
22
Patients Reporting Any Error by Number
of Doctors Seen in Past Two Years, Sicker Adults,
2005
Percent
75
1 doctor
4 or more doctors
48
50
28
25
12
35
31
14
14
40
37
12
15
22
0
UK
GER
NZ
AUS
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
CAN
US
23
Doctors Reporting Routinely Receiving Alerts about
Potential Problem with Drug Dose/Interaction
Yes, using a manual system
Yes, using a computerized system
Percent of physicians
100
10
75
33
50
25
0
31
10
CAN
80
28
23
US
2
6
6
93
87
91
NET
NZ
UK
40
GER
AUS
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
24
Incorrect Lab/Diagnostic Test or
Delay in Receiving Abnormal Test Results, Sicker
Adults, 2005
Percent reporting either lab test error in past two years
75
50
25
9
11
GER
UK
14
14
NZ
AUS
18
23
0
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
CAN
US
Doctors Reporting Routinely Receiving Alerts to
Provide Patients with Test Results, 2006
Yes, using a manual system
Yes, using a computerized system
Percent of physicians
100
75
50
25
0
14
16
NET
37
6
CAN
40
8
9
51
53
NZ
UK
15
US
17
30
32
GER
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
52
AUS
25
26
Medical Mistake or Medication Error
Occurred Outside the Hospital, Sicker Adults, 2005
Base: Experienced medical mistake or medication error
Percent saying error occurred outside the hospital
100
60
63
63
63
CAN
AUS
GER
NZ
67
77
50
0
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
UK
US
Developed Infection While in the Hospital, Sicker 27
Adults, 2005
Base: Hospitalized in past 2 years
Percent
50
25
3
7
7
8
CAN
US
AUS
10
10
NZ
UK
0
GER
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Deaths Due to Surgical or Medical Mishaps
per 100,000 Population in 2004
28
0.8
0.7
0.7
0.6
0.6
0.5
0.5
0.5
0.5
0.4
0.4
0.4
0.3
0.2
0.2
0.2
0.1
0.0
United
States
Germany
b
Canada
b
b
France
b
United
Australia
b
Kingdom
OECD
a
Japan
Netherlands
Median
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
29
Quality: Coordinated Care
Length of Time with Regular Doctor, Sicker Adults,30
2005
Percent:
AUS
CAN
GER
NZ
UK
US
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
8
8
3
6
4
16
Has regular doctor
No regular doctor
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Patient Report of Care Coordination, Sicker Adults,31
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 of Sicker Adults
Doctors’ Reports of Care Coordination Problems,
2006
32
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
33
Coordination Problems by Number of Doctors, Sicker
Adults, 2005
Percent
75
1 doctor
4 or more doctors
50
43
31
27
25
15
30
30
26
23
16
22
11
7
0
AUS
CAN
GER
NZ
* Either records/results did not reach doctors office in time
for appointment OR doctors ordered a duplicate medical test
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
UK
US
Receive Information Back after Referrals of
Patients to Other Doctors/Specialists, 2006
Percent of physicians reporting receive for “almost all” referrals (80% or
more)
100
75
50
61
62
68
NET
CAN
GER
75
76
UK
AUS
82
37
25
0
US
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
NZ
34
Deficiencies in Transition Planning
When Discharged from the Hospital, Sicker Adults, 2005
35
Base: Hospitalized in past 2 years
Percent who reported
when 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
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
36
Doctors’ Reports of Length of Time to Receive a
Full Hospital Discharge Report, 2006
Percent of physicians saying 15 days or more or rarely receive a full report
100
75
48
50
25
17
23
52
53
UK
GER
58
28
0
NZ
US
AUS
NET
CAN
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
Medications Reviewed When Discharged from the Hospital,
