SlideShare una empresa de Scribd logo
1 de 26
Descargar para leer sin conexión
International Health Policy and Practice:
Comparing the U.S. and Canada on
Access and Equity
Eric Schneider, MD, MSc
Senior Vice President for
Policy and Research
1
Outline
• Why compare countries’ health care systems?
• The Commonwealth Fund International Health
Policy Survey(s)
• Are we as good as our neighbors to the
north/south?
2
Why Compare Countries’ Health Care Systems?
“Americans have the best
health care system in the
world” - 2004
President Delivers State
of the Union Speech
3
International Trends in Health Spending
Health spending per capita
($US PPP)
Total health spending as
percent of GDP
Note: PPP = Purchasing power parity.
Source: OECD Health Data 2014; U.S. National Health Expenditure Accounts.
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
1980
1984
1988
1992
1996
2000
2004
2008
2012
US
SWIZ
GER
CAN
FR
JPN
UK
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1980
1984
1988
1992
1996
2000
2004
2008
2012
US
FR
SWIZ
GER
CAN
JPN
UK
$9,077
$4,602
10.9%
16.9%
4
Adults’ Views of Health Care System, 2013
Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.
25
40
42
42
44
46
47
48
51
54
63
48
49
50
48
46
42
45
43
44
40
33
27
11
8
10
10
12
8
9
5
7
4
0% 20% 40% 60% 80% 100%
US
FR
CAN
GER
SWE
NOR
NZ
AUS
NETH
SWIZ
UK
Works well, only minor changes Fundamental changes Completely rebuild
Percent of adults
5
• 17th year of an 11-country survey (began in 1998)
 Initially: Australia, Canada, New Zealand, U.K., and U.S.
 Recent years: France, Germany, Netherlands, Norway,
Sweden, Switzerland
Commonwealth Fund Annual International Surveys
• 3-year survey cycle:
 General population:
 1998, 2001, 2004, 2007, 2010, 2013
 Sicker/Older population:
 1999, 2002, 2005, 2008, 2011, 2014
 Physicians:
 2000, 2006, 2009, 2012, 2015 (in field)
6
What do we hope to learn?
• Identify shared goals and strategies
– Inform US policy reform efforts
– Identify potentially transferable innovations
• Measurement
– To expand the portfolio of internationally-
comparable metrics used to compare country
performance and track the impact of reforms
– “What works” and “what doesn’t”
7
Areas Studied
 Quality improvement
 Chronic illness/management
 Use of the ED
 Hospital care
 Medication use
 System complexity
 Health care coverage
 Demographics
 Views of the health system
 Access and affordability
 Primary care
 Doctor-patient relationship
 Prevention/health promotion
 Care coordination
 Health information
technology
 Patient safety
• Focus on respondent observations (less on opinions)
• General themes:
8
Survey Sample
Total
Sample
Minimum Maximum United
States
Canada
2011
Survey of
Sicker
Adults
18,667 750 4,804 1,200 3,958
2012,
Survey of
Primary
Care
Providers
9,776 500 2,124 1,012 2,124
2013,
Survey of
Adults
20,045 1,000 5,412 2,002 5,412
9
Survey Administration Protocol
• Sicker Adults (2011)
– Mode: Computer-assisted telephone interviews
– Field period: March – June 2011
• Primary Care Physicians (2012)
– Mode: Mail and phone survey of primary care
physicians
– Field period: March – July 2012
• General Population (2013)
– Mode: Computer-assisted telephone interviews
– Field period: February- June 2013
10
“Mirror, Mirror” Ranking of
Health Care System Performance
11
Mirror, Mirror:
Dimensions and Indicators
QUALITY
(44 indicators)
ACCESS
(12
indicators)
EFFICIENCY
(11 indicators)
EQUITY
(High/low
income
comparison 10
indicators)
HEALTHY
LIVES
(WHO and
OECD data, 3
indicators)
Effective Care
(13)
Cost-
Related
Access (5)
Expenditures
(2)
Access to care
(10)
Mortality
amenable to
health care (1)
Safe Care (7) Timeliness
of Care (7)
Administrative
Burden (4)
Infant
Mortality (1)
Coordinated Care
(13)
Duplication (3) Healthy Life
Expectancy (1)
Patient-Centered
Care (11)
Tech usage (2)
12
Media Coverage of Mirror, Mirror
Mirror, Mirror is the
most frequently viewed
publication on the
Fund’s website
134,000
233,608
0
50,000
100,000
150,000
200,000
250,000
Mirror, Mirror 2010 Mirror, Mirror 2014
Page Views*
*Views since June 2014 for 2014 edition; views from 2010-2013 for 2010 edition.
Findings published annually in Health Affairs.
13
Ranking of Canada and US Health Care
System Performance: Access and Equity
CANADA USA
ACCESS 9 9
COST-RELATED PROBLEM 5 11
TIMELINESS OF CARE 11 5
EQUITY 9 11
14
Percent of adults who(se):
Cost-Related Access Problems
15
Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (2) 2012
International Survey of Primary Care Doctors
Didn’t fill prescription;
skipped medical test,
treatment or follow-up; or
had medical problem but did
not visit doctor in past year
due to cost1
Insurance denied payment
for medical care or did not
pay as much as expected1
Had serious problems paying
or was unable to pay medical
bills1
Physicians think their
patients often have difficulty
paying for medications or
out-of-pocket costs2
13
14
7
26
14
37
28
23
