JANUARY

Recommendations

Info

Table 3. Selected Health System Performance Indicators for 11 Countries Adults’ access to care, 2013 New United United Australia Canada France Germany Netherlands Zealand Norway Sweden Switzerland Kingdom States Able to get same-day/next-day appointment when sick 58% 41% 57% 76% 63% 72% 52% 58% n/a 52% 48% Very/somewhat easy getting care after hours 46% 38% 36% 56% 56% 54% 58% 35% 49% 69% 39% Waited 2 months or more for specialist appointment a 18% 29% 18% 10% 3% 19% 26% 17% 3% 7% 6% Waited 4 months or more for elective surgery b 10% 18% 4% 3% 1% 15% 22% 6% 4% n/a 7% Experienced access barrier because of cost in past year c 16% 13% 18% 15% 22% 21% 10% 6% 13% 4% 37% Safety problems among sicker adults, 2014 o,p Health professional did not review their prescriptions in past year 16% 16% 47% 19% 37% 23% 37% 48% 27% 21% 14% Care coordination Experienced a coordination problem in past 2 years d 21% 32% 7% 41% 21% 20% 37% 24% 29% 24% 35% and transitions among older adults, 2014 o Experienced gaps in hospital discharge planning in past 2 years e 41% 44% 54% 56% 59% n/a 70% 67% 56% 38% 28% Chronic care management Had a treatment plan they could carry out in daily life 80% 76% 62% 30% 41% 64% 53% 41% 47% 73% 83% adults, 2014 n,o Between visits, has health care professional they can contact to ask questions or to get advice 65% 67% 53% 43% 83% 75% 55% 75% 58% 71% 84% among older Primary care Routinely receives and reviews clinical outcomes data 35% 23% 43% 44% 88% 65% 32% 79% 9% 86% 52% practices receive performance Routinely receives and reviews patient satisfaction and experience data 46% 17% 3% 25% 61% 60% 9% 88% 15% 88% 63% feedback, 2015 Routinely receives data comparing performance to other practices 13% 17% 49% 29% 42% 61% 4% 55% 37% 71% 37% OECD health care Diabetes lower extremity amputation rates per 100,000 population, 2013 4.5 7.4 7.5 9.2 4.7 k 5.9 j 5.7 4.1 3.1 j 3.1 n/a quality indicators i Breast cancer five-year survival rate, 2008–2013 (or nearest period) 88% q n/a 86.2% 85.8% r 85.3% 86.0% 89.8% r 89.4% n/a 81.1% 88.9% q Mortality after admission for acute myocardial infarction per 100 admissions over age 45, 2013 g 4.1 m 6.7 7.2 8.7 7.6 m,k 6.6 6.7 4.5 m 7.7 7.6 5.5 Avoidable deaths, 2013 Mortality amenable to health care h (deaths per 100,000 population) 68 k 78 k 64 k 88 72 89 k 69 72 n/a 86 115 l Prevention, 2013 i Percentage of children with measles immunization 94% 95% 89% 97% 96% 92% 93% 97% 93% 95% 91% Public views of health system, 2013 Percentage of population over age 65 with influenza immunization n/a 64% 52% 58.6% j 69% 69% 21% 46% 46% l 76% 67% j Works well, minor changes needed 48% 42% 40% 42% 51% 47% 46% 44% 54% 63% 25% Fundamental changes needed 43% 50% 49% 48% 44% 45% 42% 46% 40% 33% 48% Needs to be completely rebuilt 9% 8% 11% 10% 5% 8% 12% 10% 7% 4% 27% Sources (unless noted otherwise): 2013, 2014, and 2015 Commonwealth Fund International Health Policy Surveys. a Base: Saw or needed to see a specialist in past two years. b Base: Needed elective surgery in past two years. c Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care. d Test results/medical records not available at time of appointment and/or doctors ordered medical test that had already been done; received conflicting information from different doctors; and/or specialist lacked medical history or regular doctor was not informed about specialist care. e When discharged from the hospital: you did not receive written information about what to do when you returned home and symptoms to watch for; hospital did not make sure you had arrangements for follow-up care; someone did not discuss with you the purpose of taking each medication; and/or you did not know who to contact if you had a question about your condition or treatment. Base: hospitalized overnight in the past two years. f Base: Has a regular doctor or place of care. g In-hospital case-fatality rates within 30 days of admission. h Source: WHO Mortality files (number of deaths by age group) and populations (except Human Mortality Database for CAN, UK, and US). List of amenable causes: Nolte E, McKee M. Variations in amenable mortality—Trends in 16 high-income nations. Health Policy. 