Among Sicker Adults in Six Countries, 2005
37
Percent of hospitalized patients with new prescription who reported
prior medications were reviewed at discharge
100
86
77
73
72
69
67
NZ
US
50
0
GER
AUS
UK
CAN
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
Missed Opportunities to
Engage Patient in Care, Sicker Adults, 2005
40
Base: Adults with chronic disease
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
41
Were Risks Explained Before a Hospital Procedure
in an Understandable Way?, Sicker Adults, 2005
Base: Hospitalized in past 2 years
Percent who said risks were NOT explained
50
25
12
14
16
17
18
21
0
GER
US
UK
NZ
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
AUS
CAN
42
Did Doctors and Nurses Involve You as
Much as You Wanted in Care Decisions? , Sicker Adults, 2005
Base: Hospitalized in past 2 years
Percent NOT involved as much as would like
50
25
16
19
21
22
22
NZ
GER
AUS
UK
27
0
US
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
CAN
43
Top Two Most Important Types of
Information About Surgeons, Sicker Adults, 2005
Base: Had major surgery in the past 2 years
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
Missed Opportunity to Engage Patients
on Choice and Quality, Sicker Adults, 2005
44
Base: Had major surgery in the past 2 years
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
45
Quality: Quality Improvement
Efforts
Physician 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
70
35
41
70
50
Percent reporting their practice:
Sets formal
targets for clinical
performance
26
27
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
46
Physicians’ Reports on Availability of Data
on Clinical Outcomes or Performance,
2006
Percent of
physicians
reporting yes:
47
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
Primary Care Doctor’s Practice Has Documented 48
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
49
Primary 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
Primary Care Doctors’ Reports of Any Financial 50
Incentives for Quality of Care Improvement, 2006
Percent of physicians reporting any financial incentive*
100
95
79
75
72
58
43
50
41
30
25
0
UK
NZ
AUS
NET
GER
CAN
*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
US
51
Access to Care
Cost-Related Access Problems, Sicker Adults, 2005
Percent in past year
due to cost:
52
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 followup
20
12
14
21
5
33
Percent who said
yes to at least
one of the above
34
26
28
38
13
51
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Americans Spend More Out-of-Pocket
on Health Care Expenses, 2004
53
Total health care spending per capita
$7,000
United States
$6,000
$5,000
$4,000
France
Netherlands
$3,000
$2,000
Canada
Germany a
OECD Median
Australiab
Japan a
New Zealand
$1,000
$0
$0
$100
$200
$300
$400
$500
$600
Out-of-pocket spending per capita
a2003
b2003
Total Health Care Spending, 2002 OOP Spending
Source: The Commonwealth Fund, calculated from OECD Health Data 2006.
$700
$800
$900
Out-of-Pocket Medical Costs
in the Past Year, Sicker Adults, 2005
54
Percent with out of pocket expenses for medical bills more than $1000, US
In the past year
75
50
34
25
4
8
8
NZ
GER
14
14
AUS
CAN
0
UK
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
US
Physicians’ Perception of Patient Access:
55
Patients Often Have Difficulty Paying for Medications,
2006
Percent of physicians
75
51
50
25
7
13
15
UK
AUS
23
24
GER
CAN
27
0
NET
NZ
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
US
Waiting Time to See Doctor When Sick or Need 56
Medical Attention, Sicker Adults in Six Countries,
2005
Last time you were sick or needed medical attention,
how quickly could you get an appointment to see a doctor?