59
41
0 25 50 75 100
Canada
US
15
Out-of-pocket expenses
for medical bills > $1,000
in past year, = to USD1
Timeliness of Care
51
62
48
29
18
59
61
28
6
7
0 25 50 75 100
Canada US
Last time needed medical
attention, was able to see
doctor or nurse the same or
next day3
Very or somewhat difficult
to get medical care in the
evening, weekend, or on a
holiday without going to
the emergency room1*
Waiting time for emergency
care was 2 hours or more1**
Percent of patients reported:
Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (3) 2011 Commonwealth Fund International Health
Policy Survey of Sicker Adults in Eleven Countries; *base: sought after-hours care; **base: used an emergency room in past 2
years; ***base: saw or needed to see a specialist in past 2 years; ****base: those needing elective surgery in past year
16
Waiting time to see a
specialist was 2 months or
more1***
Waiting time of 4 months
or more for elective/
nonemergency
surgery1****
Timeliness of Care Cont’d
Source: (2) 2012 International Survey of Primary Care Doctors
23
29
8
6
0 5 10 15 20 25 30 35 40 45 50
Canada US
Patients often experience
difficulty getting
specialized tests (e.g., CT,
MRI)2
Patients often experience
long wait times to receive
treatment after diagnosis2
17
Percent of doctors who reported:
Equity Measures: U.S. and Canada
Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (3) 2011 Commonwealth Fund International Health
Policy Survey of Sicker Adults in Eleven Countries
12
17
7
14
8
6
9
3
4
4
0 20 40 60 80 100
Canada - low income
Canada - high income
8
4
10
4
Rated doctor
fair/poor1
Did not get
recommended test,
treatment, or follow-
up because of cost in
past year1
18
Percent of patients who:
Rated quality of
care fair/poor3
Had medical problem
but did not visit
doctor because of
cost in the past year1
Did not fill prescription
or skipped doses
because of cost in the
past year1
15
27
39
31
30
6
7
17
11
12
0 20 40 60 80 100
US - low income
US - high income
9
20
22
20
18
6
Equity Measures: U.S. and Canada
55
67
29
48
10
47
59
30
43
9
0 20 40 60 80 100
Canada -low income
Canada -high income
8
8
1
5
1
Last time needed
medical attention
not able to see
doctor or nurse
same or next day3
Somewhat or very
difficult to get care
on evenings,
weekends, or
holidays1*
Waited 2 months
or longer for
specialist
appointment1**
19
Percent of Patients who report:
Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (3) 2011 Commonwealth Fund International Health Policy Survey ofSicker
Adults in Eleven Countries; *base: sought after-hours care; **base: needed to see specialist in past 2 years; ***base: those going to ER
Waited 2 hours
or more in
ER1***
Unnecessary
duplication of
medical tests in
past 2 years3
45
70
9
36
19
39
53
4
16
14
0 20 40 60 80 100
US -low income
US -high income
6
17
5
20
5
Other Dimension Rankings: Canada and US Health
Care System Performance
CANADA USA
QUALITY CARE 9 5
EFFECTIVE CARE 7 3
SAFE CARE 10 7
COORDINATED CARE 8 6
PATIENT-CENTERED CARE 8 4
EFFICIENCY 10 11
HEALTHY LIVES 8 11
OVERALL RANKING 10 11
20
Conclusions
• Comparison of countries’ health systems with
systematically-collected data can offer a useful
antidote to conventional wisdom
• Tracking results can inform national policy
discussions and research on policy and
delivery system reforms, both in the U.S. and
in other countries
21
Survey Co-funders in 2014
• Australia: New South Wales Bureau of Health Information.
• Canada: Canadian Institute for Health Information, Canadian Institutes
of Health Research, Health Quality Ontario, Commissaire à la Santé et
au Bien-être du Québec, and Health Quality Council of Alberta.
• France: Haute Autorité de Santé and Caisse Nationale d’Assurance
Maladie des Travailleurs Salariés.
• Germany: Federal Ministry of Health and the National Institute for
Quality Measurement in Health Care.
• Netherlands: Ministry of Health, Welfare, and Sport and the Scientific
Institute for Quality of Healthcare at Radboud University Nijmegen
Medical Centre.
• Norway: Norwegian Knowledge Centre for the Health Services.
• Sweden: Ministry of Health and Social Affairs.
• Switzerland: Federal Office of Public Health.
• United Kingdom: The Health Foundation. 22
Acknowledgements
CMWF IHP Survey Team
23
References
1.Karen Davis, Kristof Stremikis, David Squires, and
Cathy Schoen. Mirror, Mirror On The Wall. Online:
The Commonwealth Fund 2014.
2. Commonwealth Fund Commission, Why Not the
Best? 2011.
3. Institute of Medicine, Crossing the Quality
Chasm, 2001.
24
APPENDIX
25
Calculation of Ranks
• Countries ranked by calculating means and
ranking scores from highest to lowest
• Tied observations assigned the score that would
be assigned if no tie occurred
• Summary ranking created for each Scorecard
domain of quality and access by averaging
individual ranked scores within each country
and ranking these averages from highest to
lowest (1=highest; 11=lowest)
26

