health & society csa-europ assistance barometer 2013_synthesis

Health & Society Barometer

2013: 7

Main learning points

In October 2006, the Europ Assistance Group and the Cercle Santé

annual pan-European barometer on "the relationship and practices of European citizens with regard to their health

systems".

Set against the context of regular change

comparative enlightenment on the position of the citizens in the countries studied,

feed into the major debates that are gripping the healthcare sector.

In 2013, the barometer is being published at

8 European countries, as well as the United States, are now included within the field of study of the barometer.

Healthcare and, more broadly, the means of accessing

context or via new technologies, are the main concerns of the citizens of all of these countries. This barometer not

only allows us to evaluate their opinion and their expectations with regard to the preserv

systems, but also to study the manner in which the populations perceive the quality of their treatment. It thus

contributes to gaining a better appreciation of the level of consciousness

new challenges associated with healthcare.

Health & Society Barometer - Europ Assistance / CSA

2013: 7th

wave of the barometer

Main learning points

the Europ Assistance Group and the Cercle Santé Société, with the CSA Institute, launched an

"the relationship and practices of European citizens with regard to their health

changes within these systems, the objective of this

on the position of the citizens in the countries studied, in order that their opinions

feed into the major debates that are gripping the healthcare sector.

In 2013, the barometer is being published at a time when Europ assistance is celebrating its 50


Healthcare and, more broadly, the means of accessing care quality, including when travelling, within a professional


only allows us to evaluate their opinion and their expectations with regard to the preserv


iation of the level of consciousness shown in public opinion regarding the

challenges associated with healthcare.

1

Europ Assistance / CSA.

the CSA Institute, launched an

"the relationship and practices of European citizens with regard to their health

within these systems, the objective of this barometer is to provide

in order that their opinions can

a time when Europ assistance is celebrating its 50th

anniversary.


including when travelling, within a professional


only allows us to evaluate their opinion and their expectations with regard to the preservation of their healthcare


shown in public opinion regarding the

On the occasion of the 50

th anniversary of the assistance service,

founder of Europ Assistance, the Santé

addressing the topic of healthcare and travel,

Also studied within the barometer are the changes in opinion regarding:

• The evaluation of the healthcare system and the quality of trea

account not only the

the doctors and its development since 2010, the trust placed in the healthcare

authorities in each country regarding the limiting of risks, an observ

perception of the various future threats since 2009 and new sources of financing.

• Social requirements,

treatments and the issue of the desired means of financing in order to stre

equality.

• The cancellation or postponement of medical treatments

whom?

• The care for dependent elderly people

country since 2006,

adequacy of public support in financing home care and, more broadly, the recognition

of the issue of dependency by public authorities. Furthermore, other than family, what

types of organisations should be called on to provide this

should be prioritised and to what equipment should preference be given, including

technological devices? And finally, how can these services be financed?

• Healthcare and new communication technologies

viewing of healthcare information online since 2006, the sharing and exchanging of

opinion regarding healthcare on social networks and the Internet, the perception of the

development of continual home monitoring by mobile telephone and the evolution of

this perception since 2010, the possible use of webcams for a remote GP consultation.

Finally, public awareness of genome mapping and the intention to use it, measured

since 2011.

• Healthcare and business,

regard to expatriation, depending on their country of

Safety, Schooling and

• The final topic,

awareness of the various populations has developed with regard to the importance of

their healthcare system and its impact on the economy.

This barometer was established on the basis of a telephone survey conducted by the CSA in

of 500 individuals per country of study in Europe, as well as 1,000 individuals in the United States, representative

of the population aged 18 years and older, distributed across nine countries

Sweden (2006), Poland (2009), the United States,

2013.

anniversary of the assistance service, established in France by Pierre Desnos, the

& Société Europ Assistance-CSA barometer focuses in

healthcare and travel, assessing the benefits of repatriation for medical reasons.

Also studied within the barometer are the changes in opinion regarding:

The evaluation of the healthcare system and the quality of trea

account not only the organisation of this system, but also the technical competence of


authorities in each country regarding the limiting of risks, an observ


Social requirements, including the evaluation of equality when it comes to accessing

treatments and the issue of the desired means of financing in order to stre

The cancellation or postponement of medical treatments

care for dependent elderly people is a measure of the change in opinion in each

country since 2006, as regards the organisation and quality of



types of organisations should be called on to provide this home care, what measures



Healthcare and new communication technologies, with the development of the

iewing of healthcare information online since 2006, the sharing and exchanging of



perception since 2010, the possible use of webcams for a remote GP consultation.


Healthcare and business, measuring the respective expectations of employees wit

regard to expatriation, depending on their country of origin, focussing on Healthcare,

Safety, Schooling and Salary.

The final topic, Healthcare and economy addresses the manner in which the


their healthcare system and its impact on the economy.

This barometer was established on the basis of a telephone survey conducted by the CSA in


of the population aged 18 years and older, distributed across nine countries - Germany, France, Great Britain, Italy

nd (2009), the United States, Austria (2010) and Spain (since 2011), between May and June

2

in France by Pierre Desnos, the

CSA barometer focuses in its 2013 edition on

assessing the benefits of repatriation for medical reasons.

The evaluation of the healthcare system and the quality of treatments, taking into

also the technical competence of


authorities in each country regarding the limiting of risks, an observation on the


including the evaluation of equality when it comes to accessing

treatments and the issue of the desired means of financing in order to strengthen this

The cancellation or postponement of medical treatments, what treatments? for

is a measure of the change in opinion in each

as regards the organisation and quality of this care provision, the



home care, what measures



, with the development of the

iewing of healthcare information online since 2006, the sharing and exchanging of



perception since 2010, the possible use of webcams for a remote GP consultation.


measuring the respective expectations of employees with

origin, focussing on Healthcare,

the manner in which the


This barometer was established on the basis of a telephone survey conducted by the CSA institute, with a sample


Germany, France, Great Britain, Italy,

Austria (2010) and Spain (since 2011), between May and June

I- Evaluation of the healthcare system and

treatments

Organisation: consolidation in the medium term

Concerning the assessment of the public regarding the

differences of opinion are found between Austrians, who seem the most satisfied with an average score of 6.3/10,

and the Polish who bring up the rear at 2.8,

whom the average fell by half a point in relation to 2012, to 3.2. The Austrians also set themselves apart in that

47% of them consider their system to be very good or even excellent, f

nonetheless of this opinion. Great Britain

(5.0), Spain and Sweden (4.8) and then the United States (4.5).

In terms of changing opinions in the medium term

compare the averages observed between

than 1 point between these two dates, which can be explained by the generall

Outer Rhine health insurance schemes. As for Sweden, the country has experienced a slight downward trend,

falling from 5.3 in 2006 to 4.8 in 2013

point).

France remains stable, as do Austria, Great Britain

United States, the opinions have remained stable since 2010, despite a little increase in 2012.

Technical competence of doctors: a positive trend

Concerning the assessment made regarding

the opinions in the various countries are relatively stable from the previous year, with only the United States falling

by 0.3 points compared to 2012, yet still remaining the most positive (6.8) ahead of the Austrians (6.5),

Polish replace the Italians in last place (4.7).

If you consider the European countries together, the trend over two years is slightly positive and averages out at

5.6, following the considerable drop observed in all of the European countries b

Evaluation of the healthcare system and of

Organisation: consolidation in the medium term

the assessment of the public regarding the organisation of their healthcare system in 2013

between Austrians, who seem the most satisfied with an average score of 6.3/10,

and the Polish who bring up the rear at 2.8, nonetheless reducing the gap between themselves and the Italians, for


of them consider their system to be very good or even excellent, far ahead of the British, of whom 29

nonetheless of this opinion. Great Britain thus exceeds the average, with 5.2, followed by France (5.1), Germany

(5.0), Spain and Sweden (4.8) and then the United States (4.5).

medium term, the general trend tends towards a structural balance if you

compare the averages observed between 2006 and 2013. Only Germany experienced an upward variation of more

than 1 point between these two dates, which can be explained by the generally positive financial situation of the


falling from 5.3 in 2006 to 4.8 in 2013, and especially Italian opinion has significantly degraded since 2009 (

, Great Britain returning to its balanced trend following the peak in 2007.

the opinions have remained stable since 2010, despite a little increase in 2012.

tors: a positive trend

Concerning the assessment made regarding the technical competence of the doctors, diagnostics and treatments,


by 0.3 points compared to 2012, yet still remaining the most positive (6.8) ahead of the Austrians (6.5),

Polish replace the Italians in last place (4.7).


5.6, following the considerable drop observed in all of the European countries between 2010 and 2011.

3

of the quality of

organisation of their healthcare system in 2013, clear

between Austrians, who seem the most satisfied with an average score of 6.3/10,

nonetheless reducing the gap between themselves and the Italians, for


ar ahead of the British, of whom 29% are

5.2, followed by France (5.1), Germany

, the general trend tends towards a structural balance if you

2006 and 2013. Only Germany experienced an upward variation of more

y positive financial situation of the


, and especially Italian opinion has significantly degraded since 2009 (- 1

returning to its balanced trend following the peak in 2007. In the

the opinions have remained stable since 2010, despite a little increase in 2012.

, diagnostics and treatments,


by 0.3 points compared to 2012, yet still remaining the most positive (6.8) ahead of the Austrians (6.5), while the


etween 2010 and 2011.

Confidence in the healthcare authorities: stabilised opinions

72% of British state that they have confidence in

the risks associated with the taking of medication

prostheses, probe implants and endoscopic equipment. However, only 42 and 56

views respectively.

However, the level of confidence among the same Polish survey particip

with the taking of medication increased considerably between 2012 and 2013 (42

British (72 vs. 61%), when it continued to fall in

stable from one year to the next in the other countries.

Regarding the risks associated with the use of medical prostheses, probe implants and endoscopic equipment, only

the Spanish declare themselves considerably less confident, fall

confidence of the British increases by 15 points (to 81

Germans (increasing to 56%) and the Polish (to 56

Even the confidence of the French increases by 5

drug and breast implants recently making the news.

Threats to the future: Europe relatively more calm than the United States

With regard to the perception of threat

of medical errors to be very important, ahead of Americans (78

French and Austrians consider this risk to be very important.

In terms of development, there is a very noticeable drop among Spanish with regard to this risk being taken into

account (70% vs. 86%), but also to a lesser extent among Austrians (37% vs. 48

the other hand, a significant increase is to be observed among Polish and Americans, 66

risk of medical errors to be very significant in 2012, whereas 74

in 2013.

The waiting times before receiving treatment

of Spanish, 75% of British and 72% of Italians. However, a very noticeable drop in the perception of this threat is to

be observed among Spanish (-10 points), Swedish (59

In the United States on the other hand, a significant increase is to be noted, with 66

waiting times a threat, compared to 57%

At 76%, Spanish have the largest proportion to consider

threat that their healthcare system must overcome, followed by Americans (74

be noted that, compared to 2012, this proportion decreases consi

considerably in the United States (74 vs. 68

A very noticeable drop in this fear can be observed among Italians between 2012 (67

drop experienced in 2011 in Germany stabilises and an increase in the perception of this threat is evident in Austria

(49 vs. 43%).

With regard to this issue of personal financing

the United States, Poland, Italy and Great Britain on the one hand, where an increase in this type of financing is

considered a very significant threat by 50

other hand, where less than 50% of residents share this opinion.

authorities: stabilised opinions

of British state that they have confidence in the controls put in place by the healthcare authorities to limit

the risks associated with the taking of medication and 81% for the risks associated with the use of medical

prostheses, probe implants and endoscopic equipment. However, only 42 and 56% of the Polish express these

However, the level of confidence among the same Polish survey participants with regard to the risks associated

with the taking of medication increased considerably between 2012 and 2013 (42% vs. 35

to fall in Spain (63 vs. 66%) and in Italy (51 vs. 55%

stable from one year to the next in the other countries.


the Spanish declare themselves considerably less confident, falling from 69% in 2012 to 66

confidence of the British increases by 15 points (to 81%), that of the Swedish by 10 points (to 76

) and the Polish (to 56%) by 8 points.

French increases by 5 points, in spite of the legal proceedings regarding the Mediator

drug and breast implants recently making the news.


threats to the future of the healthcare systems, 82% of British consider the

to be very important, ahead of Americans (78%), followed by Italians (75

French and Austrians consider this risk to be very important.

terms of development, there is a very noticeable drop among Spanish with regard to this risk being taken into

), but also to a lesser extent among Austrians (37% vs. 48%) and Germans (45% vs. 54

ase is to be observed among Polish and Americans, 66

to be very significant in 2012, whereas 74% and 78% respectively consider this to be the case

receiving treatment continue to concern the vast majority of Polish (87

of Italians. However, a very noticeable drop in the perception of this threat is to

10 points), Swedish (59% vs. 68%) and, to a lesser extent, among Italians (

In the United States on the other hand, a significant increase is to be noted, with 66% of the population considering

% one year prior to this.

portion to consider the increase in personal financing

threat that their healthcare system must overcome, followed by Americans (74%) and then Polish (70

be noted that, compared to 2012, this proportion decreases considerably in Spain (76 vs. 85

considerably in the United States (74 vs. 68%). Poland remains relatively stable.

A very noticeable drop in this fear can be observed among Italians between 2012 (67%) and 2013 (58


personal financing, a distinction can be drawn between two groups of countries: Sp


considered a very significant threat by 50% of the population, and Sweden, Austria, Germany and France on the

of residents share this opinion.

4

the controls put in place by the healthcare authorities to limit

for the risks associated with the use of medical

of the Polish express these

ants with regard to the risks associated

vs. 35%), as did that of the

%), and remained relatively


in 2012 to 66% in 2013, while the

), that of the Swedish by 10 points (to 76%) and that of the

, in spite of the legal proceedings regarding the Mediator


of British consider the risks

), followed by Italians (75%), while only 37% of

terms of development, there is a very noticeable drop among Spanish with regard to this risk being taken into

) and Germans (45% vs. 54%). On

ase is to be observed among Polish and Americans, 66% of whom assessed the

respectively consider this to be the case

to concern the vast majority of Polish (87%), but also 78%

of Italians. However, a very noticeable drop in the perception of this threat is to

extent, among Italians (-5 points).

of the population considering

the increase in personal financing to be a very significant

) and then Polish (70%). It should

derably in Spain (76 vs. 85%) while it increases

) and 2013 (58%), while the


, a distinction can be drawn between two groups of countries: Spain,


of the population, and Sweden, Austria, Germany and France on the

In the long-term, the perception of a threat regarding the inequality of access to treatment

even though a distinction continues to be drawn between a group of countries where the vast majority

population is sensitive to this threat, and three countries; Germany (50

opinions are more divided. Of the Spanish, 84

top place with the British, ahead of the Polish (71

Sources of financing: in favour of a higher excess towards procedures?

Concerning the opinion of citizens regarding the means of covering the increase in healthcare

Swedish (69%) remain the most favourable to the

this solution. A downward trend is to be observed among the French and the Americans, where only 30

population is in favour of this method of financin

number of people in support of the system involving the payment of an excess

(40%), Germany (30%) and the United States (42

and mutuals, ahead of the Italians at 28

Austrians (39%) and Polish (41%).

For 8 years, and since the launch of our barometer, there is mounting evidence to show that the traditional division

between the systems is tending to fade, with public opinion changing

public - in favour of private insurance or payment of an excess towards the procedure, to the detriment of

compulsory contributions, with the notable and traditional exception of Sweden, and to a lesser extent Great

Britain, where people remain very committed to the National Health Service.