2011 Sep. i Source: OECD Health Data 2015. j 2012. k 2011. l 2010. m Admissions resulting in a transfer are included. n Who had at least one chronic condition. o Age 65 or older. p Who are taking four or more prescription medications regularly. q 2006–11. r 2006–12. 8 The Commonwealth Fund
Table 4. Provider Organization and Payment in 18 Countries Provider ownership Provider payment Primary care role Primary care Hospitals Primary care payment Hospital payment Australia Private Public (~65% of beds), private (~35%) Canada Private Public/private mix (proportions vary by region), mostly not-for-profit China Private/public mix (private village doctors and clinics; public township and community hospitals providing GP services) Public (~55%)/private (~45%) mix (mainly public in rural areas, public and private in urban areas) ~95% FFS, ~5% incentive payments Mostly FFS (~45%–85%, depending on province), but some alternatives (e.g., capitation) for group practices FFS for private providers, salaries and FFS for GPs employed by hospitals Denmark Private Almost all public ~70% FFS, ~30% capitation England Mainly private, limited number of NHS-owned practices with salaried physicians Mostly public, some private France Private Mostly public (67% of capacity), some private for-profit (25%) and private not-for-profit Germany Private Public (~50% of beds); private nonprofit (~33%); private for-profit (~17%) India Israel Mainly public, some private in urban areas Nonprofit, either salaried by Health Plan or Health Plan contractors Private non- and for-profit (~63% of beds) and public Public (~50%), private nonprofit (including health plans, ~45%), private for-profit (~5%) Italy Private Mostly public (~80% of beds), some private (~20%) Japan Mostly private Mainly private nonprofit (~80% of beds), some public (~20%) Mix capitation/FFS/P4P; salary payments for a minority (the salaried GPs are employees of private group practices, not of the NHS) Mix FFS/P4P/flat EUR40 [USD48] bonus per year per patient with chronic disease and regional agreements for salaried GPs a FFS Salary for staff at public providers, FFS (paid OOP) for private providers Mainly capitation and some FFS to private providers, salary if owned by health plan Mix capitation (~70% of total), FFS and limited P4P (~30%) Most FFS, some per-case daily or monthly payments Netherlands Private Mostly private, nonprofit Mix capitation and FFS for ‘core’ activities (75% in total), some bundled payments and P4P negotiated with insurers New Zealand Private Mostly public, some private Mix capitation (~50% of total), FFS patient payments (~50%) Norway Singapore Mainly private (95% of general practitioners) Almost all private, with some larger public clinics for lower-income population Almost all public, some private not-for-profit, some for-profit hospitals offering elective treatment only Mainly public, 20%–30% private based on activity GPs: Capitation from municipal contracts (~35% of income), government-sponsored FFS (~35%) and user-charges (~30%) FFS Global budgets and case-based payment in public hospitals (includes physician costs); FFS in private hospitals Mostly global budgets, case-based payment in some provinces (does not include physician costs) Mainly FFS, with some pilot projects using case-based payments, capitation, or global budgets Mainly global budgets and case-based payments (includes physician costs) Mainly case-based payments (60%) plus budgets for mental