THE COMMONWEALTH FUND The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries The Commonwealth Fund November 2010

THE COMMONWEALTH

FUND

The Commonwealth Fund

2010 International Health Policy Survey

in Eleven Countries

The Commonwealth Fund

November 2010

2

THE COMMONWEALTH

FUND


• Telephone survey March to June 2010 of adults ages 18 and older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

• Final samples: 3,552 Australia, 3,302 Canada, 1,402 France, 1,005 Germany, 1,001 Netherlands, 1,000 New Zealand, 1,058 Norway, 2,100 Sweden, 1,306 Switzerland, 1,511 United Kingdom, and 2,501 United States.

• Conducted by Harris Interactive subcontractors, and Dutch Scientific Institute for Quality of Healthcare, Haute Authorité de Santé (HAS), Swedish Ministry of Health, Swiss Federal Office of Public Health, and Norwegian Knowledge for the Health Services.

• Examined differences between above- and below-average (median) income respondents, controlling for age and health status

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• A selection of findings from the 2010 Commonwealth Fund International Health Policy Survey were originally published in: C. Schoen, R. Osborn, D. Squires, M. M. Doty, R. Pierson, and S. Applebaum, "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," Health Affairs Web First, Nov. 18, 2010.

• This chartpack presents data beyond what was included in the article.


4

THE COMMONWEALTH

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4

International Comparison of Spending on Health, 1980–2008

0

1000

2000

3000

4000

5000

6000

7000

8000

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand

Average spending on healthper capita ($US PPP)

0

2

4

6

8

10

12

14

16

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia

Total expenditures on healthas percent of GDP

Source: OECD Health Data 2010 (June 2010).

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System Views and Confidence

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Overall Views of Health Care System, 2010

Percent AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US

Only minor changes needed

24 38 42 38 51 37 40 44 46 62 29

Fundamental changes needed

55 51 47 48 41 51 46 45 44 34 41

Rebuild completely 20 10 11 14 7 11 12 8 8 3 27

Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

7

THE COMMONWEALTH

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7

76 7685 82

88 84

70 67

89 92

70

0

25

50

75

100

AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US

Confident Will Receive Most-Effective Treatment if Sick

Percent responded, if they became seriously ill, confident/very confident they would get most-effective treatment, including drugs and diagnostic tests


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THE COMMONWEALTH

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8

64 6873 70

8175

69 7078

90

58

0

25

50

75

100


Confident Will Be Able to Afford Needed Care

Percent responded, if they became seriously ill, confident/very confident they would be able to afford the care they needed


9

THE COMMONWEALTH

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9

Affordability and Cost-Related Access Barriers

10

THE COMMONWEALTH

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10

35

5147

41 39

61

33

50

20

76

31

0

25

50

75

100

AU

S

CA

N

FR

GE

RN

ETH N

Z

NO

R

SW

E

SW

IZ UK

US

Out-of-Pocket Medical Costs in the Past Year, in U.S. Dollars

Percent

2112

48 9 7

16

2

25

1

35

AU

S

CA

N

FR

GE

R

NE

TH NZ

NO

R

SW

E

SW

IZ UK

US

$200 or less $1,000 or more


11

THE COMMONWEALTH

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11Cost-Related Access Problems

in the Past Year


Did not fill prescription or skipped doses

12 10 7 6 3 7 6 7 4 2 21

Had a medical problem but did not visit doctor

13 4 6 16 2 9 6 5 6 2 22

Skipped test, treatment, or follow-up

14 5 6 10 3 8 5 4 4 3 22

Yes to at least one of the above

22 15 13 25 6 14 11 10 10 5 33


12

THE COMMONWEALTH

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12

86

9

3 46 5 5 6

2

20

0

10

20

30

40


Serious Problems Paying or Unable to Pay Medical Bills in the Past Year

Percent


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THE COMMONWEALTH

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13

Access to Needed Care and Waiting Times

14

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14

65

45

6266

7278

45

57

93

70

57

0

25

50

75

100

AU

S

CA

N

FR

GE

RN

ETH N

Z

NO

R

SW

E

SW

IZ UK

US

Access to Doctor or Nurse When Sick or Needed Care

Percent*

14

33

17 16

5 5

28 25

28

19

Same- or next-day appointment

Waited six days or more


* Base: Answered question.