To sum up, since the beginning of the barometer,

balanced out with regard to the assessment of the healthcare system, in spite of short

regard to the perception of threats, here too r

alarming news, which confirms the general confidence expressed in the healthcare authorities and the competence

of doctors. Finally, with regard to sources of financing, an increase in positive opinions

especially among younger generations and those who are active. Only in Sweden and Great Britain do the majority

remain committed to increasing taxes or comp

the perception of a threat regarding the inequality of access to treatment

even though a distinction continues to be drawn between a group of countries where the vast majority

population is sensitive to this threat, and three countries; Germany (50%), Austria (50%

opinions are more divided. Of the Spanish, 84% of whom felt this threat in 2012, only 73

ish, ahead of the Polish (71%) and the Americans (70%).


Concerning the opinion of citizens regarding the means of covering the increase in healthcare

remain the most favourable to the mandatory deductions, while half of British remain committed to

this solution. A downward trend is to be observed among the French and the Americans, where only 30

in favour of this method of financing. By contrast, a considerable increase is to be noted in the

system involving the payment of an excess per medical treatment, in France

) and the United States (42%). Only 29% of Germans opt for the

ahead of the Italians at 28%, although this remains the solution preferred by the majority of


between the systems is tending to fade, with public opinion changing - depending on the country and the target

e insurance or payment of an excess towards the procedure, to the detriment of

, with the notable and traditional exception of Sweden, and to a lesser extent Great

very committed to the National Health Service.

since the beginning of the barometer, in the long-term the opinions in the various countries

out with regard to the assessment of the healthcare system, in spite of short

regard to the perception of threats, here too relative structural balance has been observed, in spite of occasional


rces of financing, an increase in positive opinions


remain committed to increasing taxes or compulsory contributions.

5

the perception of a threat regarding the inequality of access to treatment appears to stabilise,

even though a distinction continues to be drawn between a group of countries where the vast majority of the

%) and France (53%) where

of whom felt this threat in 2012, only 73% do so in 2013, sharing


Concerning the opinion of citizens regarding the means of covering the increase in healthcare expenses, the

while half of British remain committed to

this solution. A downward trend is to be observed among the French and the Americans, where only 30% of the

g. By contrast, a considerable increase is to be noted in the

per medical treatment, in France

of Germans opt for the use of optional insurance

, although this remains the solution preferred by the majority of


depending on the country and the target

e insurance or payment of an excess towards the procedure, to the detriment of

, with the notable and traditional exception of Sweden, and to a lesser extent Great

term the opinions in the various countries have

out with regard to the assessment of the healthcare system, in spite of short-term fluctuations. With

observed, in spite of occasional


rces of financing, an increase in positive opinions about excess is noted,


II – Social requirements

Access to treatments: consensus regarding the end, much less so regarding the means

In the long-term, opinions appear relatively stable in all of the countries when assessing if the health system

guarantees equality of access to treatment

2012, to 28% in 2013, dropping some way below its lowest level, observed in 2011 (33

the British (59%) seem relatively optimistic compared to the citizens of the other European countries, in which the

proportion of positive opinions varies between 28

show a considerable increase from 34 to 41

With regard to the need or otherwise to increase contributions or taxes in order to guarantee more equal access

to treatment, the majority of Swedish

and taxes, while French return to the level observed three years ago

increase in taxes or compulsory contributions is met with strong, or even

having the highest level of opposition, an increase of 5 points compared to 2012. Italy is closely followed by Spain,

recording a 74% rate of negative opinion.

and compulsory contributions, but not much more than Europeans on average (57%).

Between Sweden, at one extreme with 80

other extreme, with the same proportion against such an increase, it would appear that opposition is culturally

determined, with an evident distinction

Austria, Germany and Poland occupying the middle ground between the two extremes.

A more and more concerning postponement of treatments

18% of Europeans and 23% of Americans claim to have

treatment on account of financial difficulties.

39% of Polish stated that they had to make this choice, 33

of Germans compared to 30% in 2012, and 20

4% cancellation rate compared to 9% in 2012, outperforms Sweden at 6

Observing the case of France in closer detail, which this year posted the greatest increase among all the countrie

studied, it is evident that it is mainly women, those aged 18

while in Germany it is mainly men, those aged 18

covered by insurance claim to have postponed or declined

and 30% of those with personal insurance.

Regarding the nature of treatments declined

in 14% of cases, however, routine treatments are mentioned spontaneously in 18

In France, in 2013 dental treatments (25

2012, ahead of the purchase of glasses (17

Finally, if you consider the development over time regarding the various types of treatment, relative stability or

even a positive trend with regard to routine treatments

On the other hand, there is also a trend towards a

Social requirements


term, opinions appear relatively stable in all of the countries when assessing if the health system

equality of access to treatment for every citizen. Only Italy fell from a 44%

ing some way below its lowest level, observed in 2011 (33

) seem relatively optimistic compared to the citizens of the other European countries, in which the

proportion of positive opinions varies between 28% (Italy and Poland) and 48% (Austria), while the Americans

show a considerable increase from 34 to 41%.

the need or otherwise to increase contributions or taxes in order to guarantee more equal access

(80%) and British (55%) are still in favour of the increase of contri

return to the level observed three years ago (44%). In all of the other countries, this

increase in taxes or compulsory contributions is met with strong, or even very strong, opposition, with Italy (80


rate of negative opinion. A majority of Americans (59%) is unfavourable to an in

and compulsory contributions, but not much more than Europeans on average (57%).

Between Sweden, at one extreme with 80% of people in favour of increasing contributions or taxes, and Italy at the


distinction between the countries of the northern and southern Europe, with France,

Austria, Germany and Poland occupying the middle ground between the two extremes.

A more and more concerning postponement of treatments in France and Poland

of Americans claim to have, during the past year, postponed or declined

treatment on account of financial difficulties.

of Polish stated that they had to make this choice, 33% of French compared with 27

in 2012, and 20% of Italians compared to 27% one year earlier. Great Britain, with a

in 2012, outperforms Sweden at 6%.

Observing the case of France in closer detail, which this year posted the greatest increase among all the countrie

studied, it is evident that it is mainly women, those aged 18-39 and active individuals who decline

while in Germany it is mainly men, those aged 18-39 and active individuals. In the United States, 60

m to have postponed or declined treatment, but so too do 44

of those with personal insurance.

re of treatments declined by individuals in the United States, dental treatments

however, routine treatments are mentioned spontaneously in 18% of cases.

dental treatments (25%) remain the most affected, with a considerable increase compared to

the purchase of glasses (17%).

er the development over time regarding the various types of treatment, relative stability or

routine treatments can be noted, excluding in Poland and the United States.

On the other hand, there is also a trend towards an increase in difficulties regarding intensive treatments

6


term, opinions appear relatively stable in all of the countries when assessing if the health system

% rate of positive opinion in

ing some way below its lowest level, observed in 2011 (33%). The Spanish (67%) and

) seem relatively optimistic compared to the citizens of the other European countries, in which the

(Austria), while the Americans

the need or otherwise to increase contributions or taxes in order to guarantee more equal access

of the increase of contributions

. In all of the other countries, this

very strong, opposition, with Italy (80%)


A majority of Americans (59%) is unfavourable to an increase of taxes

of people in favour of increasing contributions or taxes, and Italy at the


northern and southern Europe, with France,

in France and Poland

postponed or declined medical

of French compared with 27% the previous year, 24%

one year earlier. Great Britain, with a

Observing the case of France in closer detail, which this year posted the greatest increase among all the countries

nd active individuals who decline or postpone,

39 and active individuals. In the United States, 60% of people not

treatment, but so too do 44% of Medicaid recipients

dental treatments are postponed

of cases.

remain the most affected, with a considerable increase compared to

er the development over time regarding the various types of treatment, relative stability or

can be noted, excluding in Poland and the United States.

intensive treatments, with a

major turn for the worse in the United States and a negative progression with regard to the

medication that is, generally speaking, more pron

has a tendency to escalate, particularly in France with an increase of 6

postponed by 17% of French, compared to 10

Americans (10%).

In summary, a positive development and consolidation

of the health system to guarantee equal medical treatment for all, although such opinion remains in the minority.

With regard to resorting to increasing taxes to ensure more equal access, on the other hand, there

of reverse symmetry between the countries in the north and south of Europe regarding opposition, the former

very much in favour of taxation, and the latter strongly opposing it.

