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THE

COMMONWEALTH
FUND

The Commonwealth Fund


2012 International Health Policy Survey
of Primary Care Physicians
2012 INTERNATIONAL SYMPOSIUM ON HEALTH CARE POLICY
Cathy Schoen and Robin Osborn
The Commonwealth Fund
November 2012

2012 Commonwealth Fund International Health Policy Survey

Mail and phone survey of primary care physicians in Australia,


Canada, France, Germany, Netherlands, New Zealand, Norway,
Sweden, Switzerland, United Kingdom, and United States
Samples: Australia (500), Canada (2,124), France (501), Germany
(909), Netherlands (522), New Zealand (500), Norway (869), Sweden
(1,314), Switzerland (1,025), United Kingdom (500), and United
States (1,012)
Survey in the field March to July 2012
Conducted by Harris Interactive and country contractors
Core topics: Health information technology; access; care
coordination; financial incentives for quality improvement;
assessment and feedback of practice performance; system views
and physician satisfaction
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Health Information Technology

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Doctors Use of Electronic Medical Records


in Their Practice, 2009 and 2012
Percent

100

99 98 97 98 97 97
96 97 95
92 94

2009
88

80

2012

82
72

69 68 67
56

60

46
37

40

41

20

0
NETH NOR

NZ

UK

AUS

SWE

GER

US

FR

CAN

SWIZ
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Source: 2009 and 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Doctors with Electronic Medical Records and


Multifunctional Health IT Capacity
Percent

Uses EMR
100
80

97

Uses EMR with multifunctional HIT capacity


98

97

92

98
88
69

68
60

60

82
67

59

56
41

40

33

27

20

12

11

10

SWIZ

CAN

GER

FR

NOR

0
UK

AUS

NZ

NETH

US

SWE

Note: Multifunctional health IT capacityuses electronic medical record and at least two electronic functions: for order
entry management, generating patient information, generating panel information, and routine clinical decision support.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

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Doctor Routinely Receives Electronic Prompts About


Potential Problems with Rx Dose or Interaction
Percent

100

93

89

88

85

80

70
58

60

41

40

30

26

25

GER

SWIZ

22

20

0
NET

NZ

AUS

UK

SWE

US

FRA

CAN

NOR
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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Doctor Can Electronically Exchange Patient Summaries


and Test Results with Doctors Outside their Practice
Percent

100

80

60

55

52

49

49

45

40

39

38
31

27

22

20

14

0
NZ

SWE

NET

SWIZ

NOR

FRA

UK

US

AUS

GER

CAN
THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Access and Barriers to Care

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Doctors Perception of Patient Access Barriers

Percent
reporting
their patients
OFTEN have:

AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Difficulty paying
out-of-pocket
costs

25

26

29

21

42

26

16

13

59

Difficulty getting
diagnostic tests

16

38

41

27

59

10

15

14

23

Long waits to
see a specialist

60

73

59

68

21

75

60

49

10

28

28

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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

10

Practice Has Arrangement for Patients After-Hours Care


to See Doctor or Nurse
Percent

100

95

94

90

89
81

80

80

78

76
67

60

45
40

34

20

0
UK

NETH

NZ

GER

AUS

NOR* SWIZ

FR

SWE

CAN

* In Norway, respondents were asked whether there practice has arrangements or if there are regional arrangements.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

US
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Almost All Patients Can Get Same- or Next-Day Appointment


Percent of doctors responding almost all patients (>80%) can get a
same- or next-day appointment when one is requested

100

86
80

62
60

61

59

56

55
47

42

38

40

28

22

20

0
FR

SWIZ NETH

NZ

GER

UK

US

NOR

AUS

SWE

CAN
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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

12

Electronic Access for Patients

Percent
reporting their
practice allows
patients to:

AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Request
appointments or
referrals online

17

22

13

13

51

66

30

40

30

Request refills
for prescriptions
online

15

26

63

25

53

88

48

56

36

E-mail about
medical
question

20

11

39

45

46

38

26

41

68

35

34

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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

13

Care Coordination

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Practice Uses Nurse Case Managers or Navigators


for Patients with Serious Chronic Conditions
Percent

100

80

78

73

68

68
59

60

51
44

43

41

40

20

20

0
UK

NETH

NZ

SWIZ

AUS

NOR

CAN

US

Note: Question asked differently in France.


Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

SWE

GER
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COMMONWEALTH
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Primary Care Doctors Receipt of Information from Specialists

Percent said after


their patient visits
a specialist they
always receive:

15

AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Report with all


relevant health
information

32

26

51

13

13

41

26

12

59

36

19

Information
about changes to
patients drugs or
care plan

30

24

47

12

44

22

13

44

41

16

Information that
is timely and
available when
needed

13

11

26

15

27

18

11

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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

After Hospital Discharge, Primary Care Doctor Receives Needed


Information to Manage the Patient Within 48 Hours

16

Percent

100
80

67
56

60

45

42

40

40

36
21

20

21

15

14

CAN

NOR

10

0
GER

NZ

US

NET

SWIZ

AUS

UK

SWE

FRA
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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

17

Financial Incentives or Support


for Quality Improvement

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Financial Incentives and Targeted Support


Percent can
receive financial
incentives* for:

AUS

CAN

FR

GER

NET

NZ

NOR

SWE

SWIZ

UK

US

Managing patients
w/ chronic disease
or complex needs

75

70

37

60

77

83

15

49

50

21

Enhanced
preventive care
activities**

42

42

12

23

28

40

17

55

37

14

Adding
nonphysician
clinicians to
practice

53

33

60

36

33

17

10

Making home
visits

57

53

16

51

50

36

45

49

32

20

* Including special payments, higher fees, or reimbursements.


