the 2002 commonwealth fund international health policy survey adults with health problems the...

The 2002 Commonwealth Fund International Health Policy Survey

Adults with Health Problems

The Commonwealth FundHarvard University School of Public Health

Harris Interactive, Inc.

For release with five-country article in May/June 2003 Health Affairs

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 2

Adults with health problems

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.



Overall System View



Dissatisfaction with thehealth care system

36% 36%

48%

31%

44%

0%

25%

50%

75%

AUS CAN NZ UK US

Percent very or somewhat dissatisfied with their country’s health care system in general



Two Biggest Problems with theHealth 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



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



Care Coordination



Number of Doctors or Health Professionals Visited in the Past Two Years

34%

59% 57% 59% 61%65%

38% 39%32%

36%

0%

25%

50%

75%

AUS CAN NZ UK US

Saw 1-2 doctors in the past 2 years

Saw 3 or more doctors in the past 2 years



Care Coordination

In the past two years: AUS CAN NZ UK US

Sent for duplicate tests by different health professionals

13 20 17 13 22

Had to tell the same story to multiple health professionals

49 50 47 49 57

Medical records/test results did not reach doctor’s office in time for appointment

14 19 16 23 25

Received conflicting information from different health professionals

23 23 24 19 26



Percent reporting receiving conflicting information from different health

professionals by number of doctors

9%

31% 32% 32%

26%

34%

13% 11% 13%13%

0%

25%

50%

AUS CAN NZ UK US





6%

16%

28%

20%17%

28%

10% 9% 11%9%

0%

25%

50%

AUS CAN NZ UK US



Percent reporting being sent for duplicate tests by different health professionals

in the past 2 years by number of doctors



Prescription Drugs



Number of prescription medications taken regularly

66% 64% 65% 67% 71%

23% 23% 25% 22%

36%

0%

25%

50%

75%

AUS CAN NZ UK US

At least one medication on a regular or ongoing basis

Four or more medications on a regular or ongoing basis

Percent who take…



Percent saying doctor has not reviewed/discussed all of the medications they take in the past two

years

31%28%

23%

32%

22%

0%

25%

50%

AUS CAN NZ UK US

Base: Adults taking prescription drugs regularly



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



Medication and Medical Errors



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



Among those reporting an error, percent who said error caused

serious health consequences

55%60% 60%

51%

63%

0%

25%

50%

75%

AUS CAN NZ UK US

Base: Reported a medication error or believed an error was made in their care



Percent reporting medication erroror medical mistake in past 2 years

by number of doctors

28%32%

29%

21%

34%

16% 16%19%

13%15%

0%

25%

50%

AUS CAN NZ UK US





Patient–Physician Communicationand Ratings of Physician Care



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



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



Communication with PhysiciansAbout Coping with Illness

54% 55% 54%

66%

51%

0%

25%

50%

75%

AUS CAN NZ UK US

Percent saying physician has NOT discussed the emotional burdenof coping with condition in the past 2 years



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



Waiting Times, Access,and Access Problems Due to Cost



Problems with Waiting Times to Getan Appointment with Regular Doctor

17%

24%

5%

21%

14%

0%

25%

50%

AUS CAN NZ UK US

Percent reporting waiting time for an appointment withregular physician was a big problem in the past 2 years



Percent saying doctors not spending enough time during office visits was

a big problem in the past 2 years

13%

20%

9%12%

20%

0%

25%

50%

AUS CAN NZ UK US



Difficulty Seeing a Specialist

41%

53%

36% 38% 39%

0%

25%

50%

75%

AUS CAN NZ UK US

Percent reporting it is very or somewhat difficult to see a specialist



Reasons It Was Difficultto See 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

Base: Sicker adults reporting it somewhat or very difficult to see a specialist



Percent reporting long waits to be admitted to the hospital were a big problem

in the past 2 years

19%

32%

24%21%

13%

0%

25%

50%

AUS CAN NZ UK US

Base: Hospitalized in past 2 years



12%15%

11%14%

6%

0%

25%

50%

AUS CAN NZ UK US

Percent reporting having a scheduled surgery or procedure delayed because of cancellation was a

big problem in past 2 years

Base: Hospitalized with major surgery in past 2 years



9% 9% 11%15%

12%

0%

25%

50%

AUS CAN NZ UK US

Base: Respondent or family member hospitalized in the past 2 years

Percent reporting delays or problems while discharge arrangements were being made



Emergency Room Use

34%

44%

33% 34%

47%

0%

25%

50%

AUS CAN NZ UK US

Percent who used or tried to use an emergency room in the past two years



Percent reporting waiting time for emergency care was a big problem

31%

37%

28%

36%31%

0%

25%

50%

AUS CAN NZ UK US

Base: Used an emergency room in the past two years



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



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



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.

the 2002 commonwealth fund international health policy survey adults with health problems the...

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