Más contenido relacionado

La actualidad más candente

Republic of Ireland Faculty RCGP Winter meeting December 2017 William Behan
Republic of Ireland Faculty RCGP Winter meeting December 2017 William BehanRepublic of Ireland Faculty RCGP Winter meeting December 2017 William Behan
Republic of Ireland Faculty RCGP Winter meeting December 2017 William BehanDrWilliamBehan
 
Information and Communication Technologies Transform the Practice of Medicine
Information and Communication Technologies Transform the Practice of MedicineInformation and Communication Technologies Transform the Practice of Medicine
Information and Communication Technologies Transform the Practice of MedicineKamal Perera
 
Health innovation for all conference sustaining and transforming our health s...
Health innovation for all conference sustaining and transforming our health s...Health innovation for all conference sustaining and transforming our health s...
Health innovation for all conference sustaining and transforming our health s...Paul Gallant
 
Facilitating self management of chronic disease through home based tele monit...
Facilitating self management of chronic disease through home based tele monit...Facilitating self management of chronic disease through home based tele monit...
Facilitating self management of chronic disease through home based tele monit...Anthony Fanning
 
Niek Klazinga | Performance reporting in OECD countries
Niek Klazinga | Performance reporting in OECD countriesNiek Klazinga | Performance reporting in OECD countries
Niek Klazinga | Performance reporting in OECD countriesSax Institute
 
The revised OECD Health Systems Performance Framework: methodological issues ...
The revised OECD Health Systems Performance Framework: methodological issues ...The revised OECD Health Systems Performance Framework: methodological issues ...
The revised OECD Health Systems Performance Framework: methodological issues ...Sax Institute
 
Boudreaux essen
Boudreaux essenBoudreaux essen
Boudreaux essensoder145
 
Opening Keynote “Population Management: The CareMore Experience" David Ramire...
Opening Keynote “Population Management: The CareMore Experience" David Ramire...Opening Keynote “Population Management: The CareMore Experience" David Ramire...
Opening Keynote “Population Management: The CareMore Experience" David Ramire...Health IT Conference – iHT2
 
Mike Bewick: Primary care transformation: what for and why
Mike Bewick: Primary care transformation: what for and whyMike Bewick: Primary care transformation: what for and why
Mike Bewick: Primary care transformation: what for and whyThe King's Fund
 
Kay Parkinson - Cambridge Rare Disease Summit 2015
Kay Parkinson - Cambridge Rare Disease Summit 2015Kay Parkinson - Cambridge Rare Disease Summit 2015
Kay Parkinson - Cambridge Rare Disease Summit 2015CamRARE Disease Network
 
Improving Quality And Reducing Cost In Healthcare The Role Of Information And...
Improving Quality And Reducing Cost In Healthcare The Role Of Information And...Improving Quality And Reducing Cost In Healthcare The Role Of Information And...
Improving Quality And Reducing Cost In Healthcare The Role Of Information And...healthcareisi
 
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...Levi Shapiro
 

La actualidad más candente (20)

Republic of Ireland Faculty RCGP Winter meeting December 2017 William Behan
Republic of Ireland Faculty RCGP Winter meeting December 2017 William BehanRepublic of Ireland Faculty RCGP Winter meeting December 2017 William Behan
Republic of Ireland Faculty RCGP Winter meeting December 2017 William Behan
 
Information and Communication Technologies Transform the Practice of Medicine
Information and Communication Technologies Transform the Practice of MedicineInformation and Communication Technologies Transform the Practice of Medicine
Information and Communication Technologies Transform the Practice of Medicine
 
Health innovation for all conference sustaining and transforming our health s...
Health innovation for all conference sustaining and transforming our health s...Health innovation for all conference sustaining and transforming our health s...
Health innovation for all conference sustaining and transforming our health s...
 
Facilitating self management of chronic disease through home based tele monit...
Facilitating self management of chronic disease through home based tele monit...Facilitating self management of chronic disease through home based tele monit...
Facilitating self management of chronic disease through home based tele monit...
 
Niek Klazinga | Performance reporting in OECD countries
Niek Klazinga | Performance reporting in OECD countriesNiek Klazinga | Performance reporting in OECD countries
Niek Klazinga | Performance reporting in OECD countries
 
The revised OECD Health Systems Performance Framework: methodological issues ...
The revised OECD Health Systems Performance Framework: methodological issues ...The revised OECD Health Systems Performance Framework: methodological issues ...
The revised OECD Health Systems Performance Framework: methodological issues ...
 
Dr. Thombs: Rare Disease Day 2016 Conference
Dr. Thombs: Rare Disease Day 2016 Conference Dr. Thombs: Rare Disease Day 2016 Conference
Dr. Thombs: Rare Disease Day 2016 Conference
 
Boudreaux essen
Boudreaux essenBoudreaux essen
Boudreaux essen
 
EVMS8FinalDataandOutcomesEvaluationfinal
EVMS8FinalDataandOutcomesEvaluationfinalEVMS8FinalDataandOutcomesEvaluationfinal
EVMS8FinalDataandOutcomesEvaluationfinal
 
Impact diabetes
Impact diabetesImpact diabetes
Impact diabetes
 
10th Annual Utah's Health Services Research Conference - Clinical and Economi...
10th Annual Utah's Health Services Research Conference - Clinical and Economi...10th Annual Utah's Health Services Research Conference - Clinical and Economi...
10th Annual Utah's Health Services Research Conference - Clinical and Economi...
 
Day 1: Cord Fall 2021 Conference Slides
Day 1: Cord Fall 2021 Conference SlidesDay 1: Cord Fall 2021 Conference Slides
Day 1: Cord Fall 2021 Conference Slides
 
Opening Keynote “Population Management: The CareMore Experience" David Ramire...
Opening Keynote “Population Management: The CareMore Experience" David Ramire...Opening Keynote “Population Management: The CareMore Experience" David Ramire...
Opening Keynote “Population Management: The CareMore Experience" David Ramire...
 
Mike Bewick: Primary care transformation: what for and why
Mike Bewick: Primary care transformation: what for and whyMike Bewick: Primary care transformation: what for and why
Mike Bewick: Primary care transformation: what for and why
 
Kay Parkinson - Cambridge Rare Disease Summit 2015
Kay Parkinson - Cambridge Rare Disease Summit 2015Kay Parkinson - Cambridge Rare Disease Summit 2015
Kay Parkinson - Cambridge Rare Disease Summit 2015
 
Dr. Hubert Curran
Dr. Hubert CurranDr. Hubert Curran
Dr. Hubert Curran
 
Improving Quality And Reducing Cost In Healthcare The Role Of Information And...
Improving Quality And Reducing Cost In Healthcare The Role Of Information And...Improving Quality And Reducing Cost In Healthcare The Role Of Information And...
Improving Quality And Reducing Cost In Healthcare The Role Of Information And...
 
