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THE COMMONWEALTH
FUND
The Commonwealth Fund
2010 International Health Policy Survey
in Eleven Countries
The Commonwealth Fund
November 2010
2
THE COMMONWEALTH
FUND
2010 International Health Policy Survey
• Telephone survey March to June 2010 of adults ages 18 and older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.
• Final samples: 3,552 Australia, 3,302 Canada, 1,402 France, 1,005 Germany, 1,001 Netherlands, 1,000 New Zealand, 1,058 Norway, 2,100 Sweden, 1,306 Switzerland, 1,511 United Kingdom, and 2,501 United States.
• Conducted by Harris Interactive subcontractors, and Dutch Scientific Institute for Quality of Healthcare, Haute Authorité de Santé (HAS), Swedish Ministry of Health, Swiss Federal Office of Public Health, and Norwegian Knowledge for the Health Services.
• Examined differences between above- and below-average (median) income respondents, controlling for age and health status
3
THE COMMONWEALTH
FUND
33
• A selection of findings from the 2010 Commonwealth Fund International Health Policy Survey were originally published in: C. Schoen, R. Osborn, D. Squires, M. M. Doty, R. Pierson, and S. Applebaum, "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," Health Affairs Web First, Nov. 18, 2010.
• This chartpack presents data beyond what was included in the article.
2010 International Health Policy Survey
4
THE COMMONWEALTH
FUND
4
International Comparison of Spending on Health, 1980–2008
0
1000
2000
3000
4000
5000
6000
7000
8000
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand
Average spending on healthper capita ($US PPP)
0
2
4
6
8
10
12
14
16
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia
Total expenditures on healthas percent of GDP
Source: OECD Health Data 2010 (June 2010).
5
THE COMMONWEALTH
FUND
5
System Views and Confidence
6
THE COMMONWEALTH
FUND
6
Overall Views of Health Care System, 2010
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Only minor changes needed
24 38 42 38 51 37 40 44 46 62 29
Fundamental changes needed
55 51 47 48 41 51 46 45 44 34 41
Rebuild completely 20 10 11 14 7 11 12 8 8 3 27
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
7
THE COMMONWEALTH
FUND
7
76 7685 82
88 84
70 67
89 92
70
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Confident Will Receive Most-Effective Treatment if Sick
Percent responded, if they became seriously ill, confident/very confident they would get most-effective treatment, including drugs and diagnostic tests
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
8
THE COMMONWEALTH
FUND
8
64 6873 70
8175
69 7078
90
58
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Confident Will Be Able to Afford Needed Care
Percent responded, if they became seriously ill, confident/very confident they would be able to afford the care they needed
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
9
THE COMMONWEALTH
FUND
9
Affordability and Cost-Related Access Barriers
10
THE COMMONWEALTH
FUND
10
35
5147
41 39
61
33
50
20
76
31
0
25
50
75
100
AU
S
CA
N
FR
GE
RN
ETH N
Z
NO
R
SW
E
SW
IZ UK
US
Out-of-Pocket Medical Costs in the Past Year, in U.S. Dollars
Percent
2112
48 9 7
16
2
25
1
35
AU
S
CA
N
FR
GE
R
NE
TH NZ
NO
R
SW
E
SW
IZ UK
US
$200 or less $1,000 or more
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
11
THE COMMONWEALTH
FUND
11Cost-Related Access Problems
in the Past Year
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Did not fill prescription or skipped doses
12 10 7 6 3 7 6 7 4 2 21
Had a medical problem but did not visit doctor
13 4 6 16 2 9 6 5 6 2 22
Skipped test, treatment, or follow-up
14 5 6 10 3 8 5 4 4 3 22
Yes to at least one of the above
22 15 13 25 6 14 11 10 10 5 33
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
12
THE COMMONWEALTH
FUND
12
86
9
3 46 5 5 6
2
20
0
10
20
30
40
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Serious Problems Paying or Unable to Pay Medical Bills in the Past Year
Percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
13
THE COMMONWEALTH
FUND
13
Access to Needed Care and Waiting Times
14
THE COMMONWEALTH
FUND
14
65
45
6266
7278
45
57
93
70
57
0
25
50
75
100
AU
S
CA
N
FR
GE
RN
ETH N
Z
NO
R
SW
E
SW
IZ UK
US
Access to Doctor or Nurse When Sick or Needed Care
Percent*
14
33
17 16
5 5
28 25
28
19
Same- or next-day appointment
Waited six days or more
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
* Base: Answered question.
15
THE COMMONWEALTH
FUND
16
21
14 1511
14
23
18
9 8
17
0
10
20
30
40
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Worried About a Medical Problem That Took a Long Time to Be Diagnosed in Past Year
Percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
16
THE COMMONWEALTH
FUND
16Difficulty Getting After-Hours Care
Without Going to the Emergency Room
* Base: Needed care and answered question.
5965 63
57
3338
45
68
4338
63
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER*
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
17
THE COMMONWEALTH
FUND
33
44
2722
2629
26
35
2225
37
0
25
50
75
AU
S
CA
N
FR
GE
R
NE
TH NZ
NO
R
SW
E
SW
IZ UK
US
Emergency Room Use in Past Two Years
Percent
1016
5 510 8 7
129 7
15
Any ER use Used ER for condition treatableby regular doctor, if available
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
18
THE COMMONWEALTH
FUND
33
20
34 33
5246
3329
44
26
34
0
25
50
75
AUSCAN FR
GER
NETH NZNO
RSW
ESW
IZ UK US
Percent
Wait Time in Emergency Room Before Being Treated
16
31
17
4 3
12 11
20
6 4
13
Less than 30 minutes Four hours or more
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Used ER in past two years.
19
THE COMMONWEALTH
FUND
54
41
53
83
7061
5045
82
7280
0
25
50
75
100
AUSCAN FR
GER
NETH NZNO
RSW
ESW
IZ UK US
Percent
Wait Time for Specialist Appointment
28
41
28
716
22
34 31
5
19
9
Less than 1 month Two months or more
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Needed to see a specialist in past two years.
20
THE COMMONWEALTH
FUND
Percent
53
35
46
78
5954
44
34
5559
68
0
25
50
75
100
AUSCAN FR
GER
NETH NZNO
RSW
ESW
IZ UK US
Wait Time for Elective Surgery
1825
70
5 8
21 22
7
21
7
Less than 1 month Four months or more
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Needed elective surgery in past two years.
21
THE COMMONWEALTH
FUND
21
Primary Care and Patient-Centered Care
22
THE COMMONWEALTH
FUND
76
62
8882 78
84
61
73
9083
79
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Easy to Contact Doctor by Phone During Regular Hours
Percent reporting somewhat/very easy
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care and tried contacting.
23
THE COMMONWEALTH
FUND
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Has e-mailed medical question to regular doctor or place of care in past two years
2 4 2 7 2 4 4 6 3 9 6
Can make an appointment via e-mail or Web site at regular place of care
7 6 9 60 10 9 23 13 13 25 15
Online Access at Regular Place of Care
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care.
24
THE COMMONWEALTH
FUND
42
27 2318
25
57
33 37
16
5651
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Nurse Regularly Involved in Care
* For example, discusses test results, treatment plans or advises you on your health.
Percent reported a nurse or other nonphysician clinician is regularly involved in care*
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care.
25
THE COMMONWEALTH
FUND
Doctor–Patient Communication
Percent reports regular doctor always/often
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Gives opportunity to ask questions about recommended treatment
88 85 83 91 87 92 77 65 92 91 86
Explains things in a way that is easy to understand
91 89 89 94 93 92 86 74 94 89 89
Involves you as much as you want in care decisions
86 83 82 84 81 92 80 62 85 90 86
Spends enough time with you 85 80 85 91 89 90 76 67 90 88 82
All of the above 69 60 59 63 75 79 62 47 72 59 63
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care.
26
THE COMMONWEALTH
FUND
87 84 8492
8893
75
57
89 8985
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Regular Doctor Knows Important Information About Medical History
Percent reporting doctor often/always knows important information about medical history
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care.
