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11-country health care survey: U.S. adults have the worst health

A new 11-country survey from the Commonwealth Fund finds that adults in the US are sicker than people in other high income-countries countries like Germany or UK.

November 16, 2016. A new 11-country survey from The Commonwealth Fund finds that adults in the United States are sicker than people in other high-income countries. These survey findings were presented by the Commonwealth Fund during their annual meeting in Washington D.C. The access to health care is much better organized in other high-income nations like Germany or UK.

Despite a statistically significant decline from 2013, about one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. By comparison, as few as 7 percent in the U.K. and Germany and 8 percent in the Netherlands and Sweden experienced these cost barriers. The Commonwealth Fund’s 2016 international survey interviewed 26,863 adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The survey focuses on topics such as access to and experience with primary care and specialists, out of pocket costs and medical bills, prescription drug use, health status and chronic illness care, views on health care system and quality of care.  Questions focused on people’s experiences with their country’s health care system—comparing their assessments of health care access, quality, and affordability—as well as on self-reported health and well-being.

Professor Alexander Schachtrupp, B. Braun Foundation: “Studies like this may illustrate why B. Braun Foundation finances the Harkness Fellowship program. The fellows benefit from the methods and results of such big international surveys and can transfer this expertise to the healthcare system in Germany. While some aspects of health care appear to be addressed quite sufficiently in Germany other may benefit from the comparison with other countries. For example regarding after-hours care, waiting times for specialist appointments or physicians advice on diet and exercise, Germany is ranking among the last. The good news is that according to the survey German health care policy makers do not have to travel far: Netherlands has scored the best in the most recent survey and has achieved this in only the recent years by inducing appropriate changes.“

The B. Braun-Foundation takes part in the Harkness Fellowship program by financing one out of two German candidates each year. German Harkness Fellow Isabelle Scholl, Ph.D. is researching “shared decision-making in cancer care through solutions that address organizational-level barriers at the Dartmouth Institute for Health Policy and Clinical Practice. Scholl is supported by her Mentor Glyn Elwyn M.D., Ph.D., F.R.C.G.P. (Professor and Senior Scientist, The Dartmouth Institute for Health Policy & Clinical Practice) and Co-mentor Sarah Kobrin, Ph.D., M.P.H. (Acting Branch Chief, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute). In Germany, Scholl was head of the Research Group for Patient-centered Care, Evaluation and Implementation at the Department for Medical Psychology at the University Medical Center Hamburg-Eppendorf, a renowned University Hospital in Germany. "I am currently conducting expert interviews with a range of stakeholders in cancer care to analyze organizational- and system-level factors that influence the implementation of shared decision-making in cancer care. These interviews give in depth insight into current barriers and potential solutions that can foster a better routine implementation", tells Scholl about her project at the Dartmouth Institute.  

The project
Shared decision-making is especially relevant in oncology, where multiple treatments are viable and choices are preference-sensitive. Despite the push for shared decision-making on the health policy level, its implementation into practice remains a challenge, and implementation efforts have been limited to the individual patient-clinician level. However, organizational-level barriers to the implementation of shared decision-making have recently been described, and the current structure of multidisciplinary team meetings was identified as a particular barrier to shared decision-making in cancer care. This study aims to first compile an overview of organizational-level barriers to the implementation of shared decision-making in cancer care and solutions to overcome these barriers, particularly in regards to the organization of multidisciplinary team meetings, and second, to identify and explore “hot spots” of pioneering best practice solutions to address the identified factors.

LINK to the study:


About the Fellowship
The Harkness Fellowships aims to produce the next generation of health policy leaders in participating countries, as the Commonwealth Fund says. In collaboration with B. Braun-Stiftung, the Commonwealth Fund invites promising mid-career professionals—government policymakers, academic researchers, clinical leaders, hospital and insurance managers, and journalists—from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom—to apply for a unique opportunity to spend up to 12 months in the United States as a Harkness Fellow in Health Care Policy and Practice.

Fellows are placed with mentors who are leading U.S. experts at organizations such as Harvard University, Stanford University, Kaiser Permanente, the Agency for Health Care Research and Quality, and the Institute for Healthcare Improvement to study issues relevant to the Fund’s mission to support a high performing health care system ─ insurance coverage, access, and affordability; health care delivery system reforms (e.g. bundled payments, accountable care organizations, innovative approaches to care for high need/high cost patients); cost containment; and other critical issues on the health policy agenda in both the U.S. and their home countries.

A peer-reviewed journal article or policy report for Health Ministers and other high-level policy audiences is the anticipated product of the fellowship. Harkness Fellows have published their findings in top-tier journals, including: BMJ, Health Affairs, New England Journal of Medicine, JAMA and Health Policy.

LINK to the Harkness Fellowship: