The Commonwealth Fund2015 International Health Policy Survey of Primary Care Physicians in 10 Countries

EMBARGOED UNTIL 4:00 P.M. ET, DEC 7, 2015

Robin OsbornVice President

Teleconference Chart Pack

R. Osborn, D. Moulds, E. Schneider, M.M. Doty, D. Squires, D. Sarnak, “Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs,” Health Affairs, December 8, 2015.

Overview of Findings• Sample: 11,547 primary care physicians surveyed in Australia, Canada, Germany,

Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and United States

Key US findings:

• Many US primary care practices report that they are not well prepared to manage patients with complex needs

• US ranks last on primary care practice capacity to provide care after-hours (evenings, weekends, and holidays)

• US shows significant progress on electronic medical record adoption and ranks first for primary care practices giving patients electronic access to information from their medical record

• US primary care doctors report significant gaps in information flow and care coordination with specialists, hospitals, home care, and community social services providers

• More than one-half of US doctors say time spent on insurance issues is a major problem

• US doctors are least likely to say health system works well

2

Multiple Chronic

Conditions

Palliative Care

Dementia Long-Term Home Care

Services

Social Services in the

Community

Severe Mental Health

Problems

Substance Use-Related

Issues

AUS

CAN

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Doctors’ Views of Practice Preparedness to ManagePatients with Complex Needs

3

Base: Excludes doctors who report that they "never“ see these patients. Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

>75% of doctors reporting “well-prepared” >25% and ≤ 75% of doctors reporting “well-prepared” ≤ 25% of doctors reporting “well-prepared”

Top 2 countries in each category

Practice Has Arrangement for Patients’ After-Hours Care to See Doctor or Nurse

4

NETH NZ UK GER NOR AUS SWE SWIZ CAN US0

20

40

60

80

100 94 92 8985

80 78 7569

48

39

Percent

* In Norway, respondents were asked whether the practice has arrangements or if there are regional arrangements.

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Primary Care Practice Provides Patient with Electronic Access5

Percent reporting their practice offers patients the option to:

AUS CAN GER NETH NZ NOR SWE SWIZ UK US

E-mail about medical question or concern 30 15 50 57 53 32 61 80 38 57

View online, download, or transmit information from their medical record

11 7 8 13 24 3 20 11 28 60

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Primary Care Doctors’ Communication with Emergency Department and Hospital

6

NETH NZ UK US NOR CAN SWIZ GER AUS SWE0

20

40

60

80

59

43

32

26 25 23 2116 14

4

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Percent who report they always receive notification when patient is seen in the ED and discharged from the hospital:

Practice Routinely Communicates with Home Care Providers About Patients’ Needs and Services

7

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

NOR NETH SWIZ SWE US GER UK CAN AUS NZ0

20

40

60

80

100

6356 55 53 52 51

34 3229 28

Base: Excludes those who responded “not applicable.”

Percent

Doctors’ Use of Electronic Medical Records, 2006-20158

Source: 2006-2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Percent

2006 2009 2012 20150%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%NZ (100%)

NOR (99%)

SWE (99%)

NETH (98%)

UK (98%)

AUS (92%)

GER (84%)

US (84%)

CAN (73%)

SWIZ (54%)

Overall Views of Health Care SystemAmong Primary Care Physicians, 2015

US

SWE

UK

GER

CAN

AUS

NETH

SWIZ

NZ

NOR

0% 20% 40% 60% 80% 100%

16

19

22

27

36

48

50

54

57

67

69

70

72

61

61

49

46

44

42

31

14

11

6

12

3

2

2

2

1

1

Works well, only minor changes Fundamental changes Completely rebuild

Percent

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. .

9

Time Practice Spends on Insurance Issues or Claiming Payments is a MAJOR Problem

10

NOR CAN NZ AUS UK SWE SWIZ GER US NETH0

20

40

60

80

100

9

20 20 21 2127

50 52 5460

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Percent reporting time spent on administrative issues/claiming payments is a MAJOR problem:

How Stressful is Your Job as Primary Care Physician? 11

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

NETH AUS NZ NOR CAN SWIZ US GER SWE UK0

20

40

60

80

100

1724

18 18 19 17 12 126 5

64 5558 56 53 52

44 42

37 36

18 21 24 24 27 31

43 4556 59

Not too/Not at all Stressful Somewhat Stressful Extremely/Very Stressful

• Managing complex patients requires re-thinking primary care, including:

– Multidisciplinary teams and case managers

– Email access and after-hours care

– Home visits

• Policies and payment incentives need to be aligned to encourage care coordination and delivery system integration

• In addition to adoption of electronic medical records, greater interoperability and use of clinical decision support is needed

• It’s important for policymakers to hear from doctors on the frontlines

• As the Affordable Care Act gains further traction, the reforms underway— coverage expansion, additional support for primary care, medical homes, value-based purchasing—have the potential to be transformative

• But, re-designing delivery systems to better care for patients with complex conditions will need continuous iteration and evaluation to understand what works best

• Looking to other countries offers an opportunity for valuable cross-national lessons to be learned

12Take-Away Messages 12

Country Partners and Co-funders:

• Australia: New South Wales (Bureau of Health Information)

• Canada: Canadian Institute for Health Information, Health Quality Ontario, Canadian Institutes of Health Research, Quebec Health Commission, Canada Health Infoway

• France: Haute Authorité de Santé (HAS), Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (CNAMTS)

• Germany: Federal Ministry of Health, BQS Institute for Quality and Patient Safety

• 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, The Swedish Agency for Health and Care Services Analysis (Vårdanalys)

• Switzerland: Federal Office of Public Health

• United Kingdom: The Health Foundation

With appreciation to Dana Sarnak, David Squires, Michelle Doty, Eric Schneider, Donald Moulds, David Blumenthal, SSRS, and country partners for their contributions to the design of the survey, the content, and this presentation.

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Doctors’ Views on Whether Their Practice is Well Prepared to Manage Care of Patients with Complex Needs

14

Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Base: Excludes doctors who report that they "never" see these patients.

DRAFT COPY– PRELIMINARY DATA

Country

Multiple chronic

conditions(%)

Palliative care(%)

Dementia(%)

Long-term home care services

(%)

Social services in the

community(%)

Severe mental health

problems(%)

Substance use-related

issues(%)

AUS  85 48 46 47 41 34 19CAN 70 42 42 40 28 24 15GER 88 58 67 68 71 32 14NET 88 92 65 80 25 44 16NZ 81 62 41 54 48 24 20

NOR 86 54 69 78 41 56 36SWE 66 25 57 51 45 14 6SWIZ 80 48 49 64 55 26 25UK 79 81 64 60 44 43 41US 76 41 47 46 32 16 16

2015 Commonwealth Fund International Health Policy Survey15

Methodology

• 18th survey in the International Health Policy Series

• Nationally representative random samples of primary care doctors

• Primary care doctors include general practice or family physicians in all countries, as well as internists and pediatricians in the United States, Germany, and Switzerland.

• Views and experiences of primary care doctors in 10 countries

• Samples: Australia (747), Canada (2,284), Germany (559), Netherlands (618), New Zealand (503), Norway (864), Sweden (2,905), Switzerland (1,065), United Kingdom (1001), and United States (1,001)

• The survey was conducted by SSRS and country contractors

• Survey in the field March to June 2015 (plus France – September to November 2015)

• Data collection varied by country and included telephone, on-line and mail surveys.

• Response rates ranged from 19 percent in Germany to 47 percent in Sweden