15

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16

21

14 1511

14

23

18

9 8

17

0

10

20

30

40


Worried About a Medical Problem That Took a Long Time to Be Diagnosed in Past Year

Percent


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THE COMMONWEALTH

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16Difficulty Getting After-Hours Care

Without Going to the Emergency Room

* Base: Needed care and answered question.

5965 63

57

3338

45

68

4338

63

0

25

50

75

100


Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER*


17

THE COMMONWEALTH

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33

44

2722

2629

26

35

2225

37

0

25

50

75

AU

S

CA

N

FR

GE

R

NE

TH NZ

NO

R

SW

E

SW

IZ UK

US

Emergency Room Use in Past Two Years

Percent

1016

5 510 8 7

129 7

15

Any ER use Used ER for condition treatableby regular doctor, if available


18

THE COMMONWEALTH

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33

20

34 33

5246

3329

44

26

34

0

25

50

75

AUSCAN FR

GER

NETH NZNO

RSW

ESW

IZ UK US

Percent

Wait Time in Emergency Room Before Being Treated

16

31

17

4 3

12 11

20

6 4

13

Less than 30 minutes Four hours or more


Base: Used ER in past two years.

19

THE COMMONWEALTH

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54

41

53

83

7061

5045

82

7280

0

25

50

75

100

AUSCAN FR

GER

NETH NZNO

RSW

ESW

IZ UK US

Percent

Wait Time for Specialist Appointment

28

41

28

716

22

34 31

5

19

9

Less than 1 month Two months or more


Base: Needed to see a specialist in past two years.

20

THE COMMONWEALTH

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Percent

53

35

46

78

5954

44

34

5559

68

0

25

50

75

100

AUSCAN FR

GER

NETH NZNO

RSW

ESW

IZ UK US

Wait Time for Elective Surgery

1825

70

5 8

21 22

7

21

7

Less than 1 month Four months or more


Base: Needed elective surgery in past two years.

21

THE COMMONWEALTH

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21

Primary Care and Patient-Centered Care

22

THE COMMONWEALTH

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76

62

8882 78

84

61

73

9083

79

0

25

50

75

100


Easy to Contact Doctor by Phone During Regular Hours

Percent reporting somewhat/very easy


Base: Has regular doctor/place of care and tried contacting.

23

THE COMMONWEALTH

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Has e-mailed medical question to regular doctor or place of care in past two years

2 4 2 7 2 4 4 6 3 9 6

Can make an appointment via e-mail or Web site at regular place of care

7 6 9 60 10 9 23 13 13 25 15

Online Access at Regular Place of Care


Base: Has regular doctor/place of care.

24

THE COMMONWEALTH

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42

27 2318

25

57

33 37

16

5651

0

25

50

75

100


Nurse Regularly Involved in Care

* For example, discusses test results, treatment plans or advises you on your health.

Percent reported a nurse or other nonphysician clinician is regularly involved in care*



25

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Doctor–Patient Communication

Percent reports regular doctor always/often


Gives opportunity to ask questions about recommended treatment

88 85 83 91 87 92 77 65 92 91 86

Explains things in a way that is easy to understand

91 89 89 94 93 92 86 74 94 89 89

Involves you as much as you want in care decisions

86 83 82 84 81 92 80 62 85 90 86

Spends enough time with you 85 80 85 91 89 90 76 67 90 88 82

All of the above 69 60 59 63 75 79 62 47 72 59 63



26

THE COMMONWEALTH

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87 84 8492

8893

75

57

89 8985

0

25

50

75

100


Regular Doctor Knows Important Information About Medical History

Percent reporting doctor often/always knows important information about medical history



