THE COMMONWEALTH FUND 1 Comparing Health Care Systems Performance: Opportunities for Learning from Abroad Alliance for Health Reform April 11, 2008 Robin Osborn Vice President and Director International Program in Health Policy The Commonwealth Fund

THE COMMONWEALTH FUND 2 US Scorecard: Falls Short of Benchmarks on All Dimensions of a High Performance Health System Indicators U.S. compared to benchmarks Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006

THE COMMONWEALTH FUND 3 International Comparison of Spending on Health, 1980–2004 Data: OECD Health Data 2007 (October 2007) Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP

THE COMMONWEALTH FUND 4 Health Care Expenditure per Capita by Source of Funding in 2005 Adjusted for Differences in Cost of Living ab a 2004 b 2002 Source: OECD Health Data 2007

THE COMMONWEALTH FUND 5 Average Length of Stay in Hospital in 2005 a 2004 b 2003 c Source: NZ Ministry of Health, 2004 aac Source: OECD Health Data 2007 (October 2007) Average Number of Physician Visits per Capita in 2005 Utilization of Health Care Services baaaa

THE COMMONWEALTH FUND 6 Coronary Bypass Procedures per 100,000 population in 2005 a 2004 a Source: OECD Health Data 2007 (October 2007) a a a

THE COMMONWEALTH FUND 7 Spending on Physician Services per Capita in 2005 Adjusted for Differences in Cost of Living a 2004 a Source: OECD Health Data 2007 (October 2007)

THE COMMONWEALTH FUND 8 Percentage of Total Health Care Spending on Health Insurance Administration in 2005 a 2004 aa Note: Total health care spending on health insurance administration includes insurer costs only. Source: OECD Health Data 2007 (October 2007) 8 a

THE COMMONWEALTH FUND 9 Mortality Amenable to Health Care, Deaths per 100,000 population* * Countries age-standardized death rates, ages 0–74; includes ischemic heart disease DATA: International: WHO mortality database from Nolte and McKee 2008 Mortality from causes considered amenable to health care is deaths before age 75 that are potentially preventable with timely and appropriate medical care.

THE COMMONWEALTH FUND 10 Unable to Get Needed Care Because of Costs* Percent reporting yes Source: 2007 Commonwealth Fund International Health Policy Survey * Percent reporting yes to at least one of the following in the past year: Did not fill a prescription or skipped doses; had a medical problem but did not visit a doctor; skipped test, treatment or follow-up.

THE COMMONWEALTH FUND 11 Relationship with Regular Doctor Percent:AUSCANGERNZUKUS Has Regular Doctor years or more NO Regular Doctor Source: 2005 Commonwealth Fund International Health Policy Survey: Adults with Health Problems

THE COMMONWEALTH FUND 12 Percent Source: 2007 Commonwealth Fund International Health Policy Survey Able to Get Same Day Appointment with Doctor ER Use for Condition Doctor Could Have Treated if Available Percent Access to Primary Care

THE COMMONWEALTH FUND 13 Deficiencies in Care Coordination: Test or Records Not Available for Appointment/ Duplicate Tests Ordered Percent Source: 2007 Commonwealth Fund International Health Policy Survey

THE COMMONWEALTH FUND 14 Medical Mistake, Medication, or Lab Error in Past 2 Years* Percent any error Source: 2007 Commonwealth Fund International Health Policy Survey *Patient reports of medical mistake, medication error, or error in lab results (incorrect results or delay in getting abnormal results).

THE COMMONWEALTH FUND 15 Primary Care Practices With Electronic Medical Records Percent Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians

THE COMMONWEALTH FUND 16 Primary Care Doctors Reports of Financial Incentives Targeted on Quality of Care Percent receive financial incentive:* AUSCANGERNETHNZUKUS Achieving certain clinical care targets High ratings for patient satisfaction Managing patients with chronic disease/ complex needs Enhanced preventive care activities Participating in quality improvement activities * Receive or have the potential to receive. Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

THE COMMONWEALTH FUND 17 Overall Views of the Health Care System in Seven Countries, 2007 Percent reported: AUSCANGERNETHNZUKUS Only Minor Changes Needed Fundamental Changes Needed Rebuild Completely Source: 2007 Commonwealth Fund International Health Policy Survey

THE COMMONWEALTH FUND 18 Summary of Findings Country patterns reflect underlying strategic policy choices Universal coverage matters National policies and leadership matter Having a national system matters Aligning financial incentives can enhance quality and value Primary Care redesign is key to improving health system performance

THE COMMONWEALTH FUND 19 Acknowledgements With great appreciation to Meghan Bishop, Cathy Schoen, Karen Davis, and Stephen C. Schoenbaum for their contributions to this presentation