health, education, and research and training. All include physician costs, drug costs, etc. Mainly case-based payments (includes physician costs in public hospitals but not in private) and non-activity-based grants for education, research, etc. Case-based payment (includes physician costs) Global budgets for public hospitals Subject to regional variation, mainly case-based payment (except hospitals owned by regional authorities) and global budgets (includes physician costs) Case-based per diem payments plus FFS, or FFS only (includes physician costs) Mainly case-based payment (include physician costs) Global budgets (includes physician costs) Somatic: Global budgets (~50%) plus case-based payment (~50%) (includes physician costs); Psychiatric: 100% global budgets For public hospitals, combination of global budgets and case-based payments Registration with GP required No Not generally, but yes for some capitation models Not generally, with exceptions in some areas Yes (for 98% of population) Yes No, but many patients register voluntarily No No Yes in the largest health plan (Clalit), no in the other three Yes No No, but most patients register voluntarily No No, but more than 95% of patients register voluntarily No Gatekeeping Yes Yes, mainly through financial incentives varying across provinces: e.g., in most provinces, specialists receive lower fees for patients not referred Not generally, with exceptions in some areas Yes (for 98% of population) Yes Voluntary but incentivized: higher cost-sharing for visits and prescriptions without a referral from the physician with which patients registered Generally no, present in specific programs by sickness funds No Yes in two of the four health plans (including the largest, Clalit), no in the other two Yes No, but some large hospitals and academic centers charge extra fees to patients not referred Yes Yes Yes No Sweden Mixed, ~40% private ~60% public Almost all public, some private for- and not-for-profit Mix capitation (~80% of total) and FFS/limited P4P (~20%) Global budgets (~66% of total) and case-based payment/limited P4P (includes physician costs) Yes, in all counties except Stockholm No Switzerland Private Mostly public or publicly subsidized private, some private Most FFS, some capitation in managed care plans offered by insurers Case-based payments (~50% of total) and subsidies (through various mechanisms) from cantonal government No, except in some managed care plans offered by insurers No, except in some managed care plans with gatekeeping offered by insurers United States Private Mix of nonprofit (~70% of beds), public (~15%), and for-profit (~15%) Most FFS, some capitation with private plans; some incentive payments Mostly per-diem and case-based payments (usually does not include physician costs) No In some insurance programs a Bracketed figure in USD was converted from local currency using the purchasing power parity conversion rate for GDP in 2014 reported by the Organisation for Economic Co-operation and Development (2015). Notes: FFS = fee-for-service; P4P = pay-for-performance; GP = general practitioner; NHS = National Health Service; OOP = out-of-pocket. International Profiles of Health Care Systems, 2015 9
Page 1 and 2: JANUARY 2016 2015 International Pro
Page 3: 2015 International Profiles of Heal
Page 6 and 7: Table 1. Health Care System Financi
Page 11 and 12: The Australian Health Care System,
Page 13 and 14: AUSTRALIA low-income adults, childr
Page 15 and 16: AUSTRALIA In 2013, the federal gove
Page 17 and 18: What is being done to reduce dispar
Page 19: References AUSTRALIA Australian Bur
Page 22 and 23: CANADA What is covered? Services: T
Page 24 and 25: CANADA funding to 145 not-for-profi
Page 26 and 27: CANADA Organization of the Health S
Page 28 and 29: CANADA provides recommendations to