Percent of adults
Percent of adults reporting 6 days or more
100
Next day
Same day
23
13
17
50
16
17
58
56
49
36
13
23
45
30
10
23
13
15
GER
UK
3
0
NZ
GER
AUS
UK
US
CAN
NZ
AUS
US
CAN
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
56
57
Difficulty Getting Care on Nights, Weekends, Holidays Without
Going to the ER, Among Sicker Adults in Six Countries, 2005
Percent of adults who sought care reporting “very” or “somewhat” difficult
100
59
61
AUS
US
54
50
38
25
28
0
GER
NZ
UK
CAN
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
Doctor’s Reports on Whether Practice Has
Arrangement for Patients’
After-Hours Care to See Nurse/Doctor, 2006
Percent of physicians reporting “yes”
100
95
90
87
81
76
75
47
50
40
25
0
NET
NZ
UK
AUS
GER
CAN
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
US
58
59
Help Line Use, Sicker Adults, 2005
Percent who reported:
AUS
Called help line for
medical advice in the
past 2 years
10
Advice was definitely or
somewhat helpful (Base:
used help line)
90
CAN
28
86
GER
NZ
UK
US
5
10
32
13
75
86
88
80
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Waited More than Four Weeks
to See a Specialist Doctor, Sicker Adults, 2005
Base: Saw or needed to see a specialist
Percent
100
75
40
50
25
22
23
GER
US
46
57
60
CAN
UK
0
NZ
AUS
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
60
Physicians’ Perception of Patient Access:
Patients Often Experience Long Waits for
Diagnostic Tests, 2006
Percent of physicians
75
51
57
50
26
28
NET
NZ
25
6
8
9
AUS
GER
US
0
CAN
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
UK
61
Waiting Time for Elective or
Non-Emergency Surgery, Sicker Adults, 2005
Base: Needed non-emergency or elective surgery
Percent experienced wait time of 4 month or more
75
50
41
33
25
6
19
20
AUS
NZ
8
0
GER
US
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
CAN
UK
62
63
Efficiency
Went to ER for Condition That Could Have Been Treated
by Regular Doctor, Among Sicker Adults, 2005
64
Percent of adults who went to ER in past two years for condition that could have been treated
by regular doctor if available
50
26
25
21
15
12
9
6
0
GER
NZ
UK
AUS
CAN
US
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
Readmitted to a Hospital or Went to ER as
a Result of Complications After Discharge,
Sicker Adults, 2005
65
Base: Hospitalized in past 2 years
Percent readmitted or ER visit due to complications
75
50
25
20
16
10
15
17
14
NZ
UK
US
0
AUS
CAN
GER
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
66
Duplicate Medical Tests,
Sicker Adults, 2005
Percent reporting that doctor ordered test that had already been done in past two years
50
25
20
18
9
10
11
NZ
CAN
AUS
6
0
UK
US
GER
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
Test Results or Medical Record Not Available at
Time of Appointment, Among Sicker Adults, 2005
Percent reporting test results/records not available at time of appointment in past two years
50
23
25
19
11
12
GER
AUS
16
16
NZ
UK
0
CAN
US
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
Primary Care Doctors Use of Electronic Patient 68
Medical Records, 2006
Percent of physicians
100
98
92
89
79
75
50
42
28
25
23
0
NET
NZ
UK
AUS
GER
US
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
CAN
Primary Care Doctors’ Access to Electronic
Medical Record System Access, 2006
Percent with
capability to:
69
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
Practice Use of Electronic Technology, 2006
70
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
71
Primary Care Practices with Advanced
Information Capacity, 2006
Percent reporting 7 or more out of 14 functions*
100
87
83
72
75
59
50
32
19
25
8
0
NZ
UK
AUS
NET
GER
US
CAN
*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.
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
Public Investment per Capita in
Health Information Technology (HIT) as of 2005
$200
$192.79
$150
$100
$50
$31.85
$21.20
$4.93
$0
United Kingdom
Canada
Germany
Australia
$0.43
United States
Source: The Commonwealth Fund, calculated from Anderson, G.F., Frogner, B., Johns, R.A., and Reinhardt, U.
“Health Care Spending and Use of Information Technology in OECD Countries,” Health Affairs, 2006.
72
EFFICIENCY
73
International Comparison of Spending on Health, 1980–2004
Average spending on health
per capita ($US PPP)
7000
6000
United States
Germany
Canada
France
Australia
United Kingdom
Total expenditures on health
as percent of GDP
16
14
12
5000
10
4000
8
3000
6
2000
4
1000
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
0
2
United States
Germany
Canada
France
Australia
United Kingdom
0
80 982 984 986 988 990 992 994 996 998 000 002 004
9
1
1
1
1
1
1
1
1
1
1
2
2
2
Data: OECD Health Data 2005 and 2006.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
73
Health Care Spending per Capita in 2004
Adjusted for Differences in Cost of Living
$7,000
$6,102
$6,000
$5,000
$4,000
$3,165
$3,000
$3,159
$3,041
$3,005
$2,876
$2,571
$2,546
$2,249
$2,083
$2,000
$1,000
$0
United
States
Canada
France Netherlands Germany a Australiaa
OECD
United
Median
Kingdom
Japana
New
Zealand
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
74
Average Annual Growth Rate of
75
Real Health Care Spending per Capita, 1994–2004
5.0%
4.3%
4.2%
3.8%
4.0%
3.7%
3.4%
3.3%
3.2%
2.8%
2.8%
3.0%
2.4%
2.0%
1.0%
0.0%
Australia
a
United
OECD
United
New
Kingdom
Median
States
Zealand
Netherlands
France
Japan
a
Canada
Germany
a
A1994–2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Percentage of Gross Domestic Product
Spent on Health Care in 2004
76
20%
18%
16.0%
16%
14%
10.9%
12%
10.5%
9.9%
9.2%
10%
9.2%
8.7%
8.4%
8.3%
8.0%
8%
6%
4%
2%
0%
c
United
States
a
Germany
b
France
b
Canada
b
Netherlands
a
Australia
b
b
OECD
New
United
Median
Zealand
Kingdom
a2003
b2004
c2004
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.