The level of decline or postponement of treatments remains

high in Poland, Germany, Italy and in France, where it has increased significantly. At present, this phenomenon

appears to correlate more with the mechanisms of the health system rather than with the

the country.

In the United States, which has an average rate slightly higher than in Europe, the rates of postponement vary

significantly, depending on the health insurance system. This disparity is found on the other side of the

regarding the type of treatment concerned, in particular w

treatments by those not insured nor covered by Medicaid. In Europe, the purchasing of medication is significantly

affected by postponement decisions, even though at the same time it is dental treatments and the purchase of

glasses that people are increasingly likely to postpone in the majority of countries.

major turn for the worse in the United States and a negative progression with regard to the

that is, generally speaking, more pronounced in 2013. The postponement

has a tendency to escalate, particularly in France with an increase of 6 points. Regarding

of French, compared to 10% the previous year, ahead of Polish (12%) and Germans and

positive development and consolidation can be observed in terms of opinions regarding the capacity


With regard to resorting to increasing taxes to ensure more equal access, on the other hand, there


very much in favour of taxation, and the latter strongly opposing it.

or postponement of treatments remains low in Spain and in Great Britain, although it remains


appears to correlate more with the mechanisms of the health system rather than with the


significantly, depending on the health insurance system. This disparity is found on the other side of the

regarding the type of treatment concerned, in particular with huge numbers of postponement


ions, even though at the same time it is dental treatments and the purchase of

glasses that people are increasingly likely to postpone in the majority of countries.

7

major turn for the worse in the United States and a negative progression with regard to the purchasing of

ounced in 2013. The postponement of dental treatments also

Regarding glasses, purchasing is

the previous year, ahead of Polish (12%) and Germans and

in terms of opinions regarding the capacity


With regard to resorting to increasing taxes to ensure more equal access, on the other hand, there is almost a form


low in Spain and in Great Britain, although it remains


appears to correlate more with the mechanisms of the health system rather than with the economic situation of


significantly, depending on the health insurance system. This disparity is found on the other side of the Atlantic

ith huge numbers of postponements of routine


ions, even though at the same time it is dental treatments and the purchase of

III – Care for elderly and dependent people

A negative general opinion and still high

With the exception of Austrians (5.7/10), public opinions attribute a below

quality of care to those that are elderly and dependent, within their respective countries.

While 31% of Austrians go as far as to assess the organisation as very good or excellent, as do 24

particularly those over 60 years of age, only 2

In general, the manner in which the organisation and qu

perceived continues to show sharp contrast from country to country

In the long term, there is no sign of sign

evaluation of 63% can be observed in Italy, posting an average score (2.2) that is considerably lower than in 2012

(2.9).

Concerning Germany, with 4,1, this country comes back close to its level of 2011, which does not confirm on the

long term the improvement observed in 2012

remains difficult to interpret. In the United States on the other hand, a consistent improvement in the evaluations

is to be observed, with an average grade of 4.9 this year.

Public aid for home care: insufficient

Compared to 2012, in 2013 Germans (27

public financial aid for home care for elderly or dependent people

calling into question of financing programmes to promote independence. As for Germany, it came in a little below

the level for 2010 (31%).

The level of satisfaction in the other countries rose considerably or remained more or less stable, at a particularly

low level such as in Italy (19%) and in Poland (14

average level of satisfaction of 58% in S

average, sees this level climb to 62% among those aged 18

rural communities (58%). France comes in below average with just 45% p

Public authorities and the issue of

perception

With regard to the question of the awareness of public authorities regarding the issue of dependency, the same

trends are appearing, with a considerable drop in positive opinions in Germany (17

stable in the other countries. A significant increase can even be seen in Great Britain (20

vs. 26%) and in Austria (33% vs. 28%).

The voluntary sector is highly favoured

With regard to knowing "Outside of their family, from which organisation can elderly and dependent people find

the best home care support? ", the organisations in the voluntary sector or the private non

are for elderly and dependent people

A negative general opinion and still high expectations

Austrians (5.7/10), public opinions attribute a below-average score to the organisation and


of Austrians go as far as to assess the organisation as very good or excellent, as do 24

particularly those over 60 years of age, only 2% of Polish and Italians share this opinion.

the organisation and quality of care for elderly and dependent people

sharp contrast from country to country.

n the long term, there is no sign of significant variation of this negative evaluation, even though a rate of negative

3% can be observed in Italy, posting an average score (2.2) that is considerably lower than in 2012


in 2012. In Spain, the similar drop in the level that was observed (3.6 vs. 5)


is to be observed, with an average grade of 4.9 this year. Finally, France remains especially stable.

Public aid for home care: insufficient

Compared to 2012, in 2013 Germans (27% vs. 40%) and Spanish (31 vs. 49%) appear significantly less satisfied with

for home care for elderly or dependent people. In Spain, this dissatisfaction is rooted in the


action in the other countries rose considerably or remained more or less stable, at a particularly

) and in Poland (14%) which again occupy the bottom two places in this category. The

in Sweden rises to 67% among the over 60s, while Great Britain, at 56

among those aged 18-39. In Austria (52%), the best scores are observed in the

). France comes in below average with just 45% positive opinion.

Public authorities and the issue of elderly people dependency

the awareness of public authorities regarding the issue of dependency, the same

considerable drop in positive opinions in Germany (17%

stable in the other countries. A significant increase can even be seen in Great Britain (20

ctor is highly favoured

"Outside of their family, from which organisation can elderly and dependent people find

the organisations in the voluntary sector or the private non

8

average score to the organisation and


of Austrians go as far as to assess the organisation as very good or excellent, as do 24% of Americans -

this opinion.

ality of care for elderly and dependent people are

evaluation, even though a rate of negative

3% can be observed in Italy, posting an average score (2.2) that is considerably lower than in 2012


. In Spain, the similar drop in the level that was observed (3.6 vs. 5)


nally, France remains especially stable.

) appear significantly less satisfied with

In Spain, this dissatisfaction is rooted in the


action in the other countries rose considerably or remained more or less stable, at a particularly

the bottom two places in this category. The

among the over 60s, while Great Britain, at 56% on

), the best scores are observed in the

ositive opinion.

elderly people dependency: a very negative

the awareness of public authorities regarding the issue of dependency, the same

vs. 28%) and the situation

stable in the other countries. A significant increase can even be seen in Great Britain (20% vs. 15%), in France (31%

"Outside of their family, from which organisation can elderly and dependent people find

the organisations in the voluntary sector or the private non-profit sector are still

favoured by the majority of people in Germany (73

(43%). Public organisations are favoured by the majority

more balanced in Italy where private organisations come in first place with 37

ahead of public organisations at 33% and the voluntary sector at 30

In the United States, private organisations

non-profit sector, and ahead of public organisations (23

If we now consider the preferences by age, it can be noted that

among those aged 60 years and above, while, depending on the country, those aged 18

affinity towards the private or voluntary sector.

The home care widely approved

With regard to the favoured means of solving

increase in the number of elderly and dependent people

with an average of 78% in Europe and 86

A significant increase in those favouring this solution can even be noted in Italy (+ 8 points

8 points) and in Germany (+11 points), and also in Sweden (+5 points) where the increase has been consistent and

significant since 2009 (59% vs. 41% over 5 years).

Home care: supplementary resources

In order to enable the prolongation of home care,

Americans, ahead of telemonitoring,

American.

Robotics does well with 69% of opinions favourable in Europe and 61

and in Germany (75%) that one finds the lowest level for

However, a very significant increase in favourable opinions towards this solution can be noted in all countries,

likewise with regard to home carer jobs.

Still relatively unpopular in Austria (28

popularity in Great Britain, Italy and Poland, countries in which it receives scores equal to or greater than 75

French have a drop of 5 points to 50%, appearing still to have mixed feelings on the subject. The significant scores

achieved by these solutions emphasize the complementarity between

person at home.