** Including patient counseling or group visits.
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

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COMMONWEALTH
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Assessment and Feedback


of Practice Performance

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Practice Routinely Receives and Reviews Data on Patient Care

Percent
routinely
receives and
reviews data on:

20

AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Clinical
outcomes

42

23

14

54

81

64

24

78

12

84

47

Patient
satisfaction

56

15

35

39

51

90

15

84

60

THE
COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

21

Doctor Reviews Clinical Performance Against Targets


at Least Annually
Percent

100

96
83

80

67
57

60

53

47

43

43

41

40

37
22

20

0
UK

NZ

US

SWE

AUS

NET

FRA

GER

CAN

SWIZ

NOR
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COMMONWEALTH
FUND

Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

22

Doctor Routinely Receives Data Comparing Practices


Clinical Performance to Other Practices
Percent

100

80

78

55

60

55
45
35

40

34

32
25

25
15

20

5
0
UK

NZ

SWE

FR

SWIZ

US

NETH

AUS

GER

CAN

NOR
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COMMONWEALTH
FUND

Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Practice Routinely Receives and Reviews Data on Resource Use

23

Percent
routinely
receives and
reviews data on:

AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Hospital
admissions and
ED use

39

30

24

21

43

33

28

32

82

55

Frequency of
ordering tests

33

16

17

16

56

18

43

20

56

32

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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

24

System Views and Physician Satisfaction

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Physician Views of the Health System, 2009 and 2012:


System Works Well, Only Minor Changes Needed
Percent

100

2009

2012

80

60

60

45
40

33

54

18

20

61

42

40 41 37

23

53

56

46 47 46

37 39

22

17 15

0
AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US
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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Physician Views of Whether the Quality of Care in the Health Care


System Has Improved in the Past Three Years, 2012

Percent
responding
quality of care
has:

26

AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Improved

30

26

12

38

33

28

24

11

35

21

Stayed the same

50

54

52

54

40

49

60

43

66

44

53

Gotten worse

20

19

37

34

20

19

11

32

21

21

25

THE
COMMONWEALTH
FUND

Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

27

Insurance Restrictions on Medication or Treatment


for Patients Pose Major Time Concerns for Doctors
Percent saying amount of time physician or staff spend getting patients needed
medications or treatment because of coverage restrictions is a MAJOR PROBLEM

100
80
60

52
37

40
20

10

10

11

UK

SWE

AUS

NOR

17

17

FR

NZ

21

23

26

0
CAN

SWIZ NETH

GER

US
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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

28

Physician Satisfaction with Practicing Medicine


Percent

Very satisfied/satisfied
100

11

12

16

16

18

Somewhat/very dissatisfied
18

20

23

24

80

31

45

60
40

88

87

84

84

82

82

80

76

75

68

54

20
0
NETH NOR

SWIZ

UK

CAN

NZ

AUS

FR

SWE

US

GER
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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

29

Dissatisfaction with Income and Time with Patients

Percent
somewhat/
very dissatisfied
with:

AUS

CAN

FR

GER

NETH

NZ

NOR

SWE

SWIZ

UK

US

Income from
medical practice

25

20

63

33

20

25

16

28

42

21

32

Time to spend
per patient

40

40

47

48

47

44

37

54

31

59

44

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COMMONWEALTH
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Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

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U.S. Primary Care Reports, by Practice Size

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U.S. Primary Care Doctors: Access, Information Capacity,


and Administrative Burden by Practice Size
2 or fewer FTE physicians

27

Has after-hours care


arrangements

5 or more FTE physicians

41
49

Uses electronic
medical records

83

Routinely reviews
data on clinical
outcomes

33
58

Insurance restrictions
on medications/
treatments pose
major time concern

63
48
0

25

50

75

Percent
Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

100
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Cross-Cutting Themes and Implications


National policies make a difference for primary care practices
Insurance design
Support for practice infrastructure and information feedback
Health IT is spreading, but differentially across countries
Information exchange and alerts slowest to spread
Feedback on performance is not yet routine in any country
Opportunities to learn within and across countries
Access varies widely: after hours, waits, and cost barriers
New technology and shared after-hour services enable multiple
points of access
Opportunities to learn as these evolve
Gaps in communication across sites of care in all countries
undermines care coordination and integration
Primary care workforce with expanded team-work, including nurses,
key to a high performing health system

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Acknowledgments and Cofunders


Thanks to coauthors David Squires, Michelle M. Doty, Petra Rasmussen,
Roz Pierson, and Sandra Applebaum, and to Harris Interactive, Inc., and
contractors for conducting the survey. Published in Health Affairs as:
A Survey of Primary Care Doctors in Ten Countries Shows Progress in
Use of Health Information Technology, Less in Other Areas, Web First,
Nov. 15, 2012.

Canada: Health Council of Canada, Health Quality Ontario, Quebec Health


Commission, Health Quality Council of Alberta, Canada Health Infoway

France: Haute Authorit de Sant (HAS), Caisse Nationale de lAssurance


Maladie des Travailleurs Salaris (CNAMTS)

Germany: Federal Ministry of Health, German National Institute for


Quality Measurement in Health Care

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

Switzerland: Federal Office of Public Health, Swiss Medical


Association

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COMMONWEALTH
FUND