Healthcare in Europe and in the USA

Healthcare in Europe and in the USA Presentation of the results CHAM 2010 24 th September 2010

Technical pieces of information Studied countries and historical background: 2006-2007 : Germany France Italy UK Sweden 2009-2010 : Germany France Italy UK Sweden Poland 2010 : Germany France Italy UK Sweden Poland USA Austria Technical pieces of information: Telephone interviews Respondents profile: general public, aged18+ Sample size: 3600 interviews : 400 per country and 800 in the USA. Representativeness (per country) ensured by quotas set on age, gender, SEC class and region. 2

Introduction Studied topics: 1. Assessment of the healthcare system and of quality of care 2. Focus on doctors competence and training 3. Healthcare and social requirements 4. Patients mobility for access to treatment 5. New technologies 6. Prevention 7. Management of ageing and dependent people 8. Comparison across countries 3

1 Assessment of the healthcare system and of quality of care 4

1 Healthcare system How would you evaluate the organisation of the health system in [FR/UK/GE/IT/PO/SU/US] today? 8 1 3 7 7 44 10 12 27 22 3 8 7 1 15 46 46 30 36 40 2 34 17 21 12 20 21 31 32 2 26 36 44 10 8 2 12 6 27 1 24 3 36 Excellent Very good Good Average Poor DK 5

1 Healthcare system synthesis using the scores How would you evaluate the organisation of the health system in [FR/UK/GE/IT/PO/SU/US] today? Score «organisation of the health system» Excellent = 5 Very good =4 Good = 3 Average = 2 1,9 2,2 2,5 2,5 2,7 3 3 3,4 Poor = 1 Pologne Italie Allemagne USA France Suède UK Autriche 6

1 Healthcare system synthesis using the scores How would you evaluate the organisation of the health system in [FR/UK/GE/IT/PO/SU/US] today? And is the quality of health care provided when consulting a general practitioner? And, in your opinion, is the quality of care provided during hospital stays? Score «organisation of the health system» Score «quality of health care provided by a GP» Score «quality of care provided during hospital stay» Excellent = 5 Very good =4 Good = 3 Average = 2 2,8 2,7 2,6 2,5 2,2 1,9 3,5 3 3,4 3 2,5 2,5 3,4 3,1 2,7 3,4 3,4 3,1 3 3 3 3,5 3,5 3,4 Poor = 1 Pologne Italie Allemagne USA France Suède UK Autriche 7

1 Healthcare system Evolution since 2006 of the opinions on the health system s organisation Excellent = 5 Very good =4 3,6 Good = 3 Average = 2 2,8 2,3 2,4 2,4 2,5 2,8 2,7 2,7 2 2,2 2,4 2,2 2,8 2,8 3 2,9 3,1 2,5 3 1,9 1,7 Poor = 1 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 09 10 8

1 Healthcare system Evolution since 2006 of the opinions on the quality of health care provided by a GP Excellent = 5 Very good =4 3,7 Good = 3 3 3 3 3 3,4 3,2 3,1 3,4 3 2,6 2,6 2,7 3,4 3,4 3,4 3,2 3,1 3 3,1 2,5 2,8 Average = 2 Poor = 1 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 09 10 9

1 Healthcare system Evolution since 2006 of the opinions on the quality of care provided during hospital stay Excellent = 5 Very good =4 3,6 3,4 Good = 3 2,9 2,8 3 3 3,1 3,1 3,1 3 3 3,1 3 3,5 3,2 3,4 2,6 Average = 2 2,2 2,3 2,5 2,5 2,1 Poor = 1 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 09 10 10

1 Healthcare system Threats on the health system In the coming years, our health system will have to face several threats, which I am going to read to you. For each of them, do you feel that the threat is very important, somewhat important, not really important or not at all important? Total : very important Lack of public funding 72 58 45 77 53 77 62 56 Increase in direct costs for individuals 73 53 47 49 21 67 52 63 Increase in prices for medical procedures 72 48 51 55 35 67 49 76 Unequal access to health care 73 58 50 69 55 73 38 63 11

1 Healthcare system Threats on the health system In the coming years, our health system will have to face several threats, which I am going to read to you. For each of them, do you feel that the threat is very important, somewhat important, not really important or not at all important? Total : very important Waiting time before receiving treatment 57 52 69 70 52 89 34 64 Shortage of general practitioners 60 63 36 69 56 59 25 66 Risks of getting an infection in hospital 56 43 54 87 63 76 21 69 Medical errors 43 35 65 84 70 76 21 70 12