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...
 
Evidence Base for Using Technology Solutions in Behavioral Health Care
Evidence Base for Using Technology Solutions in Behavioral Health Care Evidence Base for Using Technology Solutions in Behavioral Health Care
Evidence Base for Using Technology Solutions in Behavioral Health Care
 
CORD Rare Disease Patient Survey
CORD Rare Disease Patient SurveyCORD Rare Disease Patient Survey
CORD Rare Disease Patient Survey
 

Destacado

Elizabeth Fisher: Tracking the quality of care
Elizabeth Fisher: Tracking the quality of careElizabeth Fisher: Tracking the quality of care
Elizabeth Fisher: Tracking the quality of careQualityWatch
 
Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...
Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...
Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...Investnet
 
A Global Perspective on Private Healthcare in Canada
A Global Perspective on Private Healthcare in CanadaA Global Perspective on Private Healthcare in Canada
A Global Perspective on Private Healthcare in CanadaShannon Szabo-Pickering
 
Applying quality improvement principles for pmtct option b+ at lugeye dispens...
Applying quality improvement principles for pmtct option b+ at lugeye dispens...Applying quality improvement principles for pmtct option b+ at lugeye dispens...
Applying quality improvement principles for pmtct option b+ at lugeye dispens...Ben Mbwele
 
Health indiciator year 2014
Health indiciator year 2014Health indiciator year 2014
Health indiciator year 2014chauhan25
 

Destacado (7)

Which Way to Quality in Canada? Mark Dobrow, Health Council of Canada
Which Way to Quality in Canada? Mark Dobrow, Health Council of CanadaWhich Way to Quality in Canada? Mark Dobrow, Health Council of Canada
Which Way to Quality in Canada? Mark Dobrow, Health Council of Canada
 
Elizabeth Fisher: Tracking the quality of care
Elizabeth Fisher: Tracking the quality of careElizabeth Fisher: Tracking the quality of care
Elizabeth Fisher: Tracking the quality of care
 
Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...
Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...
Maureen Charlebois, Chief Nursing Director and Group Director, Canada Health ...
 
A Global Perspective on Private Healthcare in Canada
A Global Perspective on Private Healthcare in CanadaA Global Perspective on Private Healthcare in Canada
A Global Perspective on Private Healthcare in Canada
 
Applying quality improvement principles for pmtct option b+ at lugeye dispens...
Applying quality improvement principles for pmtct option b+ at lugeye dispens...Applying quality improvement principles for pmtct option b+ at lugeye dispens...
Applying quality improvement principles for pmtct option b+ at lugeye dispens...
 
Heather Richards
Heather RichardsHeather Richards
Heather Richards
 
Health indiciator year 2014
Health indiciator year 2014Health indiciator year 2014
Health indiciator year 2014
 

Similar a International Health Policy and Practice: Comparing the U.S. and Canada on Access and Equity

Using International Comparisons to Guide Performance Improvement
Using International Comparisons to Guide Performance ImprovementUsing International Comparisons to Guide Performance Improvement
Using International Comparisons to Guide Performance ImprovementThe Commonwealth Fund
 
The paradox between current models of Primary Care and evolving Evidence Base...
The paradox between current models of Primary Care and evolving Evidence Base...The paradox between current models of Primary Care and evolving Evidence Base...
The paradox between current models of Primary Care and evolving Evidence Base...DrWilliamBehan
 
Advancing Team-Based Care: Complex Care Management in Primary Care
Advancing Team-Based Care: Complex Care Management in Primary CareAdvancing Team-Based Care: Complex Care Management in Primary Care
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
 
2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...
2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...
2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...Ernest Moy
 
The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...
The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...
The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...Odyssey Recruitment
 
Population Health Management & Volume To Value Based Care
Population Health Management & Volume To Value Based CarePopulation Health Management & Volume To Value Based Care
Population Health Management & Volume To Value Based CareIFAH
 
World Psychiatric Association - Health Systems' Performance Roundtable cana...
World Psychiatric Association - Health Systems' Performance Roundtable   cana...World Psychiatric Association - Health Systems' Performance Roundtable   cana...
World Psychiatric Association - Health Systems' Performance Roundtable cana...Université de Montréal
 
The Value Proposition of Hospice | VITAS
The Value Proposition of Hospice | VITASThe Value Proposition of Hospice | VITAS
The Value Proposition of Hospice | VITASVITASAuthor
 
Medibank Managing Director speaks at Amercian Chamber of Commerce
Medibank Managing Director speaks at Amercian Chamber of CommerceMedibank Managing Director speaks at Amercian Chamber of Commerce
Medibank Managing Director speaks at Amercian Chamber of CommerceLaura Harris
 
Ochsner Slideshare Overview 08.2023.pdf
Ochsner Slideshare Overview 08.2023.pdfOchsner Slideshare Overview 08.2023.pdf
Ochsner Slideshare Overview 08.2023.pdfBlakeWatts3
 
Patient Centered Medical Home
Patient Centered Medical HomePatient Centered Medical Home
Patient Centered Medical HomeRyan Squire
 
Jeff wells
Jeff wellsJeff wells
Jeff wellsvp1234
 
Healthcare reform beacon-may 2013
Healthcare reform beacon-may 2013Healthcare reform beacon-may 2013
Healthcare reform beacon-may 2013medwriterdg
 
Rob Reid: Redesigning primary care: the Group Health journey
Rob Reid: Redesigning primary care: the Group Health journeyRob Reid: Redesigning primary care: the Group Health journey
Rob Reid: Redesigning primary care: the Group Health journeyThe King's Fund
 
Canada p.h.project favorites
Canada p.h.project favoritesCanada p.h.project favorites
Canada p.h.project favoritesnizhgma.ru
 

Similar a International Health Policy and Practice: Comparing the U.S. and Canada on Access and Equity (20)

Using International Comparisons to Guide Performance Improvement
Using International Comparisons to Guide Performance ImprovementUsing International Comparisons to Guide Performance Improvement
Using International Comparisons to Guide Performance Improvement
 
Health Affairs
Health AffairsHealth Affairs
Health Affairs
 
The paradox between current models of Primary Care and evolving Evidence Base...
The paradox between current models of Primary Care and evolving Evidence Base...The paradox between current models of Primary Care and evolving Evidence Base...
The paradox between current models of Primary Care and evolving Evidence Base...
 