The rise of remote monitoring technologies

In response to the question, "Are you prepared to equip your elderly relatives with remote monitoring systems such

as an electronic bracelet, a fall detector or continual blood pressure monitoring in order to make their home life

safer? ", 85% of Europeans responded positively, with

place with 77%, and favourable opinions increasing in all countries in a significant, or even very significant manner,

such as in Spain (+ 19 points) or in Germany (+ 20 points).

favoured by the majority of people in Germany (73%), Austria (64%) Poland (54%), Great Britain (49

Public organisations are favoured by the majority in Sweden (59%) and in Spain (44

vate organisations come in first place with 37% of those surveyed in favour,

and the voluntary sector at 30%.

private organisations receive 39% of the votes, on an even par with the voluntary or

profit sector, and ahead of public organisations (23%).

If we now consider the preferences by age, it can be noted that public organisations

among those aged 60 years and above, while, depending on the country, those aged 18-

affinity towards the private or voluntary sector.

widely approved

solving the problems posed by the prolongation of life expectancy and the

increase in the number of elderly and dependent people it is home care that remains preferred on the whole,

in Europe and 86% in the United States.

significant increase in those favouring this solution can even be noted in Italy (+ 8 points


over 5 years).

Home care: supplementary resources

In order to enable the prolongation of home care, home carer jobs are approved by 96%

which on average receives 83% of the European vote and 90

of opinions favourable in Europe and 61% in the United States. It is in Austria (71

) that one finds the lowest level for telemonitoring.

significant increase in favourable opinions towards this solution can be noted in all countries,

.

Still relatively unpopular in Austria (28%), Sweden (41%) and Germany (42%), robotics

pularity in Great Britain, Italy and Poland, countries in which it receives scores equal to or greater than 75

, appearing still to have mixed feelings on the subject. The significant scores

s emphasize the complementarity between technical solutions and the assistance of a

The rise of remote monitoring technologies

"Are you prepared to equip your elderly relatives with remote monitoring systems such


ans responded positively, with Spanish in the top place with 93

, and favourable opinions increasing in all countries in a significant, or even very significant manner,

such as in Spain (+ 19 points) or in Germany (+ 20 points).

9

), Great Britain (49%) and France

and in Spain (44%), with the situation

of those surveyed in favour,

of the votes, on an even par with the voluntary or private

public organisations are more highly favoured

-39 have a tendency to feel

the problems posed by the prolongation of life expectancy and the

that remains preferred on the whole,

significant increase in those favouring this solution can even be noted in Italy (+ 8 points, 90%), in Great Britain (+


% of Europeans and 92% of

of the European vote and 90% of the

in the United States. It is in Austria (71%)

significant increase in favourable opinions towards this solution can be noted in all countries, and

robotics continues to increase in

pularity in Great Britain, Italy and Poland, countries in which it receives scores equal to or greater than 75%.

, appearing still to have mixed feelings on the subject. The significant scores

lutions and the assistance of a

"Are you prepared to equip your elderly relatives with remote monitoring systems such


top place with 93% and Germans in the last

, and favourable opinions increasing in all countries in a significant, or even very significant manner,

The European preference for taxation and public financing

In response to the question: "In your opinion, who should pay for the services and support that enable the daily

needs of elderly and dependent people to be met?

by the local government with taxes or compulsory contributions

financing.

These basic public financing solutions, particularly popular among those aged 60 and over and those who are

inactive, appeal to an average of 70%

2013, compared to 56% in 2012. They now favour

concerned.

On the whole, 23% of Americans advocate

government and the people concerned.

to this choice, a very significant disparity can be noted between

hand, 24% and 22% of whom respectively favour

other hand, at 9%.

In summary, the issue of the provision of care to elderly and dependent people remains a central issue in public

opinion, with people desiring that it be paid greater attention by the public authorities. The manner in which the

quality of this provision is perceived matches the assessment made by the populations regarding their healthcare

systems in general. This is particularly the case in Italy and Poland, where the scores are the lowest.

It is in the United States and in Austria that the most positive results are

With regard to the means of implementation, home care is preferred by the majority in all countries. This is now a

general underlying trend. In order to ensure this support, the majority of

voluntary organisations, with the notable exception of Swedish, the vast majority of whom prefer public

organisations, with Spanish also favouring this solution, but to a lesser extent, while Italians share their vote

between the three types of organisation.

In the United States, the choice in this area remains highly influenced by the type of social security cover held by

the population.

rence for taxation and public financing

"In your opinion, who should pay for the services and support that enable the daily

needs of elderly and dependent people to be met? ", it is evident that the majority are in favour of

by the local government with taxes or compulsory contributions or mixed financing with an emphasis on public

public financing solutions, particularly popular among those aged 60 and over and those who are

of Europeans. French are the exception with just 47

in 2012. They now favour mixed financing by both public government and the people

of Americans advocate the individual solution and 27% mixed financing by both public

government and the people concerned. Only 12% declare themselves in favour of public financing, but with regard

to this choice, a very significant disparity can be noted between recipients of Medicaid

of whom respectively favour this solution, and the recipients of an employer

the issue of the provision of care to elderly and dependent people remains a central issue in public


matches the assessment made by the populations regarding their healthcare


It is in the United States and in Austria that the most positive results are recorded.


general underlying trend. In order to ensure this support, the majority of people in all countries prefer

ganisations, with the notable exception of Swedish, the vast majority of whom prefer public


between the three types of organisation.

United States, the choice in this area remains highly influenced by the type of social security cover held by

10

"In your opinion, who should pay for the services and support that enable the daily

it is evident that the majority are in favour of public financing

or mixed financing with an emphasis on public

public financing solutions, particularly popular among those aged 60 and over and those who are

French are the exception with just 47% preferring them in

mixed financing by both public government and the people

mixed financing by both public

declare themselves in favour of public financing, but with regard

edicaid and Medicare on the one

employer-based plan on the

the issue of the provision of care to elderly and dependent people remains a central issue in public


matches the assessment made by the populations regarding their healthcare



people in all countries prefer public or

ganisations, with the notable exception of Swedish, the vast majority of whom prefer public


United States, the choice in this area remains highly influenced by the type of social security cover held by

IV- Healthcare and economy

Healthcare: an economic sector in its own

74% of Europeans and 60% of Americans believe that

is the consensus in all countries, with very high scores in Italy and Spain (85

(81%) and Austria (76%).

However, these were the result of an increase between 2

itself apart through its relative stability (59

points in Spain, +21 points in Great Britain, +18 points in Italy, +14 points in Sw

Against this background, Germany increased by 6 points (66

It should be noted that positive opinions see a slight drop in the United States, where the debate on healthcare

expenses remains unresolved.

Healthcare and economy

Healthcare: an economic sector in its own

of Americans believe that the healthcare sector contributes to economic growth.

is the consensus in all countries, with very high scores in Italy and Spain (85%), in Sweden (83

However, these were the result of an increase between 2012 and 2013, with the exception of France, which sets

itself apart through its relative stability (59 vs. 57%) and Austria which remains stable - by no means the norm: +24

points in Spain, +21 points in Great Britain, +18 points in Italy, +14 points in Sweden.

Against this background, Germany increased by 6 points (66%), and Poland by 5 points (58


11

the healthcare sector contributes to economic growth. This

), in Sweden (83%), Great Britain

012 and 2013, with the exception of France, which sets

by no means the norm: +24

(58%).


Focus for 2013

Healthcare and travel

The repatriation for medical reasons

Regarding the issue of mobility, those surveyed were required to respond to the question:

following trends concerning healthcare

for medical reasons in the event of accidents or serious illnesses suffered while travelling abroad, has represented

an improvement or not? "

Among the benefits identified, "saving lives"

for Europeans and 76% for Americans.

criterion, while Polish (37%) and French (54

"Travelling as a family" is the second most frequently selected suggestion among those surveyed.

Americans (76%) have the greatest number select

(26%) and French (39%) had the fewest number of people choose it.