Page 30 and 31: CANADA Health Council of Canada (20
Page 32 and 33: CHINA Private health insurance: Com
Page 34 and 35: CHINA is not substantially more exp
Page 36 and 37: CHINA Organization of the Health Sy
Page 38 and 39: CHINA References Chen, X. (2014).
Page 40 and 41: DENMARK In addition, nearly 1.5 mil
Page 42 and 43: DENMARK Social psychiatry and care
Page 44 and 45: DENMARK Quality data for a number o
Page 46 and 47: DENMARK portion is small, it makes
Page 48 and 49: 48
Page 50 and 51: ENGLAND immunization, and vaccinati
Page 52 and 53: ENGLAND Hospitals: Publicly owned h
Page 54 and 55: ENGLAND Organization of the Health
Page 56 and 57: ENGLAND How are costs contained? Ra
Page 58 and 59:
ENGLAND Organisation for Economic C
Page 60 and 61:
FRANCE VHI finances 13.8 percent of
Page 62 and 63:
FRANCE The average income of primar
Page 64 and 65:
FRANCE What are the key entities fo
Page 66 and 67:
FRANCE inequities in prevention rel
Page 68 and 69:
FRANCE Nolte, E., C. Knai, and M. M
Page 70 and 71:
GERMANY There were 42 substitutive
Page 72 and 73:
GERMANY The 16 state governments de
Page 74 and 75:
GERMANY management system, by the s
Page 76 and 77:
GERMANY What major innovations and
Page 78 and 79:
INDIA Private health insurance: The
Page 80 and 81:
INDIA provide after-hour care, reim
Page 82 and 83:
INDIA are provided by other ministr
Page 84 and 85:
INDIA How are costs contained? Ther
Page 86 and 87:
86
Page 88 and 89:
ISRAEL Together, these two types of
Page 90 and 91:
ISRAEL Primary care physicians are
Page 92 and 93:
ISRAEL Organization of the Health S
Page 94 and 95:
ISRAEL • Using electronic health
Page 96 and 97:
96
Page 98 and 99:
ITALY during hospitalization (Thoms
Page 100 and 101:
ITALY Some regions are promoting ca
Page 102 and 103:
ITALY Organization of the Health Sy
Page 104 and 105:
ITALY although the degree of evolut
Page 106 and 107:
ITALY The author would like to ackn
Page 108 and 109:
JAPAN What is covered? Services: Al
Page 110 and 111:
JAPAN incentives for providers to c
Page 112 and 113:
JAPAN Organization of the Health Sy
Page 114 and 115:
JAPAN The author would like to ackn
Page 116 and 117:
THE NETHERLANDS receive faster acce
Page 118 and 119:
THE NETHERLANDS Hospital payment ra
Page 120 and 121:
THE NETHERLANDS Organization of the
Page 122 and 123:
THE NETHERLANDS References Organisa
Page 124 and 125:
NEW ZEALAND provided in GP clinics.
Page 126 and 127:
NEW ZEALAND management (e.g., clean
Page 128 and 129:
NEW ZEALAND including such informat
Page 130 and 131:
NEW ZEALAND largely through efficie
Page 132 and 133:
132
Page 134 and 135:
NORWAY Primary, preventive, and nur
Page 136 and 137:
NORWAY Patients are free to choose
Page 138 and 139:
NORWAY What are the major strategie
Page 140 and 141:
NORWAY The National System for the
Page 142 and 143:
142
Page 144 and 145:
SINGAPORE Medifund is the governmen
Page 146 and 147:
SINGAPORE Public hospital funding i
Page 148 and 149:
SINGAPORE Public consultation: The
Page 150 and 151:
SINGAPORE To keep demand for servic
Page 152 and 153:
152
Page 154 and 155:
SWEDEN What is covered? Services: T
Page 156 and 157:
SWEDEN Hospitals: There are seven u
Page 158 and 159:
SWEDEN Care, which promotes use of
Page 160 and 161:
SWEDEN What major innovations and r
Page 162 and 163:
SWITZERLAND Insurers offer premiums
Page 164 and 165:
SWITZERLAND Hospitals: About 70 per
Page 166 and 167:
SWITZERLAND Organization of the Hea
Page 168 and 169:
SWITZERLAND To control pharmaceutic
Page 170 and 171:
170
Page 172 and 173:
UNITED STATES What is covered? Serv
Page 174 and 175:
UNITED STATES Administrative mechan
Page 176 and 177:
UNITED STATES The Institute of Medi
Page 178 and 179:
UNITED STATES adopted at least a ba
Page 180:
The COMMONWEALTH FUND Affordable, q
show all

JANUARY

Create successful ePaper yourself

Delete template?

Save as template?