the commonwealth fund the commonwealth fund 2012 international health policy survey of primary care...
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THE COMMONWEALTH
FUND
The Commonwealth Fund 2012 International Health Policy Survey
of Primary Care Physicians
2012 INTERNATIONAL SYMPOSIUM ON HEALTH CARE POLICY
Cathy Schoen and Robin OsbornThe Commonwealth Fund
November 2012
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2012 Commonwealth Fund International Health Policy Survey2
• Mail and phone survey of primary care physicians in Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and United States
• Samples: Australia (500), Canada (2,124), France (501), Germany (909), Netherlands (522), New Zealand (500), Norway (869), Sweden (1,314), Switzerland (1,025), United Kingdom (500), and United States (1,012)
• Survey in the field March to July 2012
• Conducted by Harris Interactive and country contractors
• Core topics: Health information technology; access; care coordination; financial incentives for quality improvement; assessment and feedback of practice performance; system views and physician satisfaction
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Health Information Technology
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NETH NOR NZ UK AUS SWE GER US FR CAN SWIZ0
20
40
60
80
100 99 97 97 96 95 94
72
46
68
37
98 98 97 9792
8882
69 67
56
41
2009 2012
Source: 2009 and 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Percent
Doctors’ Use of Electronic Medical Recordsin Their Practice, 2009 and 2012
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UK AUS NZ NETH US SWE SWIZ CAN GER FR NOR0
20
40
60
80
100 9792
97 98
69
88
41
56
82
67
98
6860 59
3327
12 11 10 7 6 4
Uses EMR Uses EMR with multifunctional HIT capacity
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.
Percent
Doctors with Electronic Medical Records and Multifunctional Health IT Capacity
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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NET NZ AUS UK SWE US FRA CAN GER SWIZ NOR0
20
40
60
80
100 9389 88 85
70
58
41
3026 25 22
Percent
Doctor Routinely Receives Electronic Prompts About Potential Problems with Rx Dose or Interaction
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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NZ SWE NET SWIZ NOR FRA UK US AUS GER CAN0
20
40
60
80
100
55 52 49 4945
39 3831
2722
14
Percent
Doctor Can Electronically Exchange Patient Summaries and Test Results with Doctors Outside their Practice
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Access and Barriers to Care
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9Doctors’ Perception of Patient Access Barriers
Percent reporting their patients OFTEN have:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Difficulty paying out-of-pocket costs
25 26 29 21 42 26 4 6 16 13 59
Difficulty getting diagnostic tests 16 38 41 27 7 59 10 15 3 14 23
Long waits to see a specialist 60 73 59 68 21 75 60 49 10 28 28
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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UK NETH NZ GER AUS NOR* SWIZ FR SWE CAN US0
20
40
60
80
100 95 9490 89
81 80 78 76
67
45
34
Percent
Practice Has Arrangement for Patients’ After-Hours Care to See Doctor or Nurse
* In Norway, respondents were asked whether there practice has arrangements or if there are regional arrangements.Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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FR SWIZ NETH NZ GER UK US NOR AUS SWE CAN0
20
40
60
80
100
86
62 61 59 56 5547
4238
2822
Percent of doctors responding almost all patients (>80%) can get a same- or next-day appointment when one is requested
Almost All Patients Can Get Same- or Next-Day Appointment
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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12Electronic Access for Patients
Percent reporting their practice allows patients to:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Request appointments or referrals online
8 7 17 22 13 13 51 66 30 40 30
Request refills for prescriptions online
7 6 15 26 63 25 53 88 48 56 36
E-mail about medical question
20 11 39 45 46 38 26 41 68 35 34
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Care Coordination
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Percent
Practice Uses Nurse Case Managers or Navigators for Patients with Serious Chronic Conditions
UK NETH NZ SWIZ AUS NOR CAN US SWE GER0
20
40
60
80
100
7873
68 68
59
5144 43 41
20
Note: Question asked differently in France.Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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15Primary Care Doctors’ Receipt of Information from Specialists
Percent said after their patient visits a specialist they always receive:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Report with all relevant health information
32 26 51 13 13 41 26 12 59 36 19
Information about changes to patient’s drugs or care plan
30 24 47 12 5 44 22 13 44 41 16
Information that is timely and available when needed
13 11 26 4 1 15 4 8 27 18 11
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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GER NZ US NET SWIZ AUS UK SWE CAN NOR FRA0
20
40
60
80
100
67
56
45 42 4036
21 2115 14
10
Percent
After Hospital Discharge, Primary Care Doctor Receives Needed Information to Manage the Patient Within 48 Hours
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Financial Incentives or Supportfor Quality Improvement
