The 2002 Commonwealth Fund International Health Policy Survey Adults with Health Problems The Commonwealth Fund Harvard University School of Public Health Harris Interactive, Inc. For release with five-country article in May/June 2003 Health Affairs

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 2 Adults with health problems Methods Survey of sicker adults in Australia, Canada, New Zealand, United Kingdom, and the United States. Adults met at least one of the following criteria: –Self reported health status is fair or poor –Serious illness in the past 2 years –Hospitalized or had major surgery in the past 2 years Final sample size of 750 in CA, NZ, UK and US. 844 in Australia One fourth to one third of adults initially screened in each country Conducted by Harris Interactive and subcontractors from March 25, 2002 to May 13, 2002 Margin of error + or – 4 percentage points for differences between countries.

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 3 Adults with health problems Overall System View

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 4 Adults with health problems Dissatisfaction with the health care system Percent very or somewhat dissatisfied with their country’s health care system in general

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 5 Adults with health problems Two Biggest Problems with the Health Care System Most Frequently Cited Problems: AUSCANNZUKUS High cost of health care Inadequate coverage of services Shortages Waiting times Not enough government funding

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 6 Adults with health problems Single Most Important Thing Government Can Do to Improve Health Care AUSCANNZUKUS Spend more money Increase number of health professionals Reduce costs Improve coverage425121

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 7 Adults with health problems Care Coordination

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 8 Adults with health problems Number of Doctors or Health Professionals Visited in the Past Two Years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 9 Adults with health problems Care Coordination

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 10 Adults with health problems Percent reporting receiving conflicting information from different health professionals by number of doctors

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 11 Adults with health problems Percent reporting being sent for duplicate tests by different health professionals in the past 2 years by number of doctors

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 12 Adults with health problems Prescription Drugs

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 13 Adults with health problems Number of prescription medications taken regularly Percent who take…

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 14 Adults with health problems Percent saying doctor has not reviewed/discussed all of the medications they take in the past two years Base: Adults taking prescription drugs regularly

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 15 Adults with health problems Problems with prescription drugs Any prescription medications that you: AUSCANNZUKUS Stopped taking without doctors advice due to side effects Skip doses to make the medication last longer Have been taking that cause serious side effects that the doctor didn’t tell you about

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 16 Adults with health problems Medication and Medical Errors

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 17 Adults with health problems Medication and Medical Errors Percent in the past two years: AUSCANNZUKUS Given the wrong medication or wrong dose by a doctor, hospital or pharmacist Believed a medical mistake was made in your treatment or care Medication error or believed an error was made

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 18 Adults with health problems Among those reporting an error, percent who said error caused serious health consequences Base: Reported a medication error or believed an error was made in their care

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 19 Adults with health problems Percent reporting medication error or medical mistake in past 2 years by number of doctors

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 20 Adults with health problems Patient–Physician Communication and Ratings of Physician Care

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 21 Adults with health problems Communication with Physicians In the past 2 years:AUSCANNZUKUS Left a doctor’s office without getting important questions answered Did not follow a doctor’s advice

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 22 Adults with health problems Missed Opportunities in Patient Discussions with Regular Doctor

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 23 Adults with health problems Communication with Physicians About Coping with Illness Percent saying physician has NOT discussed the emotional burden of coping with condition in the past 2 years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 24 Adults with health problems Patient Ratings of Physician Care Percent rating physician as excellent or very good: AUSCANNZUKUS How well he or she diagnosed your problem Spending enough time with you Being accessible by phone or in person Listening carefully to your health concerns

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 25 Adults with health problems Waiting Times, Access, and Access Problems Due to Cost

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 26 Adults with health problems Problems with Waiting Times to Get an Appointment with Regular Doctor Percent reporting waiting time for an appointment with regular physician was a big problem in the past 2 years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 27 Adults with health problems Percent saying doctors not spending enough time during office visits was a big problem in the past 2 years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 28 Adults with health problems Difficulty Seeing a Specialist Percent reporting it is very or somewhat difficult to see a specialist

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 29 Adults with health problems Reasons It Was Difficult to See Specialist* AUSCANNZUKUS Having to wait for an appointment, long waiting times for type of care Unable to afford/lack of (private) insurance Being denied a referral or having to wait for a referral Facilities or service not available locally or lack of doctors available * Does not add to 100% due to multiple responses Base: Sicker adults reporting it somewhat or very difficult to see a specialist

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 30 Adults with health problems Percent reporting long waits to be admitted to the hospital were a big problem in the past 2 years Base: Hospitalized in past 2 years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 31 Adults with health problems Percent reporting having a scheduled surgery or procedure delayed because of cancellation was a big problem in past 2 years Base: Hospitalized with major surgery in past 2 years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 32 Adults with health problems Base: Respondent or family member hospitalized in the past 2 years Percent reporting delays or problems while discharge arrangements were being made

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 33 Adults with health problems Emergency Room Use Percent who used or tried to use an emergency room in the past two years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 34 Adults with health problems Percent reporting waiting time for emergency care was a big problem Base: Used an emergency room in the past two years

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 35 Adults with health problems Access Problems Due to Cost In the past two years, did not do the following due to cost: AUSCANNZUKUS Did not fill a prescription Did not get medical care Did not get recommended test, treatment, or follow up Did not get dental care

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 36 Adults with health problems Summary and Implications Experiences of adults with health problems indicate areas of common concerns and varying performance –Care coordination problems: duplicate tests, delays and conflicting information –Deficiencies in patient-doctor communications lead to missed opportunities –Medical care and medication errors Access barriers exist in all five nations but the source and type of barrier vary widely Opportunities exist to improve care and to learn as nations tackle areas of common concern Yet, priority areas of emphasis are likely to differ

2002 Commonwealth Fund International Health Policy Survey Commonwealth Fund/Harvard/Harris Interactive 37 Adults with health problems Methods The Commonwealth Fund 2002 International Health Policy Survey consisted of interviews with adults with health problems in each of five countries: Australia, Canada, New Zealand, the United Kingdom, and the United States. To identify these adults, the survey screened initial random samples of adults 18 or older who met at least one of four criteria: reported their health as fair or poor; had serious illness, injury or disability that required intensive medical care in the past two years; or in the last two years had major surgery or had been hospitalized for something other than a normal, uncomplicated delivery of a baby. These questions resulted in a final sample of 750 or more “sicker adults” in each country who were eligible to participate in the full survey. (AUS 844, CAN 750, NZ 750, UK 750, US 755). This final survey sample represents one fourth to one third of the adults initially contacted. These sicker adults are among the most intensive users of the health care system and are particularly vulnerable to variations in quality and outcomes of care. Harris Interactive, Inc. and country affiliates conducted the interviews by telephone between March and May 2002.