On the Front Line: Primary Care Doctors Experiences in Eleven Countries

On the Front Line: Primary Care Doctors Experiences in Eleven Countries Findings from the Commonwealth Fund 12 International Health Policy Survey of Primary Care Physicians and Health Affairs article, Nov. 12 Webinar: February 5, 13 Cathy Schoen Senior Vice President, The Commonwealth Fund

Key Findings HIT: U.S. doctors use of health information technology up sharply, yet continues to lag leading countries 2 Swiss physicians least likely to use EMRs Access: U.S. doctors report patients have difficulty paying for care, and that coverage restrictions poses a major time concern Dutch and U.K. doctors have high rates of after-hours care Swiss doctors report patients have easy access to specialized care All countries struggle with communication and teamwork across health care systems Wide country variation in doctors access to information on their performance Findings point to importance of reforms to support primary care and teamwork, with information exchange 12 survey: 9,776 primary care physicians: Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, U.K., and U.S.

Dollars Health Spending per Capita, 1 Adjusted for Differences in Cost of Living 3 $9, $8, $8,233 $7, $6, $5, $4, $3, $3,22 $3,67 $3,433 $3,758 $3,974 $4,338 $4,445 $5,56 $5,27 $5,388 $2, $1, $ % GDP NZ (1.1%) AUS (9.1%)* UK (9.6%) SWE (9.6%) FR (11.6%) GER (11.6%) CAN (11.4%) NETH (12.%) SWIZ (11.4%) NOR (9.4%) US (17.6%) * 9. Source: OECD Health Data 12.

Percent Doctors Use of Electronic Medical Records in Their Practice, 9 and 12 4 1 8 99 98 9798 97 97 9697 95 92 94 88 72 82 69 6867 9 12 6 56 4 46 37 41 NETH NOR NZ UK AUS SWE GER US FR CAN SWIZ Source: 9 and 12 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Percent Doctors with Electronic Medical Records and Multifunctional Health IT Capacity Uses EMR Uses EMR with multifunctional HIT capacity 5 1 8 6 97 68 92 97 98 6 59 69 88 56 82 67 98 4 33 27 41 12 11 1 7 6 4 UK AUS NZ NETH US SWE SWIZ CAN GER FR NOR 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.

Doctor Can Electronically Exchange Patient Summaries and Test Results with Doctors Outside their Practice 6 Percent 1 8 6 4 55 52 49 49 45 39 38 31 27 22 14 NZ SWE NET SWIZ NOR FRA UK US AUS GER CAN

Doctors Perception of Patient Access Barriers 7 Percent reporting their patients OFTEN have: Difficulty paying out-of-pocket costs Difficulty getting diagnostic tests Long waits to see a specialist AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US 25 26 29 21 42 26 4 6 16 13 59 16 38 41 27 7 59 1 15 3 14 23 6 73 59 68 21 75 6 49 1 28 28

Practice Has Arrangement for Patients After-Hours Care to See Doctor or Nurse 8 Percent 1 95 94 9 89 8 6 81 8 78 76 67 4 45 34 UK NETH NZ GER AUS NOR* SWIZ FR SWE CAN US * In Norway, respondents were asked whether there practice has arrangements or if there are regional arrangements.

Almost All Patients Can Get Same- or Next-Day Appointment Percent of doctors responding almost all patients (>8%) can get a same- or next-day appointment when one is requested 9 1 86 8 6 4 62 61 59 56 55 47 42 38 28 22 FR SWIZ NETH NZ GER UK US NOR AUS SWE CAN

Electronic Access for Patients 1 Percent reporting their practice allows patients to: Request appointments or referrals online Request refills for prescriptions online E-mail about medical question AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US 8 7 17 22 13 13 51 66 3 4 3 7 6 15 26 63 25 53 88 48 56 36 11 39 45 46 38 26 41 68 35 34

Percent Practice Uses Nurse Case Managers or Navigators for Patients with Serious Chronic Conditions 11 1 8 78 73 68 68 6 59 51 44 43 41 4 UK NETH NZ SWIZ AUS NOR CAN US SWE GER Note: Question asked differently in France.

Primary Care Doctors Receipt of Information from Specialists 12 Percent said after their patient visits a specialist they always receive: Report with all relevant health information Information about changes to patient s drugs or care plan Information that is timely and available when needed AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US 32 26 51 13 13 41 26 12 59 36 19 3 24 47 12 5 44 22 13 44 41 16 13 11 26 4 1 15 4 8 27 18 11

After Hospital Discharge, Primary Care Doctor Receives Needed Information to Manage the Patient Within 48 Hours Percent 1 13 8 67 6 56 4 45 42 4 36 21 21 15 14 1 GER NZ US NET SWIZ AUS UK SWE CAN NOR FRA

Practice Routinely Receives and Reviews Data on Patient Care 14 Percent routinely receives and reviews data on: 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 9 15 84 6

Percent Doctor Routinely Receives Data Comparing Practice s Clinical Performance to Other Practices 15 1 8 78 6 4 55 55 45 35 34 32 25 25 15 5 UK NZ SWE FR SWIZ US NETH AUS GER CAN NOR

Insurance Restrictions on Medication or Treatment for Patients Pose Major Time Concerns for Doctors 16 Percent saying amount of time physician or staff spend getting patients needed medications or treatment because of coverage restrictions is a MAJOR PROBLEM 1 8 6 52 4 37 9 1 1 11 17 17 21 23 26 UK SWE AUS NOR FR NZ CAN SWIZ NETH GER US

Physician Satisfaction with Practicing Medicine 17 Percent 1 Very satisfied/satisfied Somewhat/very dissatisfied 8 11 12 16 16 18 18 23 24 31 45 6 4 88 87 84 84 82 82 8 76 75 68 54 NETH NOR SWIZ UK CAN NZ AUS FR SWE US GER

Physician Views of the Health System: System Works Well, Only Minor Changes Needed 18 Percent 1 8 6 4 61 54 53 46 46 45 4 39 37 22 15 NOR NETH NZ SWIZ UK AUS CAN SWE FR GER US

Cross-Cutting Themes and Implications 19 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 enhance access Gaps in communication across sites of care undermine care coordination and integration in all countries Primary care workforce with expanded team-work, including nurses, key to a high performing health system

12 International Health Policy Survey: Description Mail and phone survey of primary care physicians in Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and United States Final samples 9,776 in 11 countries Australia (5), Canada (2,124), France (51), Germany (99), Netherlands (522), New Zealand (5), Norway (869), Sweden (1,314), Switzerland (1,25), United Kingdom (5), and United States (1,12) Survey in the field March to July 12 (through September in Sweden) Conducted by Harris Interactive and country contractors Results published in Health Affairs C. Schoen, R. Osborn, D. Squires, et al. A Survey of Primary Care Doctors in Ten Countries Shows Progress in Use of Health Information Technology, Less in Other Areas, Nov. 15, 12.

Acknowledgments and Cofunders 21 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