1 Healthcare system Constant improvements in the quality of treatments are leading to additional spending. To pay for these additional costs, what do you think is the best solution? Increase taxes or compulsory contributions Increase private insurance, optional supplemental insurance or supplemental policies from mutual insurance companies Pay a greater excess for each medical service DK 26 32 45 23 28 17 12 17 22 16 43 61 28 28 16 40 30 20 40 25 17 15 17 23 26 26 5 17 28 19 12 26 13

2 Focus on training / communication: perception of doctors training and competence 14

2 Focus on training/ communication synthesis on doctors competence Let's talk about the competency of doctors in [FR/UK/GE/IT/PO/SU/US] At the moment how do you rate their technical skills (for diagnosis and treatments)? At the moment, how do you rate their interpersonal skills (to inform and explain)? How do you rate the sharing of information and the coordination of care between the hospital doctors and general practitioners? Excellent = 5 Score technical skills (for diagnosis and treatments) Score interpersonal skills Score sharing of information and the coordination of care Very good =4 Good = 3 Average = 2 3,3 3,5 2,9 2,9 2,6 2,6 2,9 2,7 2,4 3,4 3,4 3 3,1 3 2,7 2,6 2,3 2,2 3,5 3,6 3,2 3 2,9 2,6 Poor = 1 Allemagne France Italie UK Suède Pologne Autriche USA 15

2 Focus on training/ communication synthesis on doctors training How do you rate the training that doctors receive during their medical studies? How do you rate the ongoing knowledge acquisition that doctors receive throughout their careers? Score training during medical studies Score ongoing knowledge acquisition Excellent = 5 Very good =4 Good = 3 3,2 3,3 2,9 2,9 2,9 2,9 3,5 3,2 3,1 3,4 2,9 2,9 3,3 3,2 3,7 3,4 Average = 2 Poor = 1 Allemagne France Italie UK Suède Pologne Autriche USA 16

3 Social requirements 17

3 Social requirements Does the current health system guarantee equal access to medical care for all citizens of FR/UK/GE/IT/PO/SU/US? 29 48 41 54 35 23 52 29 Yes No 70 1 49 54 3 5 40 6 62 3 75 2 47 1 66 5 DK 18

3 Social requirements To guarantee all citizens equal access to quality care, are you for or against an increase in contributions/taxes? For Against DK 51 48 28 67 72 43 53 40 46 51 68 29 25 4 3 54 43 56 3 1 3 4 4 4 19

Current affairs 2010 update Have the consequences of the economic crisis caused you to cancel or postpone health care actions such as visits to the doctor, tests, surgical procedures, dental care or prescription drug purchases? 17 19 23 12 18 33 25 24 8 6 10 5 2 5 8 6 Yes, I have already done so Yes, I may be forced to do so 62 63 47 2 86 92 69 80 69 No, it will not change anything DK 2 2 1 1 1 2 20

Current affairs 2010 update Have the consequences of the economic crisis caused you to cancel or postpone health care actions such as visits to the doctor, tests, surgical procedures, dental care or prescription drug purchases? 09 10 09 10 09 10 09 10 09 10 09 10 + 5 points + 12 points + 5 points + 12 points Yes, I have already done so - 2 points 23 25 17 18 12 11 13 10 8 6 6 13 21

4 - Mobility 22

4 Mobility Imagine that you need surgery. Would you prefer to go to...? A specialised surgeon from a distant city A generalist surgeon close to where you live DK 68 50 55 51 82 75 60 52 26 6 49 1 39 6 43 6 16 2 23 2 37 40 3 8 23

4 Mobility Would you be willing to travel abroad to gain access to a medical technique that you feel to be of identical quality but at a lower price than in [FR/UK/GE/IT/PO/SU/US]? Yes 23 17 39 32 42 57 23 25 No DK 75 82 56 66 56 5 2 40 3 75 75 2 1 2 24

4 Mobility Imagine that you are choosing a holiday destination abroad. How much importance do you give to local health conditions when you are choosing your holiday destination? Considerable importance Little importance No importance at all DK 30 62 64 43 21 74 28 50 42 28 38 24 24 25 17 11 7 5 5 27 4 3 40 5 1 38 33 31 3 14 3 25

4 Mobility Now imagine that you had to go and live in another country. How much importance do you give to the proximity of doctors and hospitals to your new place of residence? Considerable importance Little importance No importance at all DK 74 80 69 77 45 73 68 78 41 19 23 15 19 21 13 14 5 3 4 6 3 3 12 7 5 2 2 4 4 5 2 4 26

