How High-Need Patients Experience the Health Care System in Nine Countries

U.S. health care costs are disproportionately concentrated among older adults with multiple chronic conditions or functional limitations—a population often referred to as "high-need" patients. This analysis uses data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults to investigate health care use, quality, and experiences among high-need patients in nine countries compared with other older adults. High-need patients use a greater amount of health care services and also experience more coordination problems and financial barriers to care compared with other older adults. Disparities are particularly pronounced in the United States. The comparative success of other countries, particularly in reducing financial barriers to care, may be a product of policies that specifically target high-need patients. Similarly focusing on these populations in the U.S. and effectively managing their care may improve their health status while reducing overall costs

ParkinsonNet: An Innovative Dutch Approach to Patient-Centered Care for a Degenerative Disease

Key features Multidisciplinary networks of allied health professionals in the Netherlands use evidence-based practice guidelines for treating Parkinson's disease, facilitated by a web-based platform through which patients can provide feedback about their care.Target population Adults with Parkinson's disease, an age-related neurodegenerative disorder for which no cure exists.Why it's important Many patients with degenerative chronic diseases have difficulty accessing the range of specialty medical, nursing, and supportive services they need, and available personnel often lack expertise with particular conditions. Care practices vary, and care coordination can be challenging.Benefits Lower rates of hip fractures and hospitalizations and better self-reported quality-of-life outcomes; greater knowledge of Parkinson's treatment among providers and higher job satisfaction; generally lower treatment costs where model has been implemented.Challenges Provider payment often does not cover care coordination services. The model might work best with a global payment approach

International Profiles of Health Care Systems, 2015

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Accuracy of wives' proxy reports of husbands' fertility preferences in sub-Saharan Africa

Background: Demographic researchers have recognized the importance of male partners in reproductive behavior and decision-making. Yet much of the existing literature still relies on female respondents reporting on behalf of their spouses. Objective: The objective of this study is to estimate the accuracy of wives' reports of husbands' fertility preferences in 32 countries in sub-Saharan Africa. Methods: We used couple-level data from Demographic and Health Surveys to evaluate the accuracy of wives' reports of their husbands' fertility preferences in 32 countries in sub-Saharan Africa. We created a measure of accuracy based on each partner's response to a set of fertility preference questions. We examined the overall percentages of wives who were accurate, inaccurate, or uncertain across countries. Results: Despite the fact that most couples were concordant in wanting more children, we found variation in the percentages of wives who were accurate in their proxy reports, ranging from 26Š in Chad to 58Š in Rwanda. By contrast, percentages of wives who were inaccurate were similar; approximately one-third of wives across all countries gave proxy responses that were at odds with their husbands' responses. Large percentages of wives were uncertain of their husbands' fertility preferences, reaching 50Š in Comoros. Conclusions: These findings indicate low levels of spousal discussion of fertility preferences. We encourage survey organizations to invest in collecting data from males directly. Contribution: By demonstrating that majorities of wives across countries either inaccurately perceive or are uncertain of their husband's fertility preferences, the current study justifies collecting data from male partners directly

Home Care by Self-Governing Nursing Teams: The Netherlands' Buurtzorg Model

The Dutch home-care provider Buurtzorg Nederland has attracted widespread interest for its innovative use of self-governing nurse teams. Rather than relying on different types of personnel to provide individual services—the approach taken by most home health providers—Buurtzorg expects its nurses to deliver the full range of medical and support services to clients. Buurtzorg has earned high patient and employee ratings and appears to provide high-quality home care at lower cost than other organizations. This case study reviews Buurtzorg's approach and performance thus far and considers how this model of care might be adapted for the United States

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

ABSTRACTIssue: The United States health care system spends far more than other high-income countries, yet has previously documented gaps in the quality of care.Goal: This report compares health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.Methods: Seventy-two indicators were selected in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Data sources included Commonwealth Fund international surveys of patients and physicians and selected measures from OECD, WHO, and the European Observatory on Health Systems and Policies. We calculated performance scores for each domain, as well as an overall score for each country.Key findings: The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands. Based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries' approaches if it wants to achieve an affordable high-performing health care system that serves all Americans

Older Americans Were Sicker and Faced More Financial Barriers to Health Care Than Counterparts in Other Countries

An international survey of older adults finds that seniors in the United States are sicker than their counterparts in 10 other high-income countries and face greater financial barriers to health care, despite the universal coverage that Medicare provides. Across all the countries, few elderly adults discuss mental health concerns with their primary care providers. Moreover, nearly a quarter are considered "high need" — meaning they have three or more chronic conditions or require help with basic tasks of daily living