27
THE COMMONWEALTH
FUND
76 7467
4954
84
59
43
6979
74
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Quality of Care from Doctor
Percent rated care received in past 12 months from regular doctor as very good/excellent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care.
28
THE COMMONWEALTH
FUND
28
Coordination of Care
29
THE COMMONWEALTH
FUND
66 68
51
63
35
69
55
26
55
68 69
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Regular Doctor Coordinates Care Received from Other Doctors and Places
Percent reporting doctor always/often coordinates or arranges care
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care.
30
THE COMMONWEALTH
FUND
30
Coordination Problems in the Past Two Years
Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Test results/ records not available at time of appointment
11 11 7 8 8 9 10 9 7 9 15
Received conflicting information from different health professionals
20 20 16 17 15 18 24 18 16 10 23
Duplicate tests: doctors ordered test that had already been done
10 8 14 20 4 5 9 5 11 7 17
Yes to at least one of the above 28 28 28 29 21 23 31 23 24 19 37
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
31
THE COMMONWEALTH
FUND
31
2623
28
2319 19
27
1719
13
3129
3129
42
25 26
38
2932 32
42
0
25
50
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
No chronic conditions2 or more chronic conditions
Percent experienced any of three coordination problems*
* Test results/records not available at time of appointment, received conflicting information from different health professionals, and/or doctors ordered test that had already been done.
Coordination Problems in the Past Two Years, by Number of Chronic Conditions
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
32
THE COMMONWEALTH
FUND
1113
10
17
11
22
12
26
15 1416
0
10
20
30
40
AUSCAN FR
GER
NETH NZNO
RSW
ESW
IZ UK US
Gaps in Coordination of Specialist Care
16
2220
1715
3033
2623
16
22
AUSCAN FR
GER
NETH NZNO
RSW
ESW
IZ UK US
Specialist did NOT have reason for visit/tests from regular doctor
Regular doctor NOT up-to-date about specialist care
Percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Saw specialist in past two years and has regular doctor/place of care.
33
THE COMMONWEALTH
FUND
28 30
44
32
23 22
33 31
2127 27
0
15
30
45
60
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Gaps in Emergency Room Communication with Regular Doctor
Percent for whom regular doctor/place did NOT seem informed or up-to-date about care received in ER
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Base: Has regular doctor/place of care, used ER in past two years and was treated.
34
THE COMMONWEALTH
FUND
2126
12
5
42
21
3024
9 711
0
15
30
45
60
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Failure to Communicate Test Results
Percent for whom someone sometimes, rarely, or never followed up to give results
Base: Had blood tests, x-rays, or other tests in past two years.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
35
THE COMMONWEALTH
FUND
Perception of Inefficient or Wasteful Care
Percent felt time wasted in past two years because…
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Took long time to schedule tests or specialist appointments
19 25 21 17 11 15 21 14 9 12 17
Kept waiting long time to see doctor for a scheduled appointment
35 33 25 30 18 25 28 16 27 18 29
Care was poorly organized or poorly coordinated
18 19 9 11 10 12 15 17 6 10 18
Yes to at least one of the above 48 49 38 43 30 36 44 34 37 29 38
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
36
THE COMMONWEALTH
FUND
36
Preventive Care
37
THE COMMONWEALTH
FUND
4539 37
47
59 56
28
42
22
4956
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Patient Receives Reminders for Due Preventive Care
Percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
38
THE COMMONWEALTH
FUND
Health Promotion and Lifestyle Discussions in Past Two Years
Base: Has regular doctor/place of care and visited in past two years.