Durhane Wong-Rieger (CORD) Canada's Rare Disease Strategy Brief Overview
Durhane Wong-Rieger (CORD) Canada's Rare Disease Strategy Brief Overview Durhane Wong-Rieger (CORD) Canada's Rare Disease Strategy Brief Overview
Durhane Wong-Rieger (CORD) Canada's Rare Disease Strategy Brief Overview
 
Advancing Team-Based Care: Complex Care Management in Primary Care
Advancing Team-Based Care: Complex Care Management in Primary CareAdvancing Team-Based Care: Complex Care Management in Primary Care
Advancing Team-Based Care: Complex Care Management in Primary Care
 
2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...
2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...
2014 National Healthcare Quality and Disparities Report Chartbook on Care Aff...
 
The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...
The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...
The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...
 
Population Health Management & Volume To Value Based Care
Population Health Management & Volume To Value Based CarePopulation Health Management & Volume To Value Based Care
Population Health Management & Volume To Value Based Care
 
Patient experience: where can we improve?
Patient experience: where can we improve?Patient experience: where can we improve?
Patient experience: where can we improve?
 
World Psychiatric Association - Health Systems' Performance Roundtable cana...
World Psychiatric Association - Health Systems' Performance Roundtable   cana...World Psychiatric Association - Health Systems' Performance Roundtable   cana...
World Psychiatric Association - Health Systems' Performance Roundtable cana...
 
The Value Proposition of Hospice | VITAS
The Value Proposition of Hospice | VITASThe Value Proposition of Hospice | VITAS
The Value Proposition of Hospice | VITAS
 
Health 3.0 Leadership Conference: Population Health in Detroit with David Law
Health 3.0 Leadership Conference: Population Health in Detroit with David LawHealth 3.0 Leadership Conference: Population Health in Detroit with David Law
Health 3.0 Leadership Conference: Population Health in Detroit with David Law
 
Medibank Managing Director speaks at Amercian Chamber of Commerce
Medibank Managing Director speaks at Amercian Chamber of CommerceMedibank Managing Director speaks at Amercian Chamber of Commerce
Medibank Managing Director speaks at Amercian Chamber of Commerce
 
Learning Health Care Systems
Learning Health Care SystemsLearning Health Care Systems
Learning Health Care Systems
 
Ochsner Slideshare Overview 08.2023.pdf
Ochsner Slideshare Overview 08.2023.pdfOchsner Slideshare Overview 08.2023.pdf
Ochsner Slideshare Overview 08.2023.pdf
 
Patient Centered Medical Home
Patient Centered Medical HomePatient Centered Medical Home
Patient Centered Medical Home
 
Jeff wells
Jeff wellsJeff wells
Jeff wells
 
Healthcare reform beacon-may 2013
Healthcare reform beacon-may 2013Healthcare reform beacon-may 2013
Healthcare reform beacon-may 2013
 
Rob Reid: Redesigning primary care: the Group Health journey
Rob Reid: Redesigning primary care: the Group Health journeyRob Reid: Redesigning primary care: the Group Health journey
Rob Reid: Redesigning primary care: the Group Health journey
 
Canada p.h.project favorites
Canada p.h.project favoritesCanada p.h.project favorites
Canada p.h.project favorites
 

Más de The Commonwealth Fund

The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Commonwealth Fund
 
Deaths of Despair: A Clarion Call for State Action
Deaths of Despair: A Clarion Call for State ActionDeaths of Despair: A Clarion Call for State Action
Deaths of Despair: A Clarion Call for State ActionThe Commonwealth Fund
 
Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?
Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?
Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?The Commonwealth Fund
 
Advancing Research to Reduce Low-value Health Care
Advancing Research to Reduce Low-value Health CareAdvancing Research to Reduce Low-value Health Care
Advancing Research to Reduce Low-value Health CareThe Commonwealth Fund
 
Using Measurement to Improve Performance: Insights from Scorecards
Using Measurement to Improve Performance: Insights from ScorecardsUsing Measurement to Improve Performance: Insights from Scorecards
Using Measurement to Improve Performance: Insights from ScorecardsThe Commonwealth Fund
 
Evaluation in an Era of Digital Technology Innovation : Reflections for Phi...
Evaluation in an Era of Digital Technology Innovation: Reflections for Phi...Evaluation in an Era of Digital Technology Innovation: Reflections for Phi...
Evaluation in an Era of Digital Technology Innovation : Reflections for Phi...The Commonwealth Fund
 
Designing Consumer Digital Health for Patients and Caregivers
Designing Consumer Digital Health for Patients and Caregivers Designing Consumer Digital Health for Patients and Caregivers
Designing Consumer Digital Health for Patients and Caregivers The Commonwealth Fund
 
Innovation Under Uncertainty: Maintaining Progress
Innovation Under Uncertainty: Maintaining ProgressInnovation Under Uncertainty: Maintaining Progress
Innovation Under Uncertainty: Maintaining ProgressThe Commonwealth Fund
 
The Affordable Care Act At 5 - David Blumenthal
The Affordable Care Act At 5 - David BlumenthalThe Affordable Care Act At 5 - David Blumenthal
The Affordable Care Act At 5 - David BlumenthalThe Commonwealth Fund
 

Más de The Commonwealth Fund (10)

The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...
 
