Transcript 2002 Commonwealth Fund International Health Policy Survey

The 2002 Commonwealth Fund
International Health Policy Survey
Adults with Health Problems
The Commonwealth Fund
Harvard University School of Public Health
Harris Interactive, Inc.
For release with five-country article
in May/June 2003 Health Affairs
Methods
• Survey of sicker adults in Australia, Canada, New Zealand, United
Kingdom, and the United States. 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
• Final sample size of 750 in CA, NZ, UK and US. 844 in Australia
• One fourth to one third of adults initially screened in each country
• Conducted by Harris Interactive and subcontractors from March 25,
2002 to May 13, 2002
• Margin of error + or – 4 percentage points for differences between
countries.
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Overall System View
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
3
Dissatisfaction with the
health care system
Percent very or somewhat dissatisfied with their country’s
health care system in general
75%
48%
50%
36%
36%
AUS
CAN
44%
31%
25%
0%
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
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Two Biggest Problems with the
Health Care System
Most Frequently Cited
Problems:
AUS
CAN
NZ
UK
US
High cost of health care
19
13
21
6
48
Inadequate coverage of
services
9
8
6
4
25
Shortages
31
54
20
33
5
Waiting times
31
27
41
39
3
Not enough government
funding
20
16
23
24
1
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Single Most Important Thing
Government Can Do to
Improve Health Care
AUS
CAN
NZ
UK
US
Spend more money
30
32
34
30
4
Increase number of
health professionals
14
19
5
15
2
Reduce costs
5
1
5
3
16
Improve coverage
4
2
5
1
21
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Care Coordination
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Number of Doctors or Health Professionals
Visited in the Past Two Years
Saw 1-2 doctors in the past 2 years
Saw 3 or more doctors in the past 2 years
75%
59%
57%
59%
61%
65%
50%
38%
39%
36%
34%
32%
25%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
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Care Coordination
In the past two years:
Sent for duplicate tests by
different health professionals
Had to tell the same story to
multiple health professionals
Medical records/test results did
not reach doctor’s office in time
for appointment
Received conflicting information
from different health
professionals
AUS
CAN
NZ
UK
US
13
20
17
13
22
49
50
47
49
57
14
19
16
23
25
23
23
24
19
26
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
9
Percent reporting receiving conflicting
information from different health
professionals by number of doctors
Saw 1-2 doctors in the past 2 years
Saw 3 or more doctors in the past 2 years
50%
31%
32%
34%
32%
26%
25%
13%
11%
13%
13%
9%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
10
Percent reporting being sent for duplicate
tests by different health professionals
in the past 2 years by number of doctors
Saw 1-2 doctors in the past 2 years
Saw 3 or more doctors in the past 2 years
50%
28%
28%
25%
20%
16%
10%
9%
9%
17%
11%
6%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
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Prescription Drugs
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
12
Number of prescription medications
taken regularly
Percent who take…
At least one medication on a regular or ongoing basis
Four or more medications on a regular or ongoing basis
75%
66%
65%
64%
71%
67%
50%
25%
36%
23%
23%
25%
22%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
13
Percent saying doctor has not
reviewed/discussed all of the medications
they take in the past two years
Base: Adults taking prescription drugs regularly
50%
31%
32%
28%
23%
25%
22%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
14
Problems with prescription drugs
Any prescription medications
that you:
AUS
CAN
NZ
UK
US
Stopped taking without
doctors advice due to side
effects
15
17
16
16
19
Skip doses to make the
medication last longer
9
8
7
6
16
Have been taking that cause
serious side effects that the
doctor didn’t tell you about
11
9
9
11
9
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
15
Medication and Medical Errors
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
16
Medication and Medical Errors
Percent in the past two years:
AUS CAN
NZ
UK
US
Given the wrong medication or
wrong dose by a doctor, hospital
or pharmacist
11
11
13
10
12
Believed a medical mistake was
made in your treatment or care
19
20
18
13
23
Medication error or believed an
error was made
23
25
23
18
28
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Among those reporting an error,
percent who said error caused
serious health consequences
Base: Reported a medication error or believed an error was made in their care
75%
55%
60%
63%
60%
51%
50%
25%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
18
Percent reporting medication error
or medical mistake in past 2 years
by number of doctors
Saw 1-2 doctors in the past 2 years
50%
Saw 3 or more doctors in the past 2 years
32%
28%
34%
29%
25%
21%
16%
16%
15%
19%
13%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
19
Patient–Physician Communication
and Ratings of Physician Care
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
20
Communication with Physicians
In the past 2 years:
AUS
CAN
NZ
UK
US
Left a doctor’s office without
getting important questions
answered
21
25
20
19
31
Did not follow a doctor’s
advice
31
31
27
21
39
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
21
Missed Opportunities in Patient
Discussions with Regular Doctor
Regular doctor does NOT:
AUS
CAN
NZ
UK
US
Ask for your ideas and opinions