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
a
Japan
Health Care Expenditure per Capita
by Source of Funding in 2004
77
Adjusted for Differences in Cost of Living
$7,000
$6,000
$5,000
$6,102
Private Spending
Out-of-Pocket Spending
$2,572
Public Spending
$4,000
$3,000
$803
$3,165 $3,158 $3,038
$3,005 $2,876
$483
$444
$472
$239
$2,000
$1,000
$906
$342
$313
$354
$238
$2727
$2,210
$2,475
$1,894
$2,350
$2,546 $2,461
$2,249
$148
$396
$28
$389
$1,917
$1,832
United
OECD
Japan
Kingdom
Median
$582
$370
$1,940
$2,176
$2,083
$113
$359
$1,611
$0
United
Canada
States
a2003
b2002
France Netherlands Germany
a
Australia
ab
a
(Out-of-Pocket)
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
New
Zealand
Inpatient Hospital Spending per Capita in 2004
Adjusted for Differences in Cost of Living
$1,800
$1,636
$1,600
$1,400
$1,200
$1,069
$1,044
$1,043
$1,015
$1,000
$914
$914
OECD
Canada
$879
$800
$600
$400
$200
$0
United
States
France
a
b
Germany Netherlands Australia
b
Median
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
a
Japan
78
Hospital Spending
per Inpatient Acute Care Day in 2004
79
Adjusted for Differences in Cost of Living
$2,500
$2,337
$2,000
$1,500
$1,069
$1,015
$862
$1,000
$793
$549
$419
$500
$0
United
States
France
Australia
b
Canada
a
OECD
Germany
a
a
Japan
Median
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
Average Annual Hospital Inpatient
Acute Care Days per Capita in 2004
80
Days
2.2
2.1
2.0
1.8
1.8
1.6
1.4
1.2
1.1
1.0
1.0
1.0
1.0
1.0
0.7
0.8
0.6
0.4
0.2
0.0
Japan
Germany
United
Kingdom
France
a
Australia
OECD
Median
a
Canada
United
States
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Number of Acute Care Hospital Beds
per 1,000 Population in 2004
9.0
81
8.4
8.0
7.0
6.4
6.0
5.0
3.8
4.0
3.7
3.6
3.6
3.0
3.0
2.8
2.8
2.0
1.0
0.0
Japan
Germany
France
OECD
United
Median
Kingdom
a
Australia
a
Canada Netherlands United
a
States
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Average Length of Stay for Acute Care in 2004
22.0
20.2
20.0
18.0
16.0
Days
14.0
12.0
10.0
8.7
7.3
8.0
6.6
6.6
6.1
6.0
5.6
5.5
4.0
2.0
0.0
Japan
Germany
Canada
OECD
Median
a
United
Australia
a
Kingdom
United
France
a
States
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
82
Long-Term Institutional Care Spending
per Capita in 2004
83
Adjusted for Differences in Cost of Living
$450
$409
$400
$402
$396
$392
$350
$313
$310
$300
$250
$183
$200
$150
$88
$100
$50
$0
Canada
a2003
Netherlands Germany
a
United
OECD
States
Median
a
Japan
Australia
b
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
France
Number of Long-Term Care Beds
per 1,000 Population over Age 65 in 2004
110
100
99
90
80
69
70
62
60
49
50
41
40
30
26
20
21
10
0
Canada
a
France
a
OECD
United
a
Median
a
States
a
Australia
Japan
United
Kingdom
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
84
Home Health Care Spending per Capita in 2004
Adjusted for Differences in Cost of Living
$160
$157
$147
$140
$120
$97
$100
$80
$60
$60
$46
$40
$14
$20
$10
$0
Germany
a2003
a
United
States
Netherlands
b
Canada
OECD
Median
France
a
Japan
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
85
Average Annual Growth Rate of
86
Home Health Care Spending per Capita, 1994–2004
35.0%
32.0%
30.0%
25.0%
20.0%
15.0%
13.4%
10.0%
5.5%
5.0%
3.7%
2.1%
0.0%
-5.0%
-10.0%
