How health insurance design affects access to care and costs, by income, in eleven countries

Health Affairs

Volumn 29, Issue 12, 2010, Pages 2334-2323

  Schoen, Cathy ^a   Osborn, Robin ^a   Squires, David ^a   Doty, Michelle M ^a   Pierson, Roz ^b   Applebaum, Sandra ^b  

^a Commonwealth Fund ^*  (United States)

^b Harris Interactive   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; COMPARATIVE STUDY; DEVELOPED COUNTRY; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH INSURANCE; HUMAN; INCOME; INFORMATION PROCESSING; INTERVIEW; MIDDLE AGED; ORGANIZATION AND MANAGEMENT;

ADULT; DATA COLLECTION; DEVELOPED COUNTRIES; HEALTH EXPENDITURES; HEALTH SERVICES ACCESSIBILITY; HUMANS; INCOME; INSURANCE, HEALTH; INTERVIEWS AS TOPIC; MIDDLE AGED; YOUNG ADULT;

EID: 79955665299     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0862     Document Type: Article

References (21)

1. Commonwealth Fund. Description of health care systems: Australia, Canada, Denmark, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, 2010. New York (NY): Commonwealth Fund; forthcoming 2010 Dec.
2. The Swiss exempt some services, such as preventive care. The Affordable Care Act in the United States allows deductibles up to $5,950 per individual and $11,900 per family and exempts preventive care, with those provisions to take effect in 2014. The United States has no limit on deductibles.
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6. The Commonwealth Fund provided core support for the survey, with cofunding to expand the countries included provided by the German Institute for Quality and Efficiency in Health Care; Haute Authorité de Santé and Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (France); Dutch Ministry of Health, Welfare, and Sport and the Scientific Institute for Quality of Healthcare at Radboud University Nijmegen, in the Netherlands; Norwegian Knowledge Centre for the Health Services; Swedish Ministry of Health and Social Affairs; and the Swiss Federal Office of Public Health. In addition, support for expanded country samples was provided by the UK Health Foundation; Australian Commission on Safety and Quality in Health Care and the Bureau of Health Information; and the Health Council of Canada, Ontario Health Quality Council, and Québec Health Commission.
7. This was a rapid-response survey. The field times ranged from two weeks to two months in countries with extra samples; most field times were four weeks. Subjects were called at least eight times if they did not respond. Response rates were as follows: Australia, 26 percent; Canada, 29 percent; France, 21 percent; Germany, 20 percent; the Netherlands, 21 percent; New Zealand, 30 percent; Norway, 13 percent; Sweden, 42 percent; Switzerland, 54 percent; United Kingdom, 24 percent; and United States, 26 percent.
8. To access the Technical Appendix, click on the Technical Appendix link in the box to the right of the article online.
9. The weighted variables included age, sex, region, education, and additional variables consistent with standards for each country. In the United States, the weighted variables also included race and ethnicity.
10. Schoen C, Osborn R, Huynh PT, Doty MM, Davis K, Zapert K, et al. Primary care and health system performance: adults' experiences in five countries. Health Aff (Millwood). 2004;23:w4-487-503. DOI:10.1377/hlthaff.var.487.
11. Same-day care was reported by 42 percent in Australia; 29 percent in Canada; 44 percent in France; 43 percent in Germany; 47 percent in Netherlands; 49 percent in New Zealand; 33 percent in Norway; 41 percent in Sweden; 88 percent in Switzerland; 31 percent in United Kingdom; and 38 percent in United States.
12. In 2007, about 40 percent of UK adults received elective surgery in less than one month. One-third waited four months or more. Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Toward higher-performance health systems: adults' health care experiences in seven countries, 2007. Health Aff (Millwood). 2007;26(6):w717-34. DOI: 10.1377/hlthaff.26.6.w717.
13. We lacked sufficient sample sizes to compare elective surgery waits by income, because fewer than 20 percent of the respondents had had elective surgery in the previous two years.
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