about treatment and care
51
49
47
67
47
Make clear specific goals for
treatment
23
21
25
38
20
Help you understand what you
need to do for your health
12
14
17
26
14
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
22
Communication with Physicians
About Coping with Illness
Percent saying physician has NOT discussed the emotional burden
of coping with condition in the past 2 years
75%
66%
54%
55%
54%
AUS
CAN
NZ
51%
50%
25%
0%
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
23
Patient Ratings of Physician Care
Percent rating physician
as excellent or very good:
AUS
CAN
NZ
UK
US
How well he or she
diagnosed your problem
67
62
68
57
58
Spending enough time
with you
64
57
72
55
52
Being accessible by phone
or in person
57
52
68
50
51
Listening carefully to your
health concerns
72
66
76
65
62
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
24
Waiting Times, Access,
and Access Problems Due to Cost
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
25
Problems with Waiting Times to Get
an Appointment with Regular Doctor
Percent reporting waiting time for an appointment with
regular physician was a big problem in the past 2 years
50%
24%
25%
21%
17%
14%
5%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
26
Percent saying doctors not spending
enough time during office visits was
a big problem in the past 2 years
50%
25%
20%
20%
13%
9%
12%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
27
Difficulty Seeing a Specialist
Percent reporting it is very or somewhat difficult to see a specialist
75%
53%
50%
41%
36%
38%
39%
NZ
UK
US
25%
0%
AUS
CAN
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Reasons It Was Difficult
to See Specialist*
Base: Sicker adults reporting it somewhat or very difficult to see a specialist
AUS
CAN
NZ
UK
US
Having to wait for an appointment,
long waiting times for type of care
74
86
61
75
40
Unable to afford/lack of (private)
insurance
17
3
23
5
17
Being denied a referral or having to
wait for a referral
2
10
10
6
31
Facilities or service not available
locally or lack of doctors available
18
24
19
15
13
* Does not add to 100% due to multiple responses
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
29
Percent reporting long waits to be admitted
to the hospital were a big problem
in the past 2 years
Base: Hospitalized in past 2 years
50%
32%
25%
24%
19%
21%
13%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
30
Percent reporting having a scheduled surgery
or procedure delayed because of cancellation
was a big problem in past 2 years
50%
Base: Hospitalized with major surgery in past 2 years
25%
12%
15%
11%
14%
6%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
31
Percent reporting delays or problems while
discharge arrangements were being made
Base: Respondent or family member hospitalized in the past 2 years
50%
25%
15%
9%
9%
AUS
CAN
11%
12%
0%
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
32
Emergency Room Use
Percent who used or tried to use an emergency room in the past two years
50%
47%
44%
34%
33%
34%
NZ
UK
25%
0%
AUS
CAN
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
US
Adults with health problems
33
Percent reporting waiting time for
emergency care was a big problem
Base: Used an emergency room in the past two years
50%
37%
31%
36%
31%
28%
25%
0%
AUS
CAN
NZ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
UK
US
Adults with health problems
34
Access Problems Due to Cost
In the past two years, did not
do the following due to cost:
AUS
CAN
NZ
UK
US
Did not fill a prescription
23
19
20
10
35
Did not get medical care
16
9
26
4
28
Did not get recommended test,
treatment, or follow up
16
10
15
5
26
Did not get dental care
44
35
47
21
40
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Summary and Implications
• Experiences of adults with health problems indicate areas
of common concerns and varying performance
– Care coordination problems: duplicate tests, delays
and conflicting information
– Deficiencies in patient-doctor communications lead to
missed opportunities
– Medical care and medication errors
• Access barriers exist in all five nations but the source and
type of barrier vary widely
• Opportunities exist to improve care and to learn as nations
tackle areas of common concern
• Yet, priority areas of emphasis are likely to differ
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
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Methods
The Commonwealth Fund 2002 International Health Policy Survey
consisted of interviews with adults with health problems in each of
five countries: Australia, Canada, New Zealand, the United Kingdom,
and the United States. To identify these adults, the survey screened
initial random samples of adults 18 or older who met at least one of
four criteria: reported their health as fair or poor; had serious illness,
injury or disability that required intensive medical care in the past two
years; or in the last two years had major surgery or had been
hospitalized for something other than a normal, uncomplicated
delivery of a baby. These questions resulted in a final sample of 750
or more “sicker adults” in each country who were eligible to
participate in the full survey. (AUS 844, CAN 750, NZ 750, UK 750, US
755). This final survey sample represents one fourth to one third of
the adults initially contacted. These sicker adults are among the most
intensive users of the health care system and are particularly
vulnerable to variations in quality and outcomes of care. Harris
Interactive, Inc. and country affiliates conducted the interviews by
telephone between March and May 2002.
2002 Commonwealth Fund International Health Policy Survey
Commonwealth Fund/Harvard/Harris Interactive
Adults with health problems
37