-5.0%
Japan
a1995–2003
a
Germany
b
France
Canada
United States
Netherlands
b1994–2003 c1994–2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
c
Spending on Physician Services per Capita in 200487
Adjusted for Differences in Cost of Living
$1,400
$1,362
$1,200
$1,000
$800
$563
$600
$482
$400
$436
$371
$319
$307
$200
$0
United
States
Japan
a
OECD
Australia
b
France
Canada
Germany
Median
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
a
Average Annual Growth Rate of Practicing
Physicians per 1,000 Population, 1994–2004
3.5%
3.1%
3.0%
2.5%
2.0%
1.5%
1.3%
1.3%
1.3%
1.1%
1.1%
0.9%
1.0%
0.6%
0.5%
0.0%
0.0%
United
United
OECD
Kingdom
States
Median
Germany
Japan
New
Zealand
a
a
Australia
France
Canada
a1994–2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
88
Number of Practicing Physicians
per 1,000 Population in 2004
89
4.0
3.6
3.4
3.5
3.4
3.2
3.0
2.6
2.4
2.5
2.3
2.2
2.1
2.0
2.0
1.5
1.0
0.5
0.0
Netherlands
France
Germany
OECD
Median
a
Australia
United
United
New
States
Kingdom
Zealand
a
Canada
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund, Apr. 2007).
Japan
Average Annual Number of Physician Visits
per Capita in 2004
90
16.0
14.0
13.8
12.0
10.0
8.0
6.7
6.0
6.1
6.1
6.0
5.3
5.3
3.9
4.0
3.2
2.0
0.0
Japan
a
France a
a
Canada
OECD
Median
Australia
Netherlands
United
United
New
Kingdom
Statesa
Zealand
a
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Pharmaceutical Spending per Capita in 2004
Adjusted for Differences in Cost of Living
$800
$752
$700
$599
$600
$559
$500
$438
$425
$400
$383
$377
$318
$300
$200
$100
$0
United
France
Canada
Germany
a
Japan a
Australia b
OECD Median Netherlandsb
States
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
91
Average Annual Growth Rate of Real Spending
per Capita on Pharmaceuticals, 1994–2004
9.0%
8.0%
7.7%
7.5%
7.0%
5.9%
6.0%
5.0%
4.2%
4.0%
4.2%
4.1%
3.7%
3.0%
2.0%
1.6%
1.0%
0.0%
Australia b
United
States
Canada
OECD
Netherlands b
France
Germany
a
a
Japan
Median
a1994–2003
b1994–2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
92
Percentage of Total Health Care Spending
on Health Administration and Insurance in 2004
8.0%
7.6%
7.5%
7.0%
6.0%
5.6%
5.0%
4.4%
4.0%
4.1%
3.0%
3.0%
3.0%
2.3%
2.0%
1.0%
0.0%
United
France
Germany
a
Netherlands
Canada
Australiab
OECD Median
a
Japan
States
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
93
94
Equity
Health Status by Income, 2004
Percent:
95
AUS
CAN
NZ
UK
US
Below Average
22*
19*
22*
24*
30*
Above Average
7
7
6
8
6
63*
58*
62*
64*
62*
41
42
40
39
42
Fair/Poor Health:
Any of 6 Chronic Illnesses:^
Below Average
Above Average
^ 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).
96
Insurance and Cost-Sharing Policies
in Four Countries with Universal Public Coverage
Private insurance
for services covered by public
Percent with private coverage
Public Plan Patient Cost-Sharing
Prescription Drugs
AUS
CAN
NZ
UK
Permitted only for hospital
services
Prohibited for core services in
most provinces
Permitted
Permitted
49%
79.9%
(to cover benefits excluded
from ‘free-of charge’ public
plan)
33%
12%
Variable depending on
service type and provider
None for core services
Copayments for many
services
None for basic services
(except Rx and optical)
Covered
Publicly 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).