Finally, 74% of Americans select the notion of

improvement, followed by British (60%), while this benefit is only mentioned by 21

Varying levels of maturity

With regard to achieving a qualitative measurement of the significance of each of these improvements for the

people surveyed, it can be noted that 81

with a score of 88% among the over 60s.

80% of Swedish are of the same opinion, with a high of 88

contrast, 16% of Polish do not believe that this represents an improvement. In Germany it is inte

that with the average standing at 60% of people rating it as "very significant", 99

assessment. In France, with an average of 54

attribute greater value to this criterion.

The improvement to "travelling as a family

score of 85% among those aged 60 and over. In Poland, 33

20% of Polish do not think that this is an improvement. In Italy, it is again those aged 60 and over (52

attribute major significance to this criterion, the average standing at 43

Finally, "discovering distant and lesser known countries

(68%), Germans aged 18-39 (89%). In Italy (39

motivated while in Spain (44%) it is men (49

Healthcare and travel

repatriation for medical reasons perceived first to save lives

Regarding the issue of mobility, those surveyed were required to respond to the question:

following trends concerning healthcare and travel, would you say that for yourself or people like you, repatriation


ng lives" comes in first place in most countries, achieving an average of 66

for Americans. British (81%), followed by Swedish (80%) are the most sensit

French (54%) are not as convinced.

is the second most frequently selected suggestion among those surveyed.

) have the greatest number select this criterion, far ahead of Spanish (53

ewest number of people choose it.

of Americans select the notion of "discovering distant and lesser known countries"

), while this benefit is only mentioned by 21% of Polish and 29


people surveyed, it can be noted that 81% of British attach considerable importance to the criteria

among the over 60s.

of Swedish are of the same opinion, with a high of 88% among holders of private individual insurance.

Polish do not believe that this represents an improvement. In Germany it is inte

that with the average standing at 60% of people rating it as "very significant", 99% of those aged 18

assessment. In France, with an average of 54%, it is those aged 60+ (64%) and those who are inactive (62

travelling as a family" judged to be very important by 76% of British on average, achieves a

among those aged 60 and over. In Poland, 33% of those aged 60 and over are of this opinion, whil

of Polish do not think that this is an improvement. In Italy, it is again those aged 60 and over (52

attribute major significance to this criterion, the average standing at 43%.

discovering distant and lesser known countries" motivates, in particular, British aged 60 years and over

). In Italy (39%) women (44%) and those aged 60 and over (46

) it is men (49%) and holders of supplementary individual health co

12

Regarding the issue of mobility, those surveyed were required to respond to the question: "For each of the

and travel, would you say that for yourself or people like you, repatriation


comes in first place in most countries, achieving an average of 66%

are the most sensitive to this

is the second most frequently selected suggestion among those surveyed. British and

Spanish (53%). Germans (50%), Polish

"discovering distant and lesser known countries" to represent an

Polish and 29% of French.


of British attach considerable importance to the criteria "Saving lives",

holders of private individual insurance. In

Polish do not believe that this represents an improvement. In Germany it is interesting to note

of those aged 18-39 give this

) and those who are inactive (62%) who

of British on average, achieves a

of those aged 60 and over are of this opinion, while

of Polish do not think that this is an improvement. In Italy, it is again those aged 60 and over (52%) who

es, in particular, British aged 60 years and over

) and those aged 60 and over (46%) are particularly

) and holders of supplementary individual health cover (72%).

In summary, over the years, travellers have come to consider repatriation for health reasons to be synonymous

with rescue in the event of danger, an accident or serious illness occurring while abroad. This sentiment, shared by

the majority in all countries, will, depending on the case, be more pronounced among certain categories of the

population, both among those aged 60 and over and among the younger generation. Repatriation also represents

an asset when travelling as a family and when ventur

over the years, travellers have come to consider repatriation for health reasons to be synonymous


all countries, will, depending on the case, be more pronounced among certain categories of the


an asset when travelling as a family and when venturing into "exotic" countries, whether young or not so young.

13

over the years, travellers have come to consider repatriation for health reasons to be synonymous


all countries, will, depending on the case, be more pronounced among certain categories of the


ing into "exotic" countries, whether young or not so young.

Healthcare and business

Professional mobility: priority given to quality treatment

Among the most important criteria to be taken into account when deciding whether to accept an expatriation

proposal from your employer, "access and the provision of quality treatment to you and your family in the

destination country" is far in the lead, in

71% in the United States.

British, at 76%, are relatively less susceptibl

healthy living environment and comfortable

Europeans.

65% of the latter require "the education of children in a school offering a good quality of teaching"

demanding in this respect being Germans (77

"An increase in pay" interests 80% of

Americans. The least interested by this factor are

Finally, the issue of an "overall prevention, information,

family from local geopolitical and climate

Americans. 51% of French are attracted b

Prevention of occupational illnesses: in first place

stress

With regard to the nature of the healthcare programmes that they would require within the context of their

workplace, those surveyed attributed particular priority to

than 50% of survey participants in the majority of countries, with the exception of the United States (40 and 45

Swedish appear to be particularly concerned by

back pain (77%), in particular women (83

French indicate a higher level of requirement in these three areas.

Swedish claim to be the most concerned by the

alcohol or drugs (48%), but also by obesity

problems respectively.

Germans (17 and 22%) and British (23 and

and various addictions either.

To sum up, access to and provision of high

are offered a position abroad, whatever their nationality, far ahead of any other consideration. On the other hand,

the more global mechanisms for the p

Americans appear more familiar with these solutions. As for prevention of occupational illnesses, while employees

appear concerned by back pain, stress and se

and addition, with the exception of the Swedish.

Healthcare and business

Professional mobility: priority given to quality treatment


"access and the provision of quality treatment to you and your family in the

is far in the lead, in every country. This criterion achieves an average of 85

are relatively less susceptible to this factor, whereas 71% of them express a preference for

healthy living environment and comfortable accommodation", a factor selected by an average of 60

"the education of children in a school offering a good quality of teaching"

Germans (77%), followed by Swedish (76%) and Spanish (68

of Polish, but only motivates 50% of Europeans on average, and 58

nterested by this factor are Germans (32%).

"overall prevention, information, warning and evacuation system protecting you and your

family from local geopolitical and climate-related risks" only motivates 40% of Europeans, compared to 57

French are attracted by this proposal, followed by Austrians (49%) and

Prevention of occupational illnesses: in first place - back pain and the prevention of


workplace, those surveyed attributed particular priority to back pain and stress management

majority of countries, with the exception of the United States (40 and 45

Swedish appear to be particularly concerned by back pain (75%) and stress (65%). Polish are very concerned by

), in particular women (83%), stress (71%) (women 78%) and serious illnesses

French indicate a higher level of requirement in these three areas.

claim to be the most concerned by the prevention of risks associated with the consumption of tobacco,

obesity (47%), whereas only 30 and 36% of Americans are concerned by these

and 22%) and British (23 and 22%) do not seem motivated by programs for the

access to and provision of high-quality care are essential decision-making criteria


the more global mechanisms for the prevention of risks are only of concern to a minority of Europeans, while


appear concerned by back pain, stress and serious illnesses, they seem less interested by the battle against obesity

and addition, with the exception of the Swedish.

14


"access and the provision of quality treatment to you and your family in the

every country. This criterion achieves an average of 85% in Europe and

of them express a preference for "a

, a factor selected by an average of 60% of

"the education of children in a school offering a good quality of teaching", the most

Spanish (68%).

of Europeans on average, and 58% of

warning and evacuation system protecting you and your

of Europeans, compared to 57% of

) and Swedish (48%).

back pain and the prevention of


stress management, mentioned by more

majority of countries, with the exception of the United States (40 and 45%).

Polish are very concerned by

serious illnesses (65%). On average,

prevention of risks associated with the consumption of tobacco,

of Americans are concerned by these

) do not seem motivated by programs for the prevention of obesity

criteria for employees who


revention of risks are only of concern to a minority of Europeans, while


less interested by the battle against obesity

Healthcare and new communication technologies

The Internet generation

Sweden (82%) remains the country where the

most common, followed by the United States (75

the countries with the fewest users.

