Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries

Schoen, Cathy; Osborn, Robin; Huynh, Phuong Trang; Doty, Michelle M.; Zapert, Kinga; Peugh, Jordon; Davis, Karen

doi:10.1377/hlthaff.w5.509

Cited by 283 publications

(217 citation statements)

References 11 publications

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“…Surveys of Australian medicine users consistently find substantial numbers of Australians reporting difficulties with meeting the cost of their prescriptions. [61][62][63][64] Difficulty with cost is reported as the reason for not obtaining a prescription medicine by around 20% of respondents. 61,63,65 A recent analysis of national dispensing data has confirmed the negative impact of increasing copayments on pharmaceutical affordability.…”

Section: Resultsmentioning

confidence: 99%

“…[61][62][63][64] Difficulty with cost is reported as the reason for not obtaining a prescription medicine by around 20% of respondents. 61,63,65 A recent analysis of national dispensing data has confirmed the negative impact of increasing copayments on pharmaceutical affordability. 64 Decreases in utilisation following increase in copayment and safety net level were observed for essential as well as discretionary medicines and the greatest impact was among social security beneficiaries.…”

Section: Resultsmentioning

confidence: 99%

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Australia's pharmaceutical cost sharing policy: reducing waste or affordability?

Doran

Robertson²

2009

Aust. Health Review

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In this paper we argue that Australia's pharmaceutical cost sharing policy has been applied as if cost sharing is unproblematic for medicine affordability and good health outcomes. Australian and international experience with pharmaceutical cost sharing strongly suggests a negative impact on affordability and quality use of medicines, disproportionately affecting low income patients. We argue that Australia's use of cost sharing reflects the currency of a cognitively powerful and morally charged idea -moral hazard. Moral hazard refers to the change in behaviour induced by insurance coverage. Applied to pharmaceuticals, this means that low out-of-pocket cost will lead to waste. Moral hazard mixes the explanatory power of price with the intuitively cogent notion that if people do not experience consequences they will behave irresponsibly. Cost sharing policy has gone unscrutinised and uncontested not because cost sharing is unproblematic, but because in the light of the idea of moral hazard it has all the Aust Health Rev 2009: 33(2): 231-240 question-deadening weight of common sense.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Australia's pharmaceutical cost sharing policy: reducing waste or affordability?

Doran

Robertson²

2009

Aust. Health Review

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“…This compares with consumer surveys in which half of patients reported being able to get same day appointments in Australia ahead of the UK, Canada and US, but behind New Zealand and Germany. 19 A higher proportion of Australian GPs reported arrangements for afterhours access than those in the US and Canada, but lower than those in the UK and New Zealand. The pattern of associations of the two measures of access with practice and practitioner characteristics was quite different.…”

Section: Discussionmentioning

confidence: 96%

Access to same day, next day and after-hours appointments: the views of Australian general practitioners

Harris

Davies

Fanaian

et al. 2012

Aust. Health Review

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Objective. To evaluate factors associated with the availability of same or next day appointments and after-hours access reported by Australian general practitioners (GPs). Methods. Secondary analysis of a survey of primary care practitioners conducted by the Commonwealth Fund in 2009 in 11 countries. Analysis of factors likely to be associated with reported availability of same or next day appointments and after-hours access. Findings. Of 1016 Australian GPs, 78.8% reported that most patients in their practice had access to an appointment on the same or next day and 50% that their practice had arrangements for after-hours access. Access to same or next day care was better in practices where practitioners reported larger numbers of patients seen per GP per week and reviewed their performance against annual targets, but worse in rural areas and practices routinely reviewing outcomes data. Arrangements for after-hours care were more common among GPs who were planning to retire in the next 5 years; worked in practices with high electronic functioning information systems; and received and reviewed clinical outcome data and incentives for performance. Conclusions. Improving after-hours access requires a comprehensive approach which includes incentives, improvements to information management and organised systems of care with review of data on clinical outcomes. What is known about the topic? Access to general practice is an important priority for the health system and the subject of several reforms and initiatives over the past decade in Australia. Access to same or next day appointments and after-hours has been an increasing concern related to workforce availability, and limited access to general practice is one factor influencing the demand on hospitals, especially their emergency departments. What does this paper add? This paper reports on secondary analysis of a survey of over 1000 general practitioners in Australia. Responses to questions about access to same or next day appointments or after-hours arrangements were analysed for associations with practitioner and practice characteristics and their processes and systems of care. Access to same day appointments is particularly challenging in rural general practice but is more likely to be reported by GPs working in larger practices. Incentives, quality improvement and better information management may be important strategies to improve after-hours access. What are the implications for practitioners? Strategies to improve access to appointments and to after-hours care need to be considered as part of a comprehensive approach which includes financial incentives, strengthening information systems and quality improvement activities.

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“…In the 1990s, people in the US reported much lower satisfaction with their health care systems than did Canadians, Western Europeans and the Japanese (Isaacson, 1993). A 2005 survey of six wealthy nations found that "the US often stands out for inefficient care and errors" (Schoen et al, 2005). A massive survey of 82,583 Medicare patients in 182 health plans found that non-profit health plans scored higher than for-profit on measures of overall quality, access to care and customer service (Landon et al, 2001).…”

Section: Friedman's Microeconomics: What's Wrongmentioning

confidence: 99%

The Profit Doctrine : Economists of the Neoliberal Era

Chernomas¹,

Hudson²

2016

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Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries

Cited by 283 publications

References 11 publications

Australia's pharmaceutical cost sharing policy: reducing waste or affordability?

Australia's pharmaceutical cost sharing policy: reducing waste or affordability?

Access to same day, next day and after-hours appointments: the views of Australian general practitioners

The Profit Doctrine : Economists of the Neoliberal Era

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