Private Insurance in Four Countries
with Universal Coverage, 2004
97
Percent who have private insurance in addition to public
Below average income
100
81
63
75
50
Above average income
30*
57
36*
35
19*
25
11*
0
Australia
Canada
New Zealand
United
Kingdom
* 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).
Spent More than US$1,000 Out-of-Pocket
for Medical Care in Past Year, by Income, 2004
Percent
75
Below average income
Above average income
50
24*
21
25
8*
10 12
4
6
2*
32
5
0
Australia
Canada
New
United
United
Zealand
Kingdom
States
* 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).
98
Cost-Related Access Problems, by Income, 2004 99
Percent reporting any of three access problems because of costs^
75
Below average income
Above average income
57*
44 *
50
35 *
25
24
29
26*
25
12*
12
6
0
Australia
Canada
New
United
United
Zealand
Kingdom
States
^ 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).
Access to Doctor When Sick or
Need Medical Attention, by Income, 2004
Percent waited six days or more for appointment when sick
75
Below average income
Above average income
50
25 *24
24
25
7
5
14 12
3
13
3
0
Australia
New
Zealand
United
Kingdom
United
States
Canada
* 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
ER Visit for Condition a Primary Care
Doctor Could Have Treated if Available, by Income, 2004
Percent
75
Below average income
Above average income
50
25
6
5
6
6
12
21
19
9
11
14
0
United
New
Kingdom
Zealand
Australia
United
Canada
States
Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences with Primary Care
(Schoen et al. 2004; Huynh et al. 2006).
101
Difficulty Getting Care on Nights, Weekends,
Holidays Without Going to ER, 2004
Percent saying “very” or “somewhat difficult”
100
75
Below average income
53 56
Above average income
70*
60 59
50
32 32
60
42 44
25
0
Australia
Canada
New
United
United
Zealand
Kingdom
States
•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).
102
Care Coordination, by Income, 2004
103
Base: Have seen a doctor in past two years
Percent reporting any of three care coordination problems^
75
Below average income
Above average income
50
26 28
25
29
36*
25
27
26 24
27
New
United
United
Zealand
Kingdom
States
23
0
Australia
Canada
^ 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).
Rated Doctor Fair or Poor, by Income, 2004
Percent of adults
75
Above average income
Below average income
50
25
22*
9
7
11 8
9*
4
12 11
7
0
Australia
Canada
New
Zealand
United
Kingdom
* 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).
United
States
104
Had Blood Pressure Check in Past Year,
by Income, 2004
Percent of adults
100
83 79
Below average income
79 82
75
77*
70
Above average income
72*
91
*
85
61
50
25
0
Australia
Canada
105
New
United
United
Zealand
Kingdom
States
* 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).
Had Pap Test in Past Three Years,
by Income, 2004
106
Base: Women ages 25–64
Percent
Below average income
100
75
75*
84
69*
84
Above average income
82
93
*
86
New
United
United
Zealand
Kingdom
States
*
84
71
73*
50
25
0
Australia
Canada
* 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).
107
Under 65: ER Use—
Comparisons with U.S. Insured and Uninsured, 2004
Percent under 65 with ER visit in past two years
75
50
25
*
26
39
29
30
AUS
UK
46*
34
27
0
NZ
CAN
Total
Insured Uninsured
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).
108
Under 65: Coordination Problem— Comparisons with
U.S. Insured and Uninsured, 2004
Percent under 65 with at least one of three coordination problems^
75
44 *
50
26
26
26
CAN
NZ
UK
30
33
28
25
0
AUS
Total
Insured Uninsured
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).