Percent reported discussing at regular place of care:*
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
A healthy diet and healthy eating
53 52 37 50 17 53 34 29 33 45 70
Exercise or physical activity 54 56 56 51 23 51 43 43 47 37 72
Things in your life that worry you or cause stress
43 44 47 35 27 38 35 25 34 26 49
Discussed any of the above 67 71 74 70 42 64 61 55 63 53 82
* With doctor or other clinician.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
39
THE COMMONWEALTH
FUND
Chronic Conditions and Self-Management
40
THE COMMONWEALTH
FUND
Number of Chronic Conditions
Percent of respondents with the following number of chronic conditions:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
None 35 42 40 51 44 38 42 43 52 57 35
One 26 27 31 25 28 27 24 27 26 22 23
Two or more 40 31 29 25 29 35 33 30 22 21 40
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
41
THE COMMONWEALTH
FUND
95 91 93 9387
9791
82
9691 93
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Chronically Ill Patients Who Are Confident They Can Manage Health Problems
Base: Adults with asthma, diabetes, heart disease, hypertension, and/or high cholesterol.
Percent reported confident/very confident they can manage their health problems
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
42
THE COMMONWEALTH
FUND
87 8477
66
90 89 9082 79 79
84
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Blood Pressure in Normal Range Among Patients with Heart Disease and/or Hypertension
Base: Adults with heart disease and/or hypertension and had blood pressure checked in past year.
Percent reported blood pressure in normal range last time checked
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
43
THE COMMONWEALTH
FUND
7974
6774
61
78
6757
8075 76
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Diabetics with Glucose Level in Normal Range
Base: Adults with diabetes.
Percent reported often/always keeping glucose level in normal range
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
44
THE COMMONWEALTH
FUND
Prescription Drugs
45
THE COMMONWEALTH
FUND
68
108
4
9 86 5
107
0
10
20
30
40
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Confusion Over New Prescription
Base: Regularly takes at least one prescription drug.
Percent reported being unsure what new prescription drug was for or how to take it in past two years
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
46
THE COMMONWEALTH
FUND
Experiences with Prescription Drugs in Past Two Years
Percent reported someone from regular place of care:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Did not review all medications including those prescribed by other doctors
21 31 42 45 54 28 52 60 35 43 23
Did not explain the potential side effects of a medication
22 26 45 46 61 27 49 52 41 41 23
Did not give written list of all prescribed medications
48 52 71 74 77 52 77 55 72 54 46
At least one of the above problems 56 67 86 83 90 63 88 84 84 68 60
Base: Has regular doctor/place of care and regularly takes at least one prescription drug.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
47
THE COMMONWEALTH
FUND
Patient Safety
48
THE COMMONWEALTH
FUND
Medical, Medication, or Lab Test Errors in Past Two Years
* Base: Had blood test, x-rays, or other tests in past two years.
Percent reported: AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Wrong medicationor dose
4 6 9 2 4 5 8 5 5 2 6
Medical mistake in treatment 8 8 6 6 5 6 11 6 8 3 10
Incorrect diagnostic/lab test results*
2 4 3 2 3 2 3 2 3 3 5
Delays in abnormaltest results*
6 10 3 5 4 6 9 8 2 6 9
Any medical, medication, or lab errors
14 17 14 10 11 12 21 13 13 8 18
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
49
THE COMMONWEALTH
FUND
82 86 8479 80
8679
88
68
7986
0
25
50
75
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Medical, Medication, or Lab Test ErrorsOccurred Outside Hospital
Percent reported error occurred outside hospital
Base: Reported medical mistake, medication error, and/or lab test error or delay in past two years.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
50
THE COMMONWEALTH
FUND
11 13 126 8 9
18
11 116
13
29
40
25 2420
38
49
40
3228
38
0
15
30
45
60
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
1 or 2 doctors 4 or more doctors
Any Medical, Medication, or Lab Test Errors,by Number of Doctors Seen
Percent
Base: Reported medical mistake, medication error, and/or lab test error or delay in past two years.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
51
THE COMMONWEALTH
FUND
51
Insurance Complexity
52
THE COMMONWEALTH
FUND
52
Problems with Health Insurance
Percent reported in the past year:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Spent a lot of time on paperwork or disputes over medical bills
6 6 11 16 8 4 8 3 6 3 17
Health insurance denied payment or did not pay as much as expected
11 12 18 11 15 4 2 2 10 2 25
Yes to either 14 15 23 23 20 6 9 4 13 5 31
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
53
THE COMMONWEALTH
FUND
53
Confidence, Cost and Access Experiences, and Insurance Problems by Income
Slides 54 to 59: Adjusted percentages from logistic regression controlling for age, health status, and, in the U.S., insurance status.