Deaths of Despair: A Clarion Call for State Action
Deaths of Despair: A Clarion Call for State ActionDeaths of Despair: A Clarion Call for State Action
Deaths of Despair: A Clarion Call for State Action
 
Innovation Centers and Health Care
Innovation Centers and Health CareInnovation Centers and Health Care
Innovation Centers and Health Care
 
Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?
Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?
Disruptive Innovation in Health Care: A Path to High Quality, Affordable Care?
 
Advancing Research to Reduce Low-value Health Care
Advancing Research to Reduce Low-value Health CareAdvancing Research to Reduce Low-value Health Care
Advancing Research to Reduce Low-value Health Care
 
Using Measurement to Improve Performance: Insights from Scorecards
Using Measurement to Improve Performance: Insights from ScorecardsUsing Measurement to Improve Performance: Insights from Scorecards
Using Measurement to Improve Performance: Insights from Scorecards
 
Evaluation in an Era of Digital Technology Innovation : Reflections for Phi...
Evaluation in an Era of Digital Technology Innovation: Reflections for Phi...Evaluation in an Era of Digital Technology Innovation: Reflections for Phi...
Evaluation in an Era of Digital Technology Innovation : Reflections for Phi...
 
Designing Consumer Digital Health for Patients and Caregivers
Designing Consumer Digital Health for Patients and Caregivers Designing Consumer Digital Health for Patients and Caregivers
Designing Consumer Digital Health for Patients and Caregivers
 
Innovation Under Uncertainty: Maintaining Progress
Innovation Under Uncertainty: Maintaining ProgressInnovation Under Uncertainty: Maintaining Progress
Innovation Under Uncertainty: Maintaining Progress
 
The Affordable Care Act At 5 - David Blumenthal
The Affordable Care Act At 5 - David BlumenthalThe Affordable Care Act At 5 - David Blumenthal
The Affordable Care Act At 5 - David Blumenthal
 

Último

Hub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspirationHub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspirationStephen Abram
 
My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54mmazurak
 
Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.ahcitycouncil
 
O Conselho Estadual de Cultura e o Incentivo à Cultura no RS: relato de expe...
O Conselho Estadual de Cultura e o Incentivo à Cultura no RS:  relato de expe...O Conselho Estadual de Cultura e o Incentivo à Cultura no RS:  relato de expe...
O Conselho Estadual de Cultura e o Incentivo à Cultura no RS: relato de expe...Alvaro Santi
 
World Happiness Report 2024- Full Report
World Happiness Report 2024- Full ReportWorld Happiness Report 2024- Full Report
World Happiness Report 2024- Full ReportEnergy for One World
 
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptxDB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptxNAP Global Network
 
National Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO QuezonNational Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO QuezonAryaCapale
 
PPT Item # 5-6 218 Canyon Drive replat prop.
PPT Item # 5-6 218 Canyon Drive replat prop.PPT Item # 5-6 218 Canyon Drive replat prop.
PPT Item # 5-6 218 Canyon Drive replat prop.ahcitycouncil
 
Best charity ideas parents give their children’s
Best charity ideas parents give their children’sBest charity ideas parents give their children’s
Best charity ideas parents give their children’sSERUDS INDIA
 
Children who live with Grandparents are really lucky
Children who live with Grandparents are really luckyChildren who live with Grandparents are really lucky
Children who live with Grandparents are really luckySERUDS INDIA
 
SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...
SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...
SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...JSchaus & Associates
 
Water and peace go hand-in hand. World Water Day 2024
Water and peace go hand-in hand. World Water Day 2024Water and peace go hand-in hand. World Water Day 2024
Water and peace go hand-in hand. World Water Day 2024Christina Parmionova
 
PPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements PowerpointPPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements Powerpointahcitycouncil
 
Parents can give charity ideas for kids.
Parents can give charity ideas for kids.Parents can give charity ideas for kids.
Parents can give charity ideas for kids.SERUDS INDIA
 
Parents give a charity ideas for children
Parents give a charity ideas for childrenParents give a charity ideas for children
Parents give a charity ideas for childrenSERUDS INDIA
 
Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...ResolutionFoundation
 
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...Congressional Budget Office
 
Sensitivity Training for 2023 BSKE.pptx
Sensitivity Training for  2023 BSKE.pptxSensitivity Training for  2023 BSKE.pptx
Sensitivity Training for 2023 BSKE.pptxAllidaacLuap
 
CBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New ResearchCBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New ResearchCongressional Budget Office
 
For World Water Day 2024, we promote the vital link between water and peace.
For World Water Day 2024, we promote the vital link between water and peace.For World Water Day 2024, we promote the vital link between water and peace.
For World Water Day 2024, we promote the vital link between water and peace.Christina Parmionova
 

Último (20)

Hub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspirationHub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspiration
 
My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54
 
Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.
 
O Conselho Estadual de Cultura e o Incentivo à Cultura no RS: relato de expe...
O Conselho Estadual de Cultura e o Incentivo à Cultura no RS:  relato de expe...O Conselho Estadual de Cultura e o Incentivo à Cultura no RS:  relato de expe...
O Conselho Estadual de Cultura e o Incentivo à Cultura no RS: relato de expe...
 
World Happiness Report 2024- Full Report
World Happiness Report 2024- Full ReportWorld Happiness Report 2024- Full Report
World Happiness Report 2024- Full Report
 
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptxDB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
 
National Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO QuezonNational Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO Quezon
 
PPT Item # 5-6 218 Canyon Drive replat prop.
PPT Item # 5-6 218 Canyon Drive replat prop.PPT Item # 5-6 218 Canyon Drive replat prop.
PPT Item # 5-6 218 Canyon Drive replat prop.
 