A slight drop in online consultation can even be observed in France (

points), while all other countries continue to increase; Germany (62

2012, and Sweden also reporting a considerable increase (+ 5 points).

On the whole, Europe increased by 5 points.

cases those living in a major city, who use the Internet for healthcare the most.

Web 2.0 Healthcare: still in its infancy

The consultation of healthcare information on the Internet

Swedish, with France and Spain in the bottom positions with level of consultation of 45% and 41% respectively in

2013.

But what is the situation regarding the exchange of information, opinions and comments re

other people? Practices are considerably less developed: 26

occasionally, followed by 21% of Americans and 16 %

practices, ahead of British at 7%. The profile of the most frequent users is the same as that for the consultation of

healthcare information on the Internet: young people, active people or residents of major cities.

Mobile telephone: renewed interest

In response to the question "are your more for or against the development of means of continual medical

monitoring via telephone", an increase of

spectacular increase in Germany to a level

country seeming to catch up with the others.

At the top, Swedish (80%) increase by a further 8 points. Austria increase

French making a slight climb to 61%, positioning themselves towards the back of the pack, yet still chased by

Germans.

If you compare the results of 2010 with those of 2013, there is no spectacular change of opinions regarding the use

of the mobile phone, but rather one can see evidence

Remote consultation: a still limited support in many countries

Regarding the issue of remote GP consultations via Internet using a webcam

by Spanish(52%), with a very noticeable increase in the number of favourable responses in these two countries,

increasing by + 13 points and +10 points resp


) remains the country where the consultation of health-related information

most common, followed by the United States (75%) and then Poland (63%). Spain (41%

A slight drop in online consultation can even be observed in France (-4 points), Spain

points), while all other countries continue to increase; Germany (62%) by 8 points in comparison with its level in

2012, and Sweden also reporting a considerable increase (+ 5 points).

On the whole, Europe increased by 5 points. Unsurprisingly, it is those aged 18-39 and active individuals, in many

cases those living in a major city, who use the Internet for healthcare the most.

Healthcare: still in its infancy

The consultation of healthcare information on the Internet has increased regularly to reach 82% among the


But what is the situation regarding the exchange of information, opinions and comments re

other people? Practices are considerably less developed: 26% of Swedish and Germans claim to do it regularly or

of Americans and 16 % of Austrians. Only 10% of French have adopt

British at 7%. The profile of the most frequent users is the same as that for the consultation of


Mobile telephone: renewed interest

"are your more for or against the development of means of continual medical

an increase of interest for this medium is to be observed in all countries, with a

spectacular increase in Germany to a level of 60% positive responses in 2013 compared with 46

country seeming to catch up with the others.

) increase by a further 8 points. Austria increases from 55%

, positioning themselves towards the back of the pack, yet still chased by


of the mobile phone, but rather one can see evidence of a gradual increase in the awareness of its potential.

a still limited support in many countries

remote GP consultations via Internet using a webcam, Swedish come top (62

very noticeable increase in the number of favourable responses in these two countries,

increasing by + 13 points and +10 points respectively. In third place are Polish (50%) followed by

15


related information on the Internet is the

%) and France (45%) remain

4 points), Spain (-2 points) and Italy (-2

) by 8 points in comparison with its level in

39 and active individuals, in many

has increased regularly to reach 82% among the


But what is the situation regarding the exchange of information, opinions and comments regarding health with

Germans claim to do it regularly or

French have adopted these

British at 7%. The profile of the most frequent users is the same as that for the consultation of


"are your more for or against the development of means of continual medical

interest for this medium is to be observed in all countries, with a

positive responses in 2013 compared with 46% in 2012, the

% in 2012 to 62% in 2013,

, positioning themselves towards the back of the pack, yet still chased by


of a gradual increase in the awareness of its potential.

Swedish come top (62%), followed

very noticeable increase in the number of favourable responses in these two countries,

) followed by Americans (48%).

In contrast, 85% of Austrians, 75% of Germans and 69

increase of 16 points regarding the number of positive opinions,

whom also remain opposed to this solution, with only 39

In summary, new technologies in the area of healthcare are on the rise in all countries, as people are becoming

more familiar with their use. While consulting medical information on the Internet has become commonplace,

exchanging opinions on healthcare is not yet an

has been accepted on principle, but users are yet to familiarise themselves with the new applications. Regarding

remote consultation, it is to be observed that usage is developing more slow

and cultural resistance varies from one country to the next.

of Germans and 69% of French are not in favour of this. With a spectacular

umber of positive opinions, Italians (42%) catch up with

whom also remain opposed to this solution, with only 39% in favour.

, new technologies in the area of healthcare are on the rise in all countries, as people are becoming


exchanging opinions on healthcare is not yet an established habit. Likewise, the idea of using one's mobile phone


remote consultation, it is to be observed that usage is developing more slowly than the technologies themselves,

and cultural resistance varies from one country to the next.

16

French are not in favour of this. With a spectacular

) catch up with British, the majority of

, new technologies in the area of healthcare are on the rise in all countries, as people are becoming


established habit. Likewise, the idea of using one's mobile phone


ly than the technologies themselves,

To sum up…

A dynamic barometer

Since its creation in 2006, the annual pan

citizens with regard to their health systems"

The first is that, over the years, the barometer quickly expanded to include in its observations the United States,

and as many as eight European countries

communism to capitalism. Contrasts were thus particularly evident between the countries that maintain strong

and specific policies, with somewhat uneven levels of economic development, distinct social trad

systems of healthcare coverage. Having been able to observe this diversity with a view to gaining a better

understanding of it is one of the major strengths of this barometer, the evolution of which has tracked that of the

fields of investigation themselves.

The second reason for this development comes as the result of the emergence of new parameters over the years,

which must be taken into consideration in order to acquire an up

practices of citizens in a system that is seeking to modernise, in particular with the introduction of new

technologies.

The third reason is that the world itself has continued to experience rapid development, with situations arising

such as economic, social and even moral crises. In these changing circumstances, the barometer also serves to help

maintain our course by using the same benchmarks in order to continue making progress and to benefit from a

more long-term vision; a more global understanding of significa

space enables us to take stock, so as to embrace a global, more long

epiphenomena.

A consolidated vision

Over a period of 3, 5 or 7 years depending on each country,

surveyed in each country regarding the organisation of their healthcare system ultimately return more or less to a

median level, the ratings differing from one country to the next but remaining coherent within eac

country.

The reading of curves over a period of several years thus enables us to disregard the characteristics unique to each

population, but also to verify whether the often abrupt variations are the consequence of measures,

announcements or events, the impact of which will fade in time.

Let's take, for example, the case of Germany, and the opinion of its population with regard to its healthcare

system, its curve having climbed the most between 2006 and 2013, increasing from 3.9 to 5, wit

2012. This variation is remarkable compared to those experienced in the other countries observed over a long

period.

As such, the opinion curve of French, by comparison, paints the picture of a long and tranquil river!

Since its creation in 2006, the annual pan-European barometer on "the relationship and practices of European

regard to their health systems" has evolved considerably, for at least three reasons.


and as many as eight European countries - some of which, such as Poland, have made the transition from


and specific policies, with somewhat uneven levels of economic development, distinct social trad


the major strengths of this barometer, the evolution of which has tracked that of the


which must be taken into consideration in order to acquire an up-to-date perspective of the relationships and

citizens in a system that is seeking to modernise, in particular with the introduction of new


ven moral crises. In these changing circumstances, the barometer also serves to help


term vision; a more global understanding of significant changes. Today this development in time and

space enables us to take stock, so as to embrace a global, more long-term perspective, looking beyond

Over a period of 3, 5 or 7 years depending on each country, it can be noted that the assessments made by those


median level, the ratings differing from one country to the next but remaining coherent within eac



r events, the impact of which will fade in time.


system, its curve having climbed the most between 2006 and 2013, increasing from 3.9 to 5, wit


French, by comparison, paints the picture of a long and tranquil river!