109
Under 65: Lab Test Errors—
Comparisons with U.S. Insured and Uninsured, 2004
Base: Under 65 who have had lab tests in past two years
Percent given wrong result or delay in receiving abnormal test result
75
50
27 *
25
9*
9
AUS
UK
12
15*
16
13
0
CAN
NZ
Total
Insured Uninsured
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)
110
Long, Healthy, and Productive Lives
Mortality Amenable to Health Care
111
Mortality from causes considered amenable to health care is deaths before age 75
that are potentially preventable with timely and appropriate medical care
Deaths per 100,000 population*
International
variation, 1998
150
100
75
88 88 88
81 84
92
97 97 99
106 107 109 109
State variation,
134
2002
129 130 132
115 115
119
110
103
84
90
50
Fr
an
ce
Ja
pa
n
Sp
a
Sw in
ed
en
I
Au ta ly
st
ra
Ca l ia
na
N da
Ne or
th wa
y
er
la
nd
s
G
re
G ece
er
m
an
y
A
Ne
us
w
t
Ze ria
al
De an d
Un
n
ite m a
rk
d
St
at
es
Fi
nl
an
Un
ite Ire d
l
d
Ki and
ng
d
Po o m
rtu
ga
l
0
U.S.
avg
10th
25th Med- 75th
ian
Percentiles
* 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.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
90th
112
Infant Mortality Rate, 2002
Infant deaths per 1,000 live births
International variation
State variation
10
9.1
8.1
7.0
6.0
5.4 5.6
5.0 5.0 5.0 5.0 5.1 5.2
5
7.1
7.0
5.3
4.4 4.4 4.5 4.5
4.1 4.1 4.1 4.2 4.2
3.0 3.0
3.3 3.5
2.2
Ic
el
a
nd
Ja
pa
Fi n
nl
an
Sw d
ed
e
No n
rw
ay
Sp
ai
Fr n
an
ce
Cz
A
ec
us
h
Re tria
pu
b
Ge lic
rm
a
Be ny
lg
i
De um
nm
ar
k
Sw
Ita
ly
itz
Ne erla
nd
th
er
la
n
Au ds
st
ra
Po lia
rtu
ga
Ire l
la
nd
Un
G
ite
re
d
ec
Ki
ng e
do
m
C
an
Ne
a
w
da
Z
Un eal
ite and
d
St *
at
es
0
U.S.
avg
10th
25th
Median
75th
90th
Percentiles
* 2001.
Data: International estimates—OECD Health Data 2005;
State estimates—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
112
Healthy Life Expectancy at Age 60, 2002
113
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
Years
30
Women
Men
22
20
20 20 20 20
20 19 19 19 19 19 19 19 19
18 18 18 18 18 18
18 17
18
18 17 17
17
17
17 16
16 16 16 16 16 16
16 16 16 16 16 15 15
15 15
14
10
S w Jap
itz an
er
la
n
Fr d
an
ce
Sp
a
Sw i n
ed
e
A
us n
tr
al
ia
Ita
A ly
us
t
C ria
an
a
B da
el
g
G ium
er
m
an
y
N
or
w
a
Ic y
el
an
Fi d
nl
N
et
a
he nd
r
N
ew lan
Ze ds
al
an
U
d
ni
G
te
r
e
d
K ece
U ing
ni
te dom
d
St
a
Po tes
rt
ug
a
Ir e l
la
n
D
C
en d
ze
ch
m
Re ar k
pu
bl
ic
0
Data: The World Health Report 2003 (WHO 2003, Annex Table 4).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
Acute Myocardial Infarction Deaths
per 100,000 Population
114
70.0
60.0
58.8
53.0
48.3
50.0
48.1
47.9
46.3
43.9
40.0
30.0
25.7
19.9
20.0
10.0
0.0
United
Kingdom b
Australiab
Germany
OECD
United
Median
States b
Canadab
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006
(New York: The Commonwealth Fund, Apr. 2007).