5 New technologies 27

5 New technologies Do you use the Internet for information relating to healthcare? Yes, regularly Yes, occasionally No, never DK 17 11 16 16 14 17 17 24 45 34 30 41 53 37 41 42 38 55 54 43 33 44 42 34 2 28

5 New technologies Do you use the Internet for information relating to healthcare? Yes, regularly Yes, occasionally 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 09 10 +15 points +14 points +21 points +2 points 11 36 11 39 12 35 17 45 +14 points +10 points 11 9 13 7 12 10 7 34 24 26 29 24 27 25 26 12 16 11 30 32 30 36 16 41 13 17 33 34 17 41 14 53 12 17 40 37 29

5 New technologies Do you dare to talk with your doctor about health information that pertains to you that you saw on the Internet? (To those who use the Internet for information relating to healthcare ) Yes No DK 90 73 52 66 91 43 80 68 9 1 27 48 32 4 5 56 18 2 32 2 1 30

5 New technologies What do you expect from a doctor with regard to health information available on the Internet? That he explain to me the aspects I did not clearly understand That he provide additional information beyond what I found That he tell me about reliable websites 86 80 74 76 61 58 48 47 85 84 83 84 68 56 75 65 73 64 55 48 82 80 59 38 31

5 New technologies Are you in favour or not in favour of the development of on-line medical consultations? In favour Not in favour DK 78 22 75 10 87 40 39 60 55 15 7 41 27 32 30 61 48 52 6 9 3 3 32

5 New technologies Are you in favour or not in favour of the development of continuous in-home monitoring resources over the telephone or Internet (e.g. measurement of blood pressure and heart rate)? In favour Not in favour DK 56 61 60 57 74 68 61 71 22 23 41 36 35 40 35 4 9 3 5 4 3 3 26 3 33

5 New technologies Do you think that these in-home medical surveillance or monitoring resources over the telephone or Internet? Enable more patients to be independent in their homes Will dehumanise medicine 71 66 80 71 78 69 72 68 51 46 38 51 34 40 44 39 34

5 New technologies - synthesis Are you in favour or not in favour of websites where doctors can be assessed? Are you in favour or not in favour of websites where hospitals can be assessed? In favour of websites where hospitals can be assessed ( les 18-39 y.o. most in favour ) In favour of websites where doctors can be assessed?(18-39 y.o. most in favour) 69 54 55 61 61 51 52 68 62 49 46 41 40 42 30 37 Allemagne France Italie UK Suède Pologne Autriche USA 35

6 Prevention 36

Current affairs 2010 update To prevent risks stemming from the appearance of new epidemics like bird flu, mad cow or the A/H1N1 flu, do you want the State to spend...? 16 16 36 54 48 42 31 11 59 71 46 36 11 33 48 52 More No change Less 26 4 33 3 17 5 7 3 15 3 8 11 10 37 4 4 DK 37

6 Prevention Have had a check-up at the dentist during the last year Have been for a check-up over the last five years Have been tested for a serious disease like cancer or AIDS overs the last five years Are interested in a lifelong health monitoring programme 100 90 80 70 60 50 40 30 20 10 0 91 91 82 75 80 83 80 69 68 61 71 67 71 65 71 59 61 50 55 55 49 44 42 42 42 36 32 42 27 31 28 19 Allemagne France Italie UK Suède Pologne Autriche USA 38

6 Prevention -synthesis It is now possible to purchase a lifelong health monitoring programme which includes preventive consultations and an annual personalised check-up. Are you personally interested in this monitoring programme? Who would pay? (Aux intéressés) / How? Interested in and payment Via the employer Via taxes Direct payment 7 7 10 7 16 8 12 10 4 3 3 5 5 7 19 11 23 10 5 5 9 11 7 2 2 7 6 5 5 7 7 via the insurance Not interested 63 52 72 54 61 77 69 50 DK 6 4 9 4 9 12 6 7 39

6 Prevention In the context of your job, do you feel that you need health programmes for...? Total «yes» Back pain 67 72 61 31 55 69 63 44 Stress management 54 57 51 51 42 57 57 46 Detecting serious illnesses 39 37 29 31 29 63 39 39 Obesity prevention 27 40 31 51 32 42 21 37 Preventing risks related to tobacco, alcohol or drug use 17 35 23 28 18 37 18 32 40

