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EMBARGOED UNTIL TUESDAY DECEMBER 8, 2015
Robin Osborn and Eric Schneider
The Commonwealth Fund
2015 Commonwealth Fund International Health Policy Survey
of Primary Care Physicians
1
2015 Commonwealth Fund International Health Policy Survey 2
• 18th annual survey
• Views and experiences of primary care doctors in 11 countries
• Samples: Australia (747), Canada (2,284), France (502), Germany (559),
Netherlands (618), New Zealand (503), Norway (864), Sweden (2,905),
Switzerland (1,065), United Kingdom (1001), and United States (1,001)
• Field period was March to June 2015 (France – September to
November 2015)
• Topics:
• Practice preparedness to manage patients with complex needs
• Capacity to provide access and care management
• Communication and care coordination
• Health information technology
• System views and physician satisfaction
Doctors’ Views of Practice Preparedness to Manage Care for Patients
with Complex Needs
3
4
Primary Care Practice Capacity to Provide Enhanced Access and Care Management
5
Practice Uses Nurses or Case Managers to Monitor and Manage Care for Patients with Chronic Conditions
6
Percent
96 96 92 90
85 81
66 65 64 60
28
0
20
40
60
80
100
FR UK NETH NZ SWE AUS US NOR CAN SWIZ GER
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Practice Staff Frequently Make Home Visits 7
88 84
57 55
43
25 24 20 20 19
6
0
20
40
60
80
100
NETH UK GER FR SWIZ AUS SWE NZ NOR CAN US
Percent
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Practice Has Arrangement for Patients to See Doctor or Nurse for After-Hours Care
8
94 92 89
85 80 78
75 71 69
48
39
0
20
40
60
80
100
NETH NZ UK GER NOR AUS SWE FR SWIZ CAN US
Percent
* In Norway, respondents were asked whether there 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 Access 9
Percent reporting
their practice offers
patients the option
to:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
E-mail about
medical question
or concern 30 15 54 50 57 53 32 61 80 38 57
View online,
download, or
transmit
information from
their medical
record
11 7 18 8 13 24 3 20 11 28 60
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Primary Care Doctors’ Experiences with
Communication and Care Coordination
10
Primary Care Doctors’ Communication with Emergency Department and Hospital
11
59
43
32
26 25 23 21
16 16 14
4
0
20
40
60
80
NETH NZ UK US NOR CAN SWIZ GER FR AUS SWE
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Percent who report they always receive notification
when a patient is seen in the ED and when a patient is discharged from the hospital:
Practice Routinely Communicates with Home Care Providers About Patients’ Needs and Services
12
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
63 56 55 53 52 51
36 34 32 29 28
0
20
40
60
80
100
NOR NETH SWIZ SWE US GER FR UK CAN AUS NZ
Base: Excludes those who responded “not applicable.”
Percent
Practice Frequently Coordinates Care with Social Services or Other Community Providers
13
Percent
65 63 60 58
51 50 45 43 42 42
35
0
20
40
60
80
100
UK GER SWIZ NZ NOR CAN AUS US NETH SWE FR
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Health Information Technology
14
Doctors’ Use of Electronic Medical Records, 2006-2015 15
Source: 2006-2015 Commonwealth Fund International Health Policy Survey of Primary Care
Physicians.