Netherlands
Franceb
Japan
a
Bronchitis, Asthma, and Emphysema Deaths
per 100,000 Population
7.0
6.4
6.0
115
6.0
5.0
5.0
4.7
4.4
4.0
4.0
3.7
3.4
3.0
3.0
2.0
1.0
0.0
Japan b
United
States b
Australia
Netherlands
OECD
Median
United
b
Kingdom
Germany
France b
a
Canada
b
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Potential Years of Life Lost Due to Malignant
Neoplasms per 100,000 Population in 2004
116
1200
1059
952
1000
912
895
885
867
847
800
800
725
600
400
200
0
France
a2003
Netherlands
b
United
Kingdom b
United
States b
OECD
Germany
Canada b
Australia b
Japan
a
Median
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Potential Years of Life Lost Due to Diseases of the
117
Circulatory System per 100,000 Population in 2004
900
800
825
700
635
600
557
550
472
500
464
437
400
419
411
300
200
100
0
United
States b
United
Kingdom b
Germany
OECD
Netherlands
a
Japan
Canada b
Australia b
France b
Median
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Potential Years of Life Lost Due to Diabetes
per 100,000 Population in 2004
118
120
100
101
80
59
60
42
40
39
39
39
30
29
25
20
0
United
States b
Canada b Netherlands Australiab
Germany
OECD
United
Median
Kingdomb
Franceb
a
Japan
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Potential Years of Life Lost Due to
Diseases of the Respiratory System in 2004
200
119
190
180
172
160
140
119
120
114
105
94
100
93
89
80
80
60
40
20
0
United
States
a
United
b
Japan
Kingdom
b
OECD
b
Australia Netherlands Germany
b
Canada
France
b
Median
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006 (New York: The Commonwealth Fund,
Apr. 2007).
Percentage of Adults Who Reported
Being Daily Smokers in 2004
120
35.0%
30.0%
30.0% 29.4%
25.5% 25.0%
25.0%
24.3% 23.0%
22.0%
20.0%
17.7%
17.0%
15.0%
15.0%
10.0%
5.0%
0.0%
Netherlands
Japan
OECD
United
Median
Kingdom
Germany
a
France
New
Zealand
a2003
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006
(New York: The Commonwealth Fund, Apr. 2007).
Australia
United
States
Canada
Obesity (BMI>30) Prevalence in 2004
121
35.0%
30.6%
30.0%
25.0%
23.0%
22.4%
20.9%
20.0%
15.0%
13.0%
12.9%
10.9%
9.5%
10.0%
5.0%
3.2%
0.0%
United
States
United
b
Kingdom
Canada
New
Zealand
OECD
a
Germany
Median
a2003
b2002
J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006
(New York: The Commonwealth Fund, Apr. 2007).
a
Netherlands
France
a
Japan
122
Health Care System Views
Views of the Health Care System in
Five Nations, 1998 to 2004
Percent saying:
123
AUS
CAN
NZ
UK
US
2004
21
21
19
26
16
2001
25
21
18
21
18
19
20
9
25
17
2004
23
14
19
13
33
2001
19
18
20
18
28
1998
30
23
32
14
33
Only Minor Changes Needed
1998
Rebuild Completely
Source: 2004, 2001 and 1998 Commonwealth Fund International Health Policy Surveys
Sicker Adults Views of the Health Care System
in 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
124
Care Experiences Reported by Adults
with Positive or Negative System Views, Sicker
Adults, 2005
125
Percent
75
Minor Change
47
50
25
Rebuild
36
20
35
16
18
24
11
0
Any medical,
medication,
or lab error
Coordination
problems
Access
problem
due to cost
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
Waited 6 days
or more for
appointment
Physician Views of the Health System, 2006
Percent saying:
126
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
5
3
42
3
4
9
16
Rebuild
Completely
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
Physician Dissatisfaction with Medical
Practice, 2006
Percent very or
somewhat
dissatisfied with:
AUS
CAN
Freedom to make
clinical decisions
8
12
74
Time to spend per
patient
33
36
Income from
medical practice
36
Overall
experience with
medical practice
14
GER NET
127
NZ
UK
US
10
26
24
31
50
35
33
51
42
40
53
23
44
18
47
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
Country Rankings
1.0-2.66
2.67-4.33
4.34-6.0
AUSTRALIA
CANADA
GERMANY
NEW
ZEALAND
UNITED
KINGDOM
UNITED
STATES
3.5
5
2
3.5
1
6
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
OVERALL RANKING (2007)
Quality Care
* 2003 data
Source: 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
Country Rankings
1.0-2.66
2.67-4.33
4.34-6.0
AUSTRALIA
CANADA
GERMANY
NEW
ZEALAND
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
$2,876*
$3,165
$3,005*
$2,083
$2,546
$6,102
Health Expenditures per Capita,
2004
UNITED
KINGDOM
UNITED
STATES
* 2003 data
Source: 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).