7 the 5 th risk: management of ageing and dependent persons 41

7 Ageing In your opinion, the care given to dependent elderly people is... 1 7 5 3 1 3 4 12 30 26 24 22 43 44 15 4 20 4 3 11 32 1 15 29 36 5 15 25 24 34 36 34 31 50 4 3 19 15 19 33 5 5 6 32 4 2 4 Excellent Very good Good Average Poor DK 42

7 Ageing Given the problems raised by increasing life spans and the rise in the number of dependent elderly people, which of the following should be our priority today? 5 17 78 2 20 78 2 14 84 5 19 77 Home care 9 40 51 Retirement homes 4 25 71 DK 5 21 74 6 15 79 43

7 Ageing Currently in our country, the public assistance provided to help dependent or elderly people stay in their homes is... 4 2 3 46 29 31 53 39 43 7 4 18 10 6 7 2 6 4 7 53 54 1 43 46 17 28 30 40 29 54 7 6 10 6 8 8 8 5 20 8 Absolutely satisfactory Somewhat satisfactory Somewhat unsatisfactory Absolutely unsatisfactory DK 44

7 Ageing Outside of their families, which organisation provides dependent elderly people with the best support to help them stay in their homes? 22 36 4 33 38 15 33 47 43 20 16 26 16 56 15 34 34 21 26 26 20 3 5 1 12 6 4 11 25 14 14 5 19 31 31 15 23 Non-profit organisations Private entities Public entities None DK 45

7 Ageing To help dependent elderly people stay in their homes, do you think we must develop...? 29 74 93 52 86 97 69 83 92 Home care jobs 14 73 74 95 92 91 Remote monitoring which makes living at home safer 28 62 75 74 94 93 Robotics which make it possible to perform daily tasks 62 90 89 46

7 Ageing Two solutions are possible to finance services and daily care for elderly and dependent people : public funding stemming from taxes and compulsory public contributions, or cost totally met by the individual or the family either from a personal insurance policy or direct payment. Which of the following financing options would you most support? Total coverage by taxes and compulsory public contributions Mix of state funding and personal/ family contributions Cost totally met by the individual or the family DK 4 17 6 6 4 31 27 32 4 3 3 31 23 49 12 15 79 61 63 60 45 64 72 70 2 4 4 2 2 2 3 47

7 Ageing Are you for or against compulsory private insurance to cover the costs of daily living for dependent elderly people? Are you for or against compulsory public insurance to cover the costs of day to day living for dependent elderly people? For a compulsory public insurance For a compulsory private insurance 62 57 46 44 45 52 52 49 46 40 27 30 33 32 37 36 Allemagne France Italie UK Suède Pologne Autriche USA 48

8 Comparison across countries 49

8 Comparisaon across countries Of these seven countries, where does one receive the best care? Germany UK USA France Italy Poland Sweden 50 / 19 28 / 3 67 / 4 38 / 11 4 / 0 31 / 1 46 / 6 XX / YY : perception of country s interviewees vs. perception other countries interviewees 50

8 Comparisaon across countries Of these seven countries, where does one get the best reimbursement of health care spending? Germany UK USA France Italy Poland Sweden 48 / 16 18 / 4 69 / 3 20 / 7 2 / 0 28 / 3 27 / 1 XX / YY : perception of country s interviewees vs. perception other countries interviewees 51

8 Comparisaon across countries Of these seven countries, which one is the most advanced in new health care technology? Germany UK USA France Italy Poland Sweden 18 / 9 13 / 2 2 / 0 20 / 2 22 / 8 50 / 31 23 / 0 XX / YY : perception of country s interviewees vs. perception other countries interviewees 52

8 Comparisaon across countries In your opinion, the health sector, which includes activities related to hospitals, medical equipment, treatments, consultations and pharmaceuticals, is an industry that... Contributes to the country's economic growth or is merely a burden for society DK 59 57 77 62 73 49 66 66 31 36 10 7 14 22 12 9 15 16 37 14 24 24 10 10 53

8 Comparisaon across countries 2006/2007/2009/2010: comparaison perception du secteur de la santé In your opinion, the health sector, which includes activities related to hospitals, medical equipment, treatments, consultations and pharmaceuticals, is an industry that... Contributes to the country's economic growth or is merely a burden for society DK 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 06 07 09 10 09 10 68 72 70 59 60 52 59 57 72 71 63 77 63 68 61 62 68 72 58 73 43 49 24 18 18 31 38 34 36 8 10 12 45 10 2 7 7 3 21 17 25 14 25 8 12 9 12 12 12 24 22 17 13 29 21 15 16 15 16 12 12 15 45 37 12 14 54