Best charity ideas parents give their children’s
Best charity ideas parents give their children’sBest charity ideas parents give their children’s
Best charity ideas parents give their children’s
 
Children who live with Grandparents are really lucky
Children who live with Grandparents are really luckyChildren who live with Grandparents are really lucky
Children who live with Grandparents are really lucky
 
SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...
SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...
SPONSORED CONTENT - MyGovWatch - RFP Cliches Debunked: What Government Buyers...
 
Water and peace go hand-in hand. World Water Day 2024
Water and peace go hand-in hand. World Water Day 2024Water and peace go hand-in hand. World Water Day 2024
Water and peace go hand-in hand. World Water Day 2024
 
PPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements PowerpointPPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements Powerpoint
 
Parents can give charity ideas for kids.
Parents can give charity ideas for kids.Parents can give charity ideas for kids.
Parents can give charity ideas for kids.
 
Parents give a charity ideas for children
Parents give a charity ideas for childrenParents give a charity ideas for children
Parents give a charity ideas for children
 
Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...
 
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
 
Sensitivity Training for 2023 BSKE.pptx
Sensitivity Training for  2023 BSKE.pptxSensitivity Training for  2023 BSKE.pptx
Sensitivity Training for 2023 BSKE.pptx
 
CBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New ResearchCBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New Research
 
For World Water Day 2024, we promote the vital link between water and peace.
For World Water Day 2024, we promote the vital link between water and peace.For World Water Day 2024, we promote the vital link between water and peace.
For World Water Day 2024, we promote the vital link between water and peace.
 

International Health Policy and Practice: Comparing the U.S. and Canada on Access and Equity