27

THE COMMONWEALTH

FUND

76 7467

4954

84

59

43

6979

74

0

25

50

75

100


Quality of Care from Doctor

Percent rated care received in past 12 months from regular doctor as very good/excellent



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THE COMMONWEALTH

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28

Coordination of Care

29

THE COMMONWEALTH

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66 68

51

63

35

69

55

26

55

68 69

0

25

50

75

100


Regular Doctor Coordinates Care Received from Other Doctors and Places

Percent reporting doctor always/often coordinates or arranges care



30

THE COMMONWEALTH

FUND

30

Coordination Problems in the Past Two Years


Test results/ records not available at time of appointment

11 11 7 8 8 9 10 9 7 9 15

Received conflicting information from different health professionals

20 20 16 17 15 18 24 18 16 10 23

Duplicate tests: doctors ordered test that had already been done

10 8 14 20 4 5 9 5 11 7 17

Yes to at least one of the above 28 28 28 29 21 23 31 23 24 19 37


31

THE COMMONWEALTH

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31

2623

28

2319 19

27

1719

13

3129

3129

42

25 26

38

2932 32

42

0

25

50


No chronic conditions2 or more chronic conditions

Percent experienced any of three coordination problems*

* Test results/records not available at time of appointment, received conflicting information from different health professionals, and/or doctors ordered test that had already been done.

Coordination Problems in the Past Two Years, by Number of Chronic Conditions


32

THE COMMONWEALTH

FUND

1113

10

17

11

22

12

26

15 1416

0

10

20

30

40

AUSCAN FR

GER

NETH NZNO

RSW

ESW

IZ UK US

Gaps in Coordination of Specialist Care

16

2220

1715

3033

2623

16

22

AUSCAN FR

GER

NETH NZNO

RSW

ESW

IZ UK US

Specialist did NOT have reason for visit/tests from regular doctor

Regular doctor NOT up-to-date about specialist care

Percent


Base: Saw specialist in past two years and has regular doctor/place of care.

33

THE COMMONWEALTH

FUND

28 30

44

32

23 22

33 31

2127 27

0

15

30

45

60


Gaps in Emergency Room Communication with Regular Doctor

Percent for whom regular doctor/place did NOT seem informed or up-to-date about care received in ER


Base: Has regular doctor/place of care, used ER in past two years and was treated.

34

THE COMMONWEALTH

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2126

12

5

42

21

3024

9 711

0

15

30

45

60


Failure to Communicate Test Results

Percent for whom someone sometimes, rarely, or never followed up to give results

Base: Had blood tests, x-rays, or other tests in past two years.


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THE COMMONWEALTH

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Perception of Inefficient or Wasteful Care

Percent felt time wasted in past two years because…


Took long time to schedule tests or specialist appointments

19 25 21 17 11 15 21 14 9 12 17

Kept waiting long time to see doctor for a scheduled appointment

35 33 25 30 18 25 28 16 27 18 29

Care was poorly organized or poorly coordinated

18 19 9 11 10 12 15 17 6 10 18

Yes to at least one of the above 48 49 38 43 30 36 44 34 37 29 38


36

THE COMMONWEALTH

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36

Preventive Care

37

THE COMMONWEALTH

FUND

4539 37

47

59 56

28

42

22

4956

0

25

50

75

100


Patient Receives Reminders for Due Preventive Care

Percent


38

THE COMMONWEALTH

FUND

Health Promotion and Lifestyle Discussions in Past Two Years

Base: Has regular doctor/place of care and visited in past two years.

Percent reported discussing at regular place of care:*


A healthy diet and healthy eating

53 52 37 50 17 53 34 29 33 45 70

Exercise or physical activity 54 56 56 51 23 51 43 43 47 37 72

Things in your life that worry you or cause stress

43 44 47 35 27 38 35 25 34 26 49

Discussed any of the above 67 71 74 70 42 64 61 55 63 53 82

* With doctor or other clinician.


