How To Get Health Care In The United States

Transcription

1 The Commonwealth Fund 2013 International Health Policy Survey in Eleven Countries Robin Osborn and Cathy Schoen The Commonwealth Fund November 2013

2 The Commonwealth Fund 2013 International Health Policy Survey in Eleven Countries 2 Survey of adults age 18 and older in eleven countries. Sample sizes: Australia (2,200), Canada (5,412), France (1,406), Germany (1,125), Netherlands (1,000), New Zealand (1,000), Norway (1,000), Sweden (2,400), Switzerland (1,500), United Kingdom (1,000), United States (2,002). Survey in the field February to June Conducted by Social Science Research Solutions and country contractors (by landline and cell phone). Presentation topics: affordability and cost-related access barriers; access to primary care, emergency department, and specialist care; complexity; and system views.

3 3 Affordability and Cost-Related Access Barriers

4 $US Health Spending per Capita, 2011 Adjusted for Differences in Cost of Living 4 $9,000 $8,508 $8,000 $7,000 $6,000 $5,000 $5,669 $5,643 $5,099 $4,522 $4,495 $4,118 $3,925 $3,800 $4,000 $3,000 $3,405 $3,182 $2,000 $1,000 $0 % GDP US (17.7%) NOR (9.3%) SWIZ (11.0%) NETH (11.9%) CAN (11.2%) GER (11.3%) FR (11.6%) SWE (9.5%) AUS (8.9%)* UK (9.4%) NZ (10.3%) * Source: OECD Health Data 2013.

5 Key National Insurance Design and Cost-Sharing Policies, AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US* Deductible No No No No Yes No No No Yes No Yes Caps on out-of-pocket spending Yes No No Yes No No Yes Yes Yes No No Core benefit Drugs Dental (adults) * Before insurance market reforms take effect in Source: S. Thomson, R. Osborn, D. Squires, and M. Jun, International Profiles of Health Care Systems, 2013, The Commonwealth Fund, Nov

6 Percent 60 Cost-Related Access Barriers and Out-of-Pocket Costs in the Past Year Experienced cost-related access problem* Spent US$1,000 or more out-of-pocket * Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care. Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

7 Serious Problems Paying or Unable to Pay Medical Bills in the Past Year 7 Percent UK SWE NOR CAN GER AUS NETH NZ SWIZ FR US Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

8 Gaps in Dental Care 8 Percent Did not visit dentist/hygenist/dental clinic in past two years Skipped dental care because of cost in past year GER SWE NOR NETH SWIZ CAN UK FR US AUS NZ Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

9 Cost and Access Problems in the Past Year for U.S. Adults, by Insurance Status 9 Experienced costrelated access problem Serious problems/ unable to pay medical bills Uninsured Insured all year Spent $1,000 or more out-of-pocket Percent Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

10 10 Access: Primary Care, Emergency Department Use, and Specialist Care

11 Access to Doctor or Nurse When Sick or Needed Care 11 Same-day or next-day appointment Waited six days or more for appointment Percent Note: Question asked differently in Switzerland. Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

12 When Calling Regular Doctor with a Question, Always or Often Hear Back on the Same Day 12 Percent GER NETH SWE SWIZ NZ AUS NOR UK US CAN FR Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

13 Access to After-Hours Care 13 Percent 100 Adults, 2013 Easy getting after-hours care without going to the ER Primary care physicians, 2012 Practice has arrangement for patients after-hours care to see doctor or nurse Base: Needed care after hours. * In Norway, doctors asked whether their practice had arrangements or there were regional arrangements. Source: 2012 and 2013 Commonwealth Fund International Health Policy Surveys.

14 Used the Emergency Department in Past Two Years 14 Percent AUS GER NETH UK NZ NOR SWIZ FR SWE US CAN US Uninsured Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

15 Patients Access to Regular Practice 15 Adults, 2013 Can practice with questions Have ed practice in past two years AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US Primary care doctors, 2012 Patients can practices with questions Source: 2012 and 2013 Commonwealth Fund International Health Policy Surveys.

16 Wait Times for Specialist Appointment 16 Less than four weeks Two months or more Percent Base: Needed to see specialist in the past two years. Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

17 17 Complexity

18 Spending on Health Insurance Administration per Capita, 2011 Adjusted for Differences in Cost of Living $US 18 $700 $600 $606 $500 $400 $300 $200 $100 $35 $55 $70 $128 $148 $199 $237 $266 $277 $0 NOR SWE AUS NZ CAN NETH GER SWIZ FR US * Source: OECD Health Data 2013.

19 Insurance Complexity and Restrictions Create Concerns for Patients and Doctors Adults, 2013 Insurance did not cover as expected/ spent a lot of time on paperwork in past year* Percent 75 Primary care physicians, 2012 Insurance coverage restrictions pose major time concern** * Adults spent a lot of time on paperwork or disputes over medical bills and/or insurance denied payment or did not pay as much as expected in the past year. ** Amount of time doctor or staff spend getting patients needed medications/treatments because of coverage restrictions is a major problem. Source: 2012 and 2013 Commonwealth Fund International Health Policy Surveys.

20 Overall Views of Health Care System, Works well, only minor changes Fundamental changes Completely rebuild UK SWIZ NETH AUS NZ NOR SWE GER CAN FR US % 20% 40% 60% 80% 100% Percent Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

21 Insights from Global and Domestic Perspectives 21 Insurance coverage and insurance design matter for ensuring access and affordability Insurance and payment policies targeted at primary care can strengthen access, including after-hours care Complexity can pose significant health system costs o U.S. provides a cautionary example Controlling costs while safeguarding access will require vigilance regarding the impact of insurance design changes o Especially for those vulnerable because of chronic disease or limited incomes Varying country insurance approaches provide rich insights looking forward

22 Acknowledgments and Country Partners 22 Thanks to coauthors David Squires and Michelle M. Doty, and to Robyn Rapoport, Eran Ben-Porath, Social Science Research Solutions, and country contractors for conducting the survey. Cofunded by: Australia: New South Wales Bureau of Health Information Canada: Health Council of Canada, Health Quality Ontario, Commissaire à la Santé et au Bien être du Québec, Health Quality Council of Alberta France: Haute Autorité de Santé (HAS), Caisse Nationale de l Assurance Maladie des Travailleurs Salariés (CNAMTS) Germany: Federal Ministry of Health, BQS Institute for Quality and Patient Safety Netherlands: Dutch Ministry of Health, Welfare and Sport, and Scientific Institute for Quality of Healthcare (IQ Healthcare) Norway: Norwegian Knowledge Centre for the Health Services Sweden: Swedish Ministry of Health and Social Affairs Switzerland: Federal Office of Public Health