  • 1. International Health Policy and Practice: Comparing the U.S. and Canada on Access and Equity Eric Schneider, MD, MSc Senior Vice President for Policy and Research 1
  • 2. Outline • Why compare countries’ health care systems? • The Commonwealth Fund International Health Policy Survey(s) • Are we as good as our neighbors to the north/south? 2
  • 3. Why Compare Countries’ Health Care Systems? “Americans have the best health care system in the world” - 2004 President Delivers State of the Union Speech 3
  • 4. International Trends in Health Spending Health spending per capita ($US PPP) Total health spending as percent of GDP Note: PPP = Purchasing power parity. Source: OECD Health Data 2014; U.S. National Health Expenditure Accounts. 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 1980 1984 1988 1992 1996 2000 2004 2008 2012 US SWIZ GER CAN FR JPN UK 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 1980 1984 1988 1992 1996 2000 2004 2008 2012 US FR SWIZ GER CAN JPN UK $9,077 $4,602 10.9% 16.9% 4
  • 5. Adults’ Views of Health Care System, 2013 Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries. 25 40 42 42 44 46 47 48 51 54 63 48 49 50 48 46 42 45 43 44 40 33 27 11 8 10 10 12 8 9 5 7 4 0% 20% 40% 60% 80% 100% US FR CAN GER SWE NOR NZ AUS NETH SWIZ UK Works well, only minor changes Fundamental changes Completely rebuild Percent of adults 5
  • 6. • 17th year of an 11-country survey (began in 1998)  Initially: Australia, Canada, New Zealand, U.K., and U.S.  Recent years: France, Germany, Netherlands, Norway, Sweden, Switzerland Commonwealth Fund Annual International Surveys • 3-year survey cycle:  General population:  1998, 2001, 2004, 2007, 2010, 2013  Sicker/Older population:  1999, 2002, 2005, 2008, 2011, 2014  Physicians:  2000, 2006, 2009, 2012, 2015 (in field) 6
  • 7. What do we hope to learn? • Identify shared goals and strategies – Inform US policy reform efforts – Identify potentially transferable innovations • Measurement – To expand the portfolio of internationally- comparable metrics used to compare country performance and track the impact of reforms – “What works” and “what doesn’t” 7
  • 8. Areas Studied  Quality improvement  Chronic illness/management  Use of the ED  Hospital care  Medication use  System complexity  Health care coverage  Demographics  Views of the health system  Access and affordability  Primary care  Doctor-patient relationship  Prevention/health promotion  Care coordination  Health information technology  Patient safety • Focus on respondent observations (less on opinions) • General themes: 8
  • 9. Survey Sample Total Sample Minimum Maximum United States Canada 2011 Survey of Sicker Adults 18,667 750 4,804 1,200 3,958 2012, Survey of Primary Care Providers 9,776 500 2,124 1,012 2,124 2013, Survey of Adults 20,045 1,000 5,412 2,002 5,412 9
  • 10. Survey Administration Protocol • Sicker Adults (2011) – Mode: Computer-assisted telephone interviews – Field period: March – June 2011 • Primary Care Physicians (2012) – Mode: Mail and phone survey of primary care physicians – Field period: March – July 2012 • General Population (2013) – Mode: Computer-assisted telephone interviews – Field period: February- June 2013 10
  • 11. “Mirror, Mirror” Ranking of Health Care System Performance 11
  • 12. Mirror, Mirror: Dimensions and Indicators QUALITY (44 indicators) ACCESS (12 indicators) EFFICIENCY (11 indicators) EQUITY (High/low income comparison 10 indicators) HEALTHY LIVES (WHO and OECD data, 3 indicators) Effective Care (13) Cost- Related Access (5) Expenditures (2) Access to care (10) Mortality amenable to health care (1) Safe Care (7) Timeliness of Care (7) Administrative Burden (4) Infant Mortality (1) Coordinated Care (13) Duplication (3) Healthy Life Expectancy (1) Patient-Centered Care (11) Tech usage (2) 12
  • 13. Media Coverage of Mirror, Mirror Mirror, Mirror is the most frequently viewed publication on the Fund’s website 134,000 233,608 0 50,000 100,000 150,000 200,000 250,000 Mirror, Mirror 2010 Mirror, Mirror 2014 Page Views* *Views since June 2014 for 2014 edition; views from 2010-2013 for 2010 edition. Findings published annually in Health Affairs. 13
  • 14. Ranking of Canada and US Health Care System Performance: Access and Equity CANADA USA ACCESS 9 9 COST-RELATED PROBLEM 5 11 TIMELINESS OF CARE 11 5 EQUITY 9 11 14
  • 15. Percent of adults who(se): Cost-Related Access Problems 15 Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (2) 2012 International Survey of Primary Care Doctors Didn’t fill prescription; skipped medical test, treatment or follow-up; or had medical problem but did not visit doctor in past year due to cost1 Insurance denied payment for medical care or did not pay as much as expected1 Had serious problems paying or was unable to pay medical bills1 Physicians think their patients often have difficulty paying for medications or out-of-pocket costs2 13 14 7 26 14 37 28 23 59 41 0 25 50 75 100 Canada US 15 Out-of-pocket expenses for medical bills > $1,000 in past year, = to USD1
  • 16. Timeliness of Care 51 62 48 29 18 59 61 28 6 7 0 25 50 75 100 Canada US Last time needed medical attention, was able to see doctor or nurse the same or next day3 Very or somewhat difficult to get medical care in the evening, weekend, or on a holiday without going to the emergency room1* Waiting time for emergency care was 2 hours or more1** Percent of patients reported: Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (3) 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries; *base: sought after-hours care; **base: used an emergency room in past 2 years; ***base: saw or needed to see a specialist in past 2 years; ****base: those needing elective surgery in past year 16 Waiting time to see a specialist was 2 months or more1*** Waiting time of 4 months or more for elective/ nonemergency surgery1****
  • 17. Timeliness of Care Cont’d Source: (2) 2012 International Survey of Primary Care Doctors 23 29 8 6 0 5 10 15 20 25 30 35 40 45 50 Canada US Patients often experience difficulty getting specialized tests (e.g., CT, MRI)2 Patients often experience long wait times to receive treatment after diagnosis2 17 Percent of doctors who reported:
  • 18. Equity Measures: U.S. and Canada Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (3) 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults in Eleven Countries 12 17 7 14 8 6 9 3 4 4 0 20 40 60 80 100 Canada - low income Canada - high income 8 4 10 4 Rated doctor fair/poor1 Did not get recommended test, treatment, or follow- up because of cost in past year1 18 Percent of patients who: Rated quality of care fair/poor3 Had medical problem but did not visit doctor because of cost in the past year1 Did not fill prescription or skipped doses because of cost in the past year1 15 27 39 31 30 6 7 17 11 12 0 20 40 60 80 100 US - low income US - high income 9 20 22 20 18 6
  • 19. Equity Measures: U.S. and Canada 55 67 29 48 10 47 59 30 43 9 0 20 40 60 80 100 Canada -low income Canada -high income 8 8 1 5 1 Last time needed medical attention not able to see doctor or nurse same or next day3 Somewhat or very difficult to get care on evenings, weekends, or holidays1* Waited 2 months or longer for specialist appointment1** 19 Percent of Patients who report: Source: (1) 2013 Commonwealth Fund International Health Policy Survey; (3) 2011 Commonwealth Fund International Health Policy Survey ofSicker Adults in Eleven Countries; *base: sought after-hours care; **base: needed to see specialist in past 2 years; ***base: those going to ER Waited 2 hours or more in ER1*** Unnecessary duplication of medical tests in past 2 years3 45 70 9 36 19 39 53 4 16 14 0 20 40 60 80 100 US -low income US -high income 6 17 5 20 5
  • 20. Other Dimension Rankings: Canada and US Health Care System Performance CANADA USA QUALITY CARE 9 5 EFFECTIVE CARE 7 3 SAFE CARE 10 7 COORDINATED CARE 8 6 PATIENT-CENTERED CARE 8 4 EFFICIENCY 10 11 HEALTHY LIVES 8 11 OVERALL RANKING 10 11 20
  • 21. Conclusions • Comparison of countries’ health systems with systematically-collected data can offer a useful antidote to conventional wisdom • Tracking results can inform national policy discussions and research on policy and delivery system reforms, both in the U.S. and in other countries 21
  • 22. Survey Co-funders in 2014 • Australia: New South Wales Bureau of Health Information. • Canada: Canadian Institute for Health Information, Canadian Institutes of Health Research, Health Quality Ontario, Commissaire à la Santé et au Bien-être du Québec, and Health Quality Council of Alberta. • France: Haute Autorité de Santé and Caisse Nationale d’Assurance Maladie des Travailleurs Salariés. • Germany: Federal Ministry of Health and the National Institute for Quality Measurement in Health Care. • Netherlands: Ministry of Health, Welfare, and Sport and the Scientific Institute for Quality of Healthcare at Radboud University Nijmegen Medical Centre. • Norway: Norwegian Knowledge Centre for the Health Services. • Sweden: Ministry of Health and Social Affairs. • Switzerland: Federal Office of Public Health. • United Kingdom: The Health Foundation. 22
  • 24. References 1.Karen Davis, Kristof Stremikis, David Squires, and Cathy Schoen. Mirror, Mirror On The Wall. Online: The Commonwealth Fund 2014. 2. Commonwealth Fund Commission, Why Not the Best? 2011. 3. Institute of Medicine, Crossing the Quality Chasm, 2001. 24
  • 26. Calculation of Ranks • Countries ranked by calculating means and ranking scores from highest to lowest • Tied observations assigned the score that would be assigned if no tie occurred • Summary ranking created for each Scorecard domain of quality and access by averaging individual ranked scores within each country and ranking these averages from highest to lowest (1=highest; 11=lowest) 26