Percent
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2009 2012 2015
NZ (100%)
NOR (99%)
SWE (99%)
NETH (98%)
UK (98%)
AUS (92%)
GER (84%)
US (84%)
CAN (73%)
FR (70%)
SWIZ (54%)
Doctor Routinely Receives Computerized Reminder for Guideline-Based Intervention or Screening Tests
16
68
46 51
33
22 19
12 8 6
9 6
77
61 56
47
27 26 20
15 10 9 7
0
20
40
60
80
100
UK NZ AUS US FR CAN NETH GER NOR SWIZ SWE
2012 2015
Percent
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Doctor Can Electronically Exchange Patient Summaries with Doctors Outside their Practice
17
58
67
58 54
46
59
46
33 30
23
14
82
75 70
67
60 57
49
42
34
22 19
0
20
40
60
80
100
NOR NZ NETH SWE UK SWIZ FR US AUS GER CAN
2012 2015
Percent
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Satisfaction with Electronic Medical Record 18
86 80 80
77 76 70 69 68
64
52
37
0
20
40
60
80
100
UK AUS FR GER NETH SWIZ NZ CAN NOR US SWE
Percent of primary care doctors reporting they are very satisfied or satisfied with their
electronic medical record
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Base: Doctors reporting they use an electronic record
Primary Care Doctors’ Views of the Health Care System and
Practice Issues
19
20 Overall Views of Health Care System
Among Primary Care Physicians, 2015
16
19
22
27
29
36
48
50
54
57
67
69
70
72
61
57
61
49
46
44
42
31
14
11
6
12
12
3
2
2
2
1
1
0% 20% 40% 60% 80% 100%
US
SWE
UK
GER
FR
CAN
AUS
NETH
SWIZ
NZ
NOR
Works well, only minor changes Fundamental changes Completely rebuild
Percent
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. .
Physician Views of the Health System, 2012 and 2015: “System Works Well, Only Minor Changes Needed”
21
45 40 37
22
54 53
61
39
46 46
15
48
36 29 27
50 57
67
19
54
22 16
0
20
40
60
80
100
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
2012 2015
Percent
Source: 2012 & 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Physician Views of Whether the Quality of Care Has Improved in the Past Three Years, 2015
22
Percent
responding quality
of care has:
AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US
Improved 24 25 12 15 21 32 33 21 13 22 25
Stayed the same 58 53 36 55 44 52 58 42 65 42 41
Become Worse 18 21 51 29 34 16 8 36 21 36 33
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Physician Satisfaction with Practicing Medicine, 2015 23
91 88 87 87 84 83 75
67 65 64 63
8 12 13 14 16 15 24
33 34 33 36
0
20
40
60
80
100
NOR AUS NZ SWIZ CAN NETH SWE UK US FR GER
Very satisfied/satisfied Somewhat/very dissatisfied
Percent
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Physician Satisfaction with Income from Medical Practice 24
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
82 81 81 78
74 72 72 67 66 64
54
0
20
40
60
80
100
SWE NETH NOR CAN NZ GER SWIZ UK US AUS FR
Percent who report they are very satisfied or satisfied with income from medical practice:
Time Practice Spends on Insurance Issues or Claiming Payments is a MAJOR problem
25
9
20 20 21 21 27
50 52 54 60
63
0
20
40
60
80
100
NOR CAN NZ AUS UK SWE SWIZ GER US NETH FRA
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:
Physician Dissatisfaction with Time Spent per Patient 26
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
25
32 33 33 34
41 44 45
55 58
73
15 20
17 19 20 15
19
10 11
24
11
0
20
40
60
80
100
AUS SWIZ CAN NOR FR NZ US GER NETH SWE UK
Percent who report they are somewhat/very dissatisfied with time spent per patient
Average time spent per patient during routine visit (minutes)
How Stressful is Your Job as Primary Care Physician? 27
Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
17 24
18 18 19 17 16 12 12 6 5
64 55
58 56 53 52
45 44 42
37 36
18 21 24 24 27 31 37 43 45
56 59
0
20
40
60
80
100
NETH AUS NZ NOR CAN SWIZ FR US GER SWE UK
Not too/Not at all Stressful Somewhat Stressful Extremely/Very Stressful
• Strengthening primary care could be key to sustainable quality and spending
• Managing the care of patients with complex needs will require primary care that is highly capable:
– Multidisciplinary teams
– Email access, after-hours care and home visits
– Effective use of health information technology, and
– Integrating care across and outside of the health care system
• Re-designing delivery systems to improve care for patients with complex conditions will require trial and evaluation to understand what works best
• As reforms disrupt current systems, managing the effects of reforms is critical
• It’s important for policymakers to hear from doctors on the frontlines
• Looking to other countries offers an opportunity for valuable cross-national lessons to be learned
Take-Away Messages
28
SPECIAL THANKS TO OUR COUNTRY 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 great appreciation to Dana Sarnak, David Squires, Michelle Doty,
Donald Moulds, David Blumenthal, SSRS, and our country partners for
their contributions to the design of the survey, the content, and
production of this presentation.
29
