New 2011 Survey of Patients with Complex Care Needs in Eleven Countries Finds That Care Is Often Poorly Coordinated
An international survey of adults living with health problems and complex care needs found that patients in the United States are much more likely than those in 10 other high-income countries to forgo needed care because of costs and to struggle with medical debt. In all the countries surveyed, patients who have a medical home reported better coordination of care, fewer medical errors, and greater satisfaction with care than those without one.
- Sicker adults in the U.S. stood out for having cost and access problems. More than one of four (27%) were unable to pay or encountered serious problems paying medical bills in the past year, compared with between 1 percent and 14 percent of adults in the other countries. In the U.S., 42 percent reported not visiting a doctor, not filling a prescription, or not getting recommended care. This is twice the rate for every other country but Australia, New Zealand, and Germany.
- In the U.S., cost-related access problems and medical bill burdens were concentrated among adults under age 65. Compared with Medicare-aged adults 65 or older, adults under 65 were far more likely to go without care because of the cost or to have problems paying bills.
- Adults with complex care needs who received care from a medical home—an accessible primary care practice that knows their medical history and helps coordinate care—were less likely to report experiencing medical errors, test duplication, and other care coordination failures. They were also more likely to report having arrangements for follow-up care after a hospitalization and more likely to rate their care highly.
- Sicker adults in the U.K. and Switzerland were the most likely to have a medical home: nearly three-quarters were connected to practices that have medical home characteristics, compared with around half in most of the other countries.
The Hidden Costs of U.S. Health Care for Consumers
From press release:
Rising health care costs, coupled with the current state of the economy, have prompted many consumers across the globe to delay care, alter household spending and worry about their ability to pay for future health care costs according to the 4th annual Deloitte Center for Health Solutions “2011 Survey of Health Care Consumers.”
Deloitte surveyed more than 15,000 health care consumers in 12 different countries including Belgium, Brazil, Canada, China, France, Germany, Luxembourg, Mexico, Portugal, Switzerland, the United Kingdom and the United States during April and May.
In the United States, three in four (75 percent) consumers say the recent economic slowdown has impacted their health care spending. Four in 10 (41 percent) are being more cautious about it, 20 percent cut back on spending, and 13 percent have reduced it considerably. In addition, 63 percent say their monthly health care spending limits their household’s ability to purchase other essentials such as housing, groceries, fuel and education. To save money, 36 percent of prescription medication users have asked their doctor to prescribe a generic drug instead of a brand name drug. These findings follow Deloitte’s, “The Hidden Costs of U.S. Health Care for Consumers: A Comprehensive Analysis,” published in March 2011, which revealed consumers spend $363 billion more on health care than traditionally reported, outpacing housing and utility costs as a discretionary household expense.
Additionally, one in four (25 percent) U.S. consumers skipped seeing a doctor when sick or injured. Of those consumers who decided not to see a doctor in the past year, those that did so due to costs ranged from a high of 49 percent in the United States, followed by Belgium (39 percent), China (35 percent) and Mexico (34 percent), to a low of 5 percent in Canada and 7 percent in the United Kingdom and Luxembourg.
More than half of all respondents from the 12 countries surveyed, with the exception of the United Kingdom (24 percent) and Canada (39 percent), also confirmed that household spending on health care limits their ability to spend on other household essentials. Additionally, between 4 in 10 and 5 in 10 respondents experienced an increase in household spending on health care in the past year with the exception of the United Kingdom (22 percent), Canada (29 percent) and China (37 percent).
UK Policy Towards Africa Shifting to Strategic Interests and Trade
Source: Chatham House
Budget cuts and a renewed focus on private sector investment in Africa as a driver of development has led the UK government to over-haul many aspects of its diplomatic engagement with states in sub-Saharan Africa, says a new paper.
While no embassies in Africa are threatened with closure for now, many have seen staff cuts which mean fewer UK staff are responsible for larger areas. These staff cuts are so widespread that a new style of British diplomatic mission know as a ‘micro post’ is emerging in Africa. If successful such a model may be rolled out globally over coming years.
‘These changes are all taking place against longer-term uncertainties over the extent to which the FCO, on Africa as elsewhere, is capable of fighting its case in Whitehall for sufficient funding and continued relevance’, says the paper’s author, Tom Cargill.
‘This is risky for the United Kingdom’s reputation globally: a crisis for Africa could conceivably force a ‘South of Suez’ withdrawal that would call into question the United Kingdom’s permanent position on the UN Security Council and international standing generally’.
Switzerland: Selected Issues Paper (PDF)
Source: International Monetary Fund
This selected issues paper on Switzerland was prepared by a staff team of the International Monetary
Fund as background documentation for the periodic consultation with the member country. It is based
on the information available at the time it was completed on April 28, 2011. The views expressed in
this document are those of the staff team and do not necessarily reflect the views of the government
of Switzerland or the Executive Board of the IMF.
Background And Selected Issues Related To The U.S. International Tax System And Systems That Exempt Foreign Business Income
Background And Selected Issues Related To The U.S. International Tax System And Systems That Exempt Foreign Business Income (PDF)
Source: Joint Committee on Taxation, United States Congress
The House Ways and Means Committee has scheduled a public hearing for May 24, 2011 on the rules in certain foreign jurisdictions for taxing foreign income. This document, prepared by the staff of the Joint Committee on Taxation, describes the U.S. international tax rules applicable to foreign income of resident taxpayers, provides a general overview of a territorial system of taxation, including a brief discussion of basic design considerations, and summarizes the rules of nine selected countries for the taxation of foreign income.
Switzerland and Liechtenstein: Country Specific Information
Source: U.S. Department of State
Switzerland is a highly developed democracy. The Principality of Liechtenstein is a democratically run constitutional monarchy divided into 11 municipalities.