39

THE COMMONWEALTH

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Chronic Conditions and Self-Management

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THE COMMONWEALTH

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Number of Chronic Conditions

Percent of respondents with the following number of chronic conditions:


None 35 42 40 51 44 38 42 43 52 57 35

One 26 27 31 25 28 27 24 27 26 22 23

Two or more 40 31 29 25 29 35 33 30 22 21 40


41

THE COMMONWEALTH

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95 91 93 9387

9791

82

9691 93

0

25

50

75

100


Chronically Ill Patients Who Are Confident They Can Manage Health Problems

Base: Adults with asthma, diabetes, heart disease, hypertension, and/or high cholesterol.

Percent reported confident/very confident they can manage their health problems


42

THE COMMONWEALTH

FUND

87 8477

66

90 89 9082 79 79

84

0

25

50

75

100


Blood Pressure in Normal Range Among Patients with Heart Disease and/or Hypertension

Base: Adults with heart disease and/or hypertension and had blood pressure checked in past year.

Percent reported blood pressure in normal range last time checked


43

THE COMMONWEALTH

FUND

7974

6774

61

78

6757

8075 76

0

25

50

75

100


Diabetics with Glucose Level in Normal Range

Base: Adults with diabetes.

Percent reported often/always keeping glucose level in normal range


44

THE COMMONWEALTH

FUND

Prescription Drugs

45

THE COMMONWEALTH

FUND

68

108

4

9 86 5

107

0

10

20

30

40


Confusion Over New Prescription

Base: Regularly takes at least one prescription drug.

Percent reported being unsure what new prescription drug was for or how to take it in past two years


46

THE COMMONWEALTH

FUND

Experiences with Prescription Drugs in Past Two Years

Percent reported someone from regular place of care:


Did not review all medications including those prescribed by other doctors

21 31 42 45 54 28 52 60 35 43 23

Did not explain the potential side effects of a medication

22 26 45 46 61 27 49 52 41 41 23

Did not give written list of all prescribed medications

48 52 71 74 77 52 77 55 72 54 46

At least one of the above problems 56 67 86 83 90 63 88 84 84 68 60

Base: Has regular doctor/place of care and regularly takes at least one prescription drug.


47

THE COMMONWEALTH

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Patient Safety

48

THE COMMONWEALTH

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Medical, Medication, or Lab Test Errors in Past Two Years

* Base: Had blood test, x-rays, or other tests in past two years.

Percent reported: AUS CAN FR GER NETH NZ NOR SWE SWIZ UK US

Wrong medicationor dose

4 6 9 2 4 5 8 5 5 2 6

Medical mistake in treatment 8 8 6 6 5 6 11 6 8 3 10

Incorrect diagnostic/lab test results*

2 4 3 2 3 2 3 2 3 3 5

Delays in abnormaltest results*

6 10 3 5 4 6 9 8 2 6 9

Any medical, medication, or lab errors

14 17 14 10 11 12 21 13 13 8 18


49

THE COMMONWEALTH

FUND

82 86 8479 80

8679

88

68

7986

0

25

50

75

100


Medical, Medication, or Lab Test ErrorsOccurred Outside Hospital

Percent reported error occurred outside hospital

Base: Reported medical mistake, medication error, and/or lab test error or delay in past two years.


50

THE COMMONWEALTH

FUND

11 13 126 8 9

18

11 116

13

29

40

25 2420

38

49

40

3228

38

0

15

30

45

60


1 or 2 doctors 4 or more doctors

Any Medical, Medication, or Lab Test Errors,by Number of Doctors Seen

Percent

Base: Reported medical mistake, medication error, and/or lab test error or delay in past two years.


51

THE COMMONWEALTH

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51

Insurance Complexity

52

THE COMMONWEALTH

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52

Problems with Health Insurance

Percent reported in the past year:


Spent a lot of time on paperwork or disputes over medical bills

6 6 11 16 8 4 8 3 6 3 17

Health insurance denied payment or did not pay as much as expected

11 12 18 11 15 4 2 2 10 2 25

Yes to either 14 15 23 23 20 6 9 4 13 5 31


53

THE COMMONWEALTH

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53

Confidence, Cost and Access Experiences, and Insurance Problems by Income

Slides 54 to 59: Adjusted percentages from logistic regression controlling for age, health status, and, in the U.S., insurance status.