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18Financial Incentives and Targeted Support
Percent can receive financial incentives* for:
AUS CAN FR GER NET NZ NOR SWE SWIZ UK US
Managing patients w/ chronic disease or complex needs
75 70 37 60 77 83 15 49 4 50 21
Enhanced preventive care activities**
42 42 12 23 28 40 17 55 5 37 14
Adding nonphysician clinicians to practice
53 33 3 5 60 36 9 33 4 17 10
Making home visits 57 53 16 51 50 36 45 49 32 20 9
* Including special payments, higher fees, or reimbursements.** Including patient counseling or group visits.Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Assessment and Feedback of Practice Performance
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20Practice Routinely Receives and Reviews Data on Patient Care
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 90 15 84 60
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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UK NZ US SWE AUS NET FRA GER CAN SWIZ NOR0
20
40
60
80
100 96
83
67
5753
4743 43 41
37
22
Percent
Doctor Reviews Clinical Performance Against Targets at Least Annually
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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22
UK NZ SWE FR SWIZ US NETH AUS GER CAN NOR0
20
40
60
80
100
78
55 55
45
35 34 3225 25
15
5
Percent
Doctor Routinely Receives Data Comparing Practice’s Clinical Performance to Other Practices
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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23Practice Routinely Receives and Reviews Data on Resource Use
Percent routinely receives and reviews data on:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Hospital admissions and ED use
39 30 9 24 21 43 33 28 32 82 55
Frequency of ordering tests 33 16 7 17 16 56 18 43 20 56 32
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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System Views and Physician Satisfaction
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25
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US0
20
40
60
80
100
23
33
41
18
60
42
56
37
47
17
4540 37
22
54 5361
3946 46
15
2009 2012
Percent
Physician Views of the Health System, 2009 and 2012:“System Works Well, Only Minor Changes Needed”
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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26Physician Views of Whether the Quality of Care in the Health Care
System Has Improved in the Past Three Years, 2012
Percent responding quality of care has:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Improved 30 26 9 12 38 33 28 24 11 35 21
Stayed the same 50 54 52 54 40 49 60 43 66 44 53
Gotten worse 20 19 37 34 20 19 11 32 21 21 25
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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UK SWE AUS NOR FR NZ CAN SWIZ NETH GER US0
20
40
60
80
100
9 10 10 1117 17
21 23 26
37
52
Insurance Restrictions on Medication or Treatment for Patients Pose Major Time Concerns for Doctors
Percent saying amount of time physician or staff spend getting patients needed medications or treatment because of coverage restrictions is a MAJOR PROBLEM
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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NETH NOR SWIZ UK CAN NZ AUS FR SWE US GER0
20
40
60
80
100
88 87 84 84 82 82 80 76 75 6854
11 12 16 16 18 18 20 23 24 3145
Very satisfied/satisfied Somewhat/very dissatisfied
Percent
Physician Satisfaction with Practicing Medicine
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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29Dissatisfaction with Income and Time with Patients
Percent somewhat/very dissatisfied with:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Income from medical practice 25 20 63 33 20 25 16 28 42 21 32
Time to spend per patient 40 40 47 48 47 44 37 54 31 59 44
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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U.S. Primary Care Reports, by Practice Size
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Has after-hours care arrangements
Uses electronic med-ical records
Routinely reviews data on clinical outcomes
Insurance restrictions on medications/
treatments pose major time concern
0 25 50 75 100
27
49
33
63
41
83
58
48
5 or more FTE physicians
2 or fewer FTE physicians
U.S. Primary Care Doctors: Access, Information Capacity, and Administrative Burden by Practice Size
31
Percent
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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Cross-Cutting Themes and Implications32
• 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 enable multiple points of access
• Opportunities to learn as these evolve
• Gaps in communication across sites of care in all countries undermines care coordination and integration
• Primary care workforce with expanded team-work, including nurses, key to a high performing health system
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3333Acknowledgments and Cofunders
• 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
Thanks to coauthors David Squires, Michelle M. Doty, Petra Rasmussen, Roz Pierson, and Sandra Applebaum, and to Harris Interactive, Inc., and contractors for conducting the survey. Published in Health Affairs as: “A Survey of Primary Care Doctors in Ten Countries Shows Progress in Use of Health Information Technology, Less in Other Areas,” Web First, Nov. 15, 2012.