For our assessment of health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, we used indicators available across five domains:
For more information on these performance domains and their component measures, see How We Measured Performance. Most of the data were drawn from surveys examining how members of the public and primary care physicians experience health care in their respective countries. These Commonwealth Fund surveys were conducted by SSRS in collaboration with partner organizations in the 10 other countries. Additional data were drawn from the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).
Public Health And Preventive Medicine In Canada Shah Pdf Free Download
Download File 🔥 https://urloso.com/2yGb5A 🔥
Readers familiar with the previous edition of this report (2017) will notice that some of the country ranks have changed. These changes should be interpreted with caution. While most of the 71 measures included in the new edition are identical to those used in 2017, 10 measures were modified because survey items, response categories, or available data changed. We replaced 17 of the 2017 measures with 16 new measures to reflect newly available data as well as to better represent previously defined performance domains and subdomains. An expert advisory panel reviewed the proposed changes. See Appendix 2 for more detail on the changes by domain.
Care process includes measures of preventive care, safe care, coordinated care, and engagement and patient preferences. The U.S. ranks #2 on this performance domain (Exhibit 1). Along with the U.K. and Sweden, the U.S. achieves higher performance on the preventive care subdomain, which includes rates of mammography screening and influenza vaccination as well as the percentage of adults who talked with their provider about nutrition, smoking, and alcohol use. New Zealand and the U.S. perform best on the safe care subdomain, with higher reported use of computerized alerts and routine review of medications. Still, in all countries, more than 10 percent of adults report experiencing medical or medication mistakes in their care.
New Zealand, Switzerland, and the Netherlands perform best among countries on the coordinated care subdomain. Switzerland, New Zealand, Australia, Norway, and France perform well on measures related to communication between primary care doctors and specialists. No country stood out at achieving good communication between the primary care and hospital, emergency department, and home-based care provider or coordination with local social services providers.
The U.S. and Germany achieve the highest performance on the engagement and patient preferences subdomain, although U.S. adults have the lowest rates of continuity with the same doctor. Among people with chronic illness, U.S. adults are among the most likely to discuss goals, priorities, and treatment options with their provider, though less likely to receive as much support from health professionals as they felt was needed.
Use of web-based portals for communicating medical concerns and refilling medications is highest among adults in Norway and the U.S. In the year prior to the COVID-19 pandemic, primary care clinicians in Sweden and Australia were the most likely to report using video consultations.
Administrative efficiency refers to how well health systems reduce documentation (paperwork) and other bureaucratic tasks that patients and clinicians frequently face during care. The top performers on the administrative efficiency domain are Norway, Australia, New Zealand, and the U.K. (Exhibit 1). The U.S. ranks last.
Our analysis of equity focuses on income-related disparities, based on standardized data across the 11 countries, in the access to care, care process, and administrative efficiency performance domains. Similar standardized data are not available for measuring equity in performance with respect to different racial and ethnic groups (see How We Measured Performance for more detail).
Within these countries, experiences reported by people in lower- and higher-income groups on 11 indicators in the affordability, timeliness, preventive care, safe care, and engagement and patient preferences subdomains are less divergent than they are within other countries (Appendix 7).
In contrast, the U.S. consistently demonstrated the largest disparities between income groups, except for those measures related to preventive services and safety of care. U.S. disparities are especially large when looking at financial barriers to accessing medical and dental care, medical bill burdens, difficulty obtaining after-hours care, and use of web portals to facilitate patient engagement. Compared to the other countries, the United States and Canada had larger income-related inequities in patient reported experiences.
In Exhibit 7, income-related performance disparities in Switzerland and Australia are as small as those in Germany and the U.K. But the cost-related access problems for higher-income residents of Switzerland and Australia resemble the levels seen among lower-income residents of the Netherlands and Canada. Adults with higher incomes in the U.S., Switzerland, and Australia are as likely as, or more likely than, adults with lower incomes in five countries to report cost-related access problems.
Health care outcomes reported here refer to those health outcomes that are most likely to be responsive to health care. On this domain, Australia, Norway, and Switzerland rank at the top of our 11-nation group (Exhibit 1). Norway has the lowest infant mortality rate (two deaths per 1,000 live births), while Australia has the highest life expectancy after age 60 (25.6 years of additional life expectancy for those who survive to age 60).
The U.S. ranks last overall on the health care outcomes domain (Exhibit 1). On nine of the 10 component measures, U.S. performance is lowest among the countries (Appendix 8), including having the highest infant mortality rate (5.7 deaths per 1,000 live births) and lowest life expectancy at age 60 (23.1 years). The U.S. ranks last on the mortality measures included in this report, with the exception of 30-day in-hospital mortality following stroke. The U.S. rate of preventable mortality (177 deaths per 100,000 population) is more than double the best-performing country, Switzerland (83 deaths per 100,000).
The U.S. has exceptionally poor performance on two other health care outcome measures. Maternal mortality is one: the U.S. rate of 17.4 deaths per 100,000 live births is twice that of France, the country with the next-highest rate (7.6 deaths per 100,000 live births).
Some high-income nations get more for their health dollars than the U.S. does. As nations strive for better health care and better health for their residents, several basic lessons emerge from our findings.
The striking contrast in performance between the U.S. and other high-income countries on avoidable mortality measures points to several intervention or policy targets. How have top-performing countries reduced avoidable mortality? A comparison of the features of top-performing countries and poorer-performing countries suggests that top-performing countries rely on four features to attain better and more equitable health outcomes:
Prioritizing maternal health is critical for reducing maternal mortality. Top-performing countries have had success in preventing maternal deaths through the removal of cost sharing for maternal care. They invest in primary care models that ensure continuity of care from conception through the postpartum period, including midwife-led models. They offer social support benefits, including parental leave.
The U.S. remains the only high-income country lacking universal health insurance coverage. With nearly 30 million people still uninsured and some 40 million with health plans that leave them potentially underinsured, out-of-pocket health care costs continue to mar U.S. health care performance.
Top-performing countries achieve near-universal coverage and much higher levels of protection against medical costs in the form of annual out-of-pocket caps on covered benefits and full coverage for highly beneficial preventive services, primary care, and effective treatments for chronic conditions. Germany abolished copayments for physician visits in 2013, while several countries have fixed annual out-of-pocket maximums for health expenditures (ranging from about USD 300 per year in Norway to USD 2,645 in Switzerland).
Australia addresses income-related equity through a mix of annual spending caps that are lower for low-income individuals as well as incentives for people to seek primary care. In 2019, 86 percent of Australians faced no out-of-pocket costs for primary care visits.
In top-performing countries, workforce policy is geared to ensuring access within communities, especially those that have been historically marginalized. Norway, with the highest number of doctors per person among the 11 countries in our study, has a much larger supply of physicians relative to its population than the U.S. has. Outside the U.S., a larger proportion of clinicians are devoted to primary care and are geographically distributed to match population needs. For example, Norwegian local municipalities, which are responsible for the supply of GPs, may apply to the national government for extra funding to ensure they have an adequate number of physicians.
Administrative requirements cost both time and money for patients, clinicians, and managers while also diverting resources away from efforts to improve care. Our results are consistent with other studies showing that administrative costs are more substantial in the U.S. than in other high-income countries. Many countries have simplified their health insurance and payment systems, usually through legislation, regulation, and standardization. For example, top-ranked Norway determines patient copayments for physician fees on a regional basis, applying the standardized copayments to all physicians practicing in the public sector within a specialty within a geographic area. 152ee80cbc
avery cd labels template 5931 download free