54

THE COMMONWEALTH

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54

Confident Will Receive Most-Effective Treatment if Sick, by Income

79 8088

8288 87

72 70

91 95

8273 71

8578 81 78

6358

8692

65

0

25

50

75

100

AUS* CAN* FR GER NETH* NZ* NOR* SWE* SWIZ* UK US*

Above-average income Below-average income(Adjusted) percent confident/very confident


Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.

* Indicates significant within-country differences with below-average income (p < 0.05).

55

THE COMMONWEALTH

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55

Cost-Related Access Problems in the Past Year, by Income

126 8

17

38

4 5 7 4

202218 17

27

13 1521

14 12

4

39

0

25

50

75

AUS* CAN* FR* GER* NETH* NZ* NOR* SWE* SWIZ* UK US*

Above-average income Below-average income


(Adjusted) percent experienced at least one of three problems**

** Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.



56

THE COMMONWEALTH

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56

Out-of-Pocket Spending of $1,000 or More in the Past Year, by Income



31

17

510 11 11

16

2

34

0

45

1612

5 5 7 6

15

2

20

0

29

0

15

30

45

60

AUS* CAN* FR GER* NETH NZ* NOR SWE SWIZ* UK US*



(Adjusted) percent

57

THE COMMONWEALTH

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57

52 2 1 2 2 1 2 2 2

910 9

13

711

610 9 9

3

24

0

10

20

30

40

AUS* CAN* FR* GER* NETH* NZ* NOR* SWE* SWIZ* UK US*


Serious Problems Paying or Unable to Pay Medical Bills in the Past Year, by Income


(Adjusted) percent



58

THE COMMONWEALTH

FUND

58

60 6459 56

31 3440

67

43

31

5563

7267

55

4437

52

70

4247

68

0

25

50

75

100

AUS CAN* FR* GER NETH* NZ NOR* SWE SWIZ UK* US*


Difficulty Getting After-Hours Care, by Income

(Adjusted) percent reported somewhat/very difficult


Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. Base: Needed care and answered question.


59

THE COMMONWEALTH

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59

Waited Two Months or Longer for Specialist Appointment, by Income

26

40

29

815 14

3532

7

18

7

31

45

30

9

24 26

3531

3

28

10

0

25

50

75

AUS* CAN FR GER NETH* NZ* NOR SWE SWIZ* UK US

Above-average income Below-average income(Adjusted) percent


Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. Base: Needed to see specialist in past two years.


60

THE COMMONWEALTH

FUND

6060

19

46

7

32

46

33

31

36

69

35

47

0 25 50 75 100

Insured all year,above-averageincome

Insured all year,below-averageincome

Uninsured

Percent

U.S. Adults Under Age 65, by Insurance and Income

Went without care because of cost

$1,000 or more out-of-pocket costs

Serious problem or unable to pay bill

Insurance difficulty


61

THE COMMONWEALTH

FUND

6161

Acknowledgments and Cofunders

• Australia: Commission on Safety and Quality in Health Care, Bureau of Health Information

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

• France: Haute Authorité de Santé (HAS), Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (CNAMTS)

• Germany: Institute for Quality and Efficiency in Health Care (IQWiG)

• Netherlands: Dutch Ministry of Health, Welfare and Sport, and IQ Health, Radboud University Nijmegen

• Norway: Norwegian Knowledge Centre for the Health Services

• Sweden: Swedish Ministry of Health

• Switzerland: Federal Office of Public Health

• United Kingdom: Health Foundation

Thanks to to Harris Interactive, Inc., and contractors for conducting the survey.

Documents

THE COMMONWEALTH FUND The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries The Commonwealth Fund November 2010