17

"the relationship and practices of European

has evolved considerably, for at least three reasons.


ich, such as Poland, have made the transition from


and specific policies, with somewhat uneven levels of economic development, distinct social traditions and varying


the major strengths of this barometer, the evolution of which has tracked that of the


date perspective of the relationships and

citizens in a system that is seeking to modernise, in particular with the introduction of new


ven moral crises. In these changing circumstances, the barometer also serves to help


nt changes. Today this development in time and

term perspective, looking beyond

e noted that the assessments made by those


median level, the ratings differing from one country to the next but remaining coherent within each individual




system, its curve having climbed the most between 2006 and 2013, increasing from 3.9 to 5, with a peak of 5.5 in


French, by comparison, paints the picture of a long and tranquil river!

Convergent ends and divergent means

While, with the notable exception of Germany, national opinions regarding healthcare systems show signs of

consolidation over time, opinions vary more greatly when one touches upon other subjects. Admittedly, there is

consensus regarding the competence of doctors or the confidence placed in the healthcare authorities in general.

It is reassuring to note, for example, that in spite of the healthcare scandals that regularly crop up here and there,

confidence in the institutions and also in the technical aspects of healthcare remains intact.

But while everyone is in agreement in demanding improved equality of access to treatment, while still observing

improvement, major division is evident when it comes to the question as to the

means of financing healthcare expenses. Here again, the observations made by the barometer since 2006 have

much to teach us.

Models in the process of becoming uniform?

In reality, everything is happening as if, little by little, the models on the basis of which the various countries have

built their social security system, and more broadly their healthcare system, have been falling into disuse.

beveridgian and bismarckian systems from which we drew influence in the initial studies seem to have lost their

relevance in light of the changing mentalities, the arrival of new generations, more global models arising from the

globalisation of practices and even new form

It is thus noted that the use of taxation to finance the increase in healthcare expenses receives fewer and fewer

votes, including in countries in which it was traditionally preferred, and this phenomenon is particularly notable

among young people, who, unlike their elders, did not experience the golden years following the Second World

War and did not taste the fruit of this period like those over 60 years of age.

The crisis and the cancellation of treatments

The crisis of 2008 no doubt contributed to expanding the generational gap, and all analyses converge in

demonstrating that the austerity policies implemented since then penalise a growing number of families and

individuals. In particular, the study reveals this in its analysis of

country. It is most revealing, for example, to note the increase in the postponement or decision not to spend

money on healthcare for needs as vital as routine treatment and medication, not to mention dental

and the purchasing of glasses, which often require supplementary insurance in order to be eligible for

reimbursement.

These postponements must have underlying reasons linked to changes in regulations relating to the organisation of

treatments and reimbursement for certain services. However, nowadays

financial reasons take precedence and those who do not benefit from comprehensive care are the first to be

sacrificed.

The case of the United States is particularly revealing when reading the results of the study, on account of the

different types of social cover from which individuals benefit

Atlantic.

ends and divergent means



egarding the competence of doctors or the confidence placed in the healthcare authorities in general.


also in the technical aspects of healthcare remains intact.


improvement, major division is evident when it comes to the question as to the means of implementation and the


Models in the process of becoming uniform?


built their social security system, and more broadly their healthcare system, have been falling into disuse.

bismarckian systems from which we drew influence in the initial studies seem to have lost their


globalisation of practices and even new forms of individualism…



young people, who, unlike their elders, did not experience the golden years following the Second World

War and did not taste the fruit of this period like those over 60 years of age.

the cancellation of treatments

ubt contributed to expanding the generational gap, and all analyses converge in


individuals. In particular, the study reveals this in its analysis of the threats perceived by those surveyed in each


money on healthcare for needs as vital as routine treatment and medication, not to mention dental



and reimbursement for certain services. However, nowadays, in the context of an economic crisis,


cularly revealing when reading the results of the study, on account of the

different types of social cover from which individuals benefit - or not as the case may be

18



egarding the competence of doctors or the confidence placed in the healthcare authorities in general.


also in the technical aspects of healthcare remains intact.


means of implementation and the



built their social security system, and more broadly their healthcare system, have been falling into disuse. Thus, the

bismarckian systems from which we drew influence in the initial studies seem to have lost their




young people, who, unlike their elders, did not experience the golden years following the Second World

ubt contributed to expanding the generational gap, and all analyses converge in


the threats perceived by those surveyed in each


money on healthcare for needs as vital as routine treatment and medication, not to mention dental treatments



, in the context of an economic crisis,


cularly revealing when reading the results of the study, on account of the

or not as the case may be - on the other side of the

A reluctance to new mandatory deductions

Paradoxically, in the European countries, where the social security systems still ensure a minimum level of cover,

the acceptance of the use of individual insurance solutions that work on the basis of an excess payment

financing - is evident.

Within a context whereby financial resources are scarce, the use of taxation to ensure equality of access to

treatment is being met with an increasingly negative response by those who are in a position to pay it, that is,

mainly those who are active and younger peo

The issues of dependency

The other major debate concerns the provision of care to the elderly.

care for the elderly has not changed since 2012. For the European countries it stands at 3.7, a long way off the

American average of 4.9. In Europe, this remains some way below the assessment of the healthcare sy

is given the grade 4.7.

Expectations therefore remain high in this area, even though improvements have already been perceived, to a

greater or lesser degree depending on the country, as a result of solutions already implemented. Among these

solutions, the provision of home care for dependent people remains the preferred solution throughout, by some

margin. However the envisaged methods of financing in order to provide this support continue to vary

considerably depending on the country, as does

private, voluntary or otherwise.

Pragmatic solutions

Aside from Swedish who are huge supporters of public financing, the solutions that are increasingly preferred are

mixed solutions with varying levels of financing, either public, private or personal. Ultimately, a homogeneous

solution does not appear to be emerging

United States, where solutions also vary depending on the different types of social insurance.

New technologies in the phase between acquisition and effective use

Consensus is beginning to be reached in the majority of countries regarding new technologies and their desired use

in prolonging home care. Therefore telemonitoring, but also robotics are being met with substantially more

positive opinions.

While telemonitoring has become commonplace, as has the use of the Internet to consult information relating to

healthcare, the sharing of information and personal opinions regarding healthcare via the web is far from being

common practice. Likewise, mobile telephone technology is awaiting a

scale, but that are as of yet only used marginally.

CSA contact: [email protected]

A reluctance to new mandatory deductions

cally, in the European countries, where the social security systems still ensure a minimum level of cover,

the acceptance of the use of individual insurance solutions that work on the basis of an excess payment

context whereby financial resources are scarce, the use of taxation to ensure equality of access to


mainly those who are active and younger people.

The other major debate concerns the provision of care to the elderly. The average score awarded to the quality of


American average of 4.9. In Europe, this remains some way below the assessment of the healthcare sy



olutions, the provision of home care for dependent people remains the preferred solution throughout, by some


considerably depending on the country, as does the choice of organisations to provide this service

Swedish who are huge supporters of public financing, the solutions that are increasingly preferred are


solution does not appear to be emerging, whether between the European countries or between Europe and the



to be reached in the majority of countries regarding new technologies and their desired use


monplace, as has the use of the Internet to consult information relating to


common practice. Likewise, mobile telephone technology is awaiting applications that would be used on a massive

scale, but that are as of yet only used marginally.

19

cally, in the European countries, where the social security systems still ensure a minimum level of cover,

the acceptance of the use of individual insurance solutions that work on the basis of an excess payment - personal

context whereby financial resources are scarce, the use of taxation to ensure equality of access to


The average score awarded to the quality of


American average of 4.9. In Europe, this remains some way below the assessment of the healthcare system, which



olutions, the provision of home care for dependent people remains the preferred solution throughout, by some


the choice of organisations to provide this service - public or

Swedish who are huge supporters of public financing, the solutions that are increasingly preferred are


, whether between the European countries or between Europe and the



to be reached in the majority of countries regarding new technologies and their desired use


monplace, as has the use of the Internet to consult information relating to


pplications that would be used on a massive

health & society csa-europ assistance barometer 2013_synthesis

Economy & Finance