54
THE COMMONWEALTH
FUND
54
Confident Will Receive Most-Effective Treatment if Sick, by Income
79 8088
8288 87
72 70
91 95
8273 71
8578 81 78
6358
8692
65
0
25
50
75
100
AUS* CAN* FR GER NETH* NZ* NOR* SWE* SWIZ* UK US*
Above-average income Below-average income(Adjusted) percent confident/very confident
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
55
THE COMMONWEALTH
FUND
55
Cost-Related Access Problems in the Past Year, by Income
126 8
17
38
4 5 7 4
202218 17
27
13 1521
14 12
4
39
0
25
50
75
AUS* CAN* FR* GER* NETH* NZ* NOR* SWE* SWIZ* UK US*
Above-average income Below-average income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent experienced at least one of three problems**
** Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
56
THE COMMONWEALTH
FUND
56
Out-of-Pocket Spending of $1,000 or More in the Past Year, by Income
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
31
17
510 11 11
16
2
34
0
45
1612
5 5 7 6
15
2
20
0
29
0
15
30
45
60
AUS* CAN* FR GER* NETH NZ* NOR SWE SWIZ* UK US*
Above-average income Below-average income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent
57
THE COMMONWEALTH
FUND
57
52 2 1 2 2 1 2 2 2
910 9
13
711
610 9 9
3
24
0
10
20
30
40
AUS* CAN* FR* GER* NETH* NZ* NOR* SWE* SWIZ* UK US*
Above-average income Below-average income
Serious Problems Paying or Unable to Pay Medical Bills in the Past Year, by Income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
58
THE COMMONWEALTH
FUND
58
60 6459 56
31 3440
67
43
31
5563
7267
55
4437
52
70
4247
68
0
25
50
75
100
AUS CAN* FR* GER NETH* NZ NOR* SWE SWIZ UK* US*
Above-average income Below-average income
Difficulty Getting After-Hours Care, by Income
(Adjusted) percent reported somewhat/very difficult
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. Base: Needed care and answered question.
* Indicates significant within-country differences with below-average income (p < 0.05).
59
THE COMMONWEALTH
FUND
59
Waited Two Months or Longer for Specialist Appointment, by Income
26
40
29
815 14
3532
7
18
7
31
45
30
9
24 26
3531
3
28
10
0
25
50
75
AUS* CAN FR GER NETH* NZ* NOR SWE SWIZ* UK US
Above-average income Below-average income(Adjusted) percent
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. Base: Needed to see specialist in past two years.
* Indicates significant within-country differences with below-average income (p < 0.05).
60
THE COMMONWEALTH
FUND
6060
19
46
7
32
46
33
31
36
69
35
47
0 25 50 75 100
Insured all year,above-averageincome
Insured all year,below-averageincome
Uninsured
Percent
U.S. Adults Under Age 65, by Insurance and Income
Went without care because of cost
$1,000 or more out-of-pocket costs
Serious problem or unable to pay bill
Insurance difficulty
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
61
THE COMMONWEALTH
FUND
6161
Acknowledgments and Cofunders
• Australia: Commission on Safety and Quality in Health Care, Bureau of Health Information
• Canada: Health Council of Canada, Ontario Quality Council, Quebec Health Commission
• France: Haute Authorité de Santé (HAS), Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (CNAMTS)
• Germany: Institute for Quality and Efficiency in Health Care (IQWiG)
• Netherlands: Dutch Ministry of Health, Welfare and Sport, and IQ Health, Radboud University Nijmegen
• Norway: Norwegian Knowledge Centre for the Health Services
• Sweden: Swedish Ministry of Health
• Switzerland: Federal Office of Public Health
• United Kingdom: Health Foundation
Thanks to to Harris Interactive, Inc., and contractors for conducting the survey.