global health comparisons and attitudes
DESCRIPTION
A global Healthcare survey presented to the Market Research Society Healthcare Conference, London 2012TRANSCRIPT
1
Global Health SurveyEXPERIENCE & PERCEPTION IN 28 COUNTRIESInternational Research Institutes www.irisnetwork.org
2
3
International Research InstituteS
INRA(1950’s)
IRIS(1986)
Split in the 1980s
5-6 members (Demoscopie (Fra), RSL (UK), NSS (NL), Demoscope (SUI), Data (Esp)
B&A joined 1997
FDS (now SPA Future Thinking) 2005
33 members in 2012
4
International Research Institutes
• A voluntary trade association (non-ownership)
• Representing and consisting of quality, multi-disciplinary Independent Agencies.
• Thought leadership, sharing experiences, working groups.
• A network with trusted, local expertise overseas.
• Meet personally every six months and virtually much more often.
5Our Study
6
IRIS International Health Survey
• First fielded in 2004….21 countries, slightly smaller-scale.
• Fielded again Autumn 2011:
– 28 countries
– 22,000 interviews
– Mix of methodologies
– Romania/Canada/Ireland-lead but planned by a group of fifteen.
BASE Method Total
TOTAL 21988Finland Online 500France CATI 959
Germany Online 1087Greece CATI & Online 1002
Hungary CATI 500Ireland Face-to-Face 1000
Italy Telepanel 2030Lithuania Face-to-Face 1005
Netherlands Online 1062Poland Online 812
Romania Face-to-Face 1100Russia CATI 520
Slovenia Online 501Turkey CATI 417
UK Online 1000Ukraine Face-to-Face 600
Sample Sizes X Country
BASE Method Total
TOTAL 21988
USA Online 1014Canada Online 1006
Chile Online 640Colombia Online 506
China Online & Face-to-Face 1000
India Face-to-Face 1056Indonesia Face-to-Face 500
Malaysia Online & Face-to-Face 427
Thailand Online 540Pakistan Face-to-Face 300
Egypt CATI 500
Australia Online 910
BASE Method All respondents
TOTAL 22364
India Face-to-Face 1056
China Online & Face-to-Face 1000
Asia + Africa CATI, Online & Face-to-Face 2270
Australia Online 910
East / Central Europe CATI, Online & Face-to-Face 4956
Western Europe CATI, Online & Face-to-Face 9007
Americas Online 3166
Sample Sizes X Region
9
Scope
• Perceived Health
• Contributors to Health
• Assessment of Local Systems
• Funding Preference
• Interaction with HCPs
• Opinion of Family Physician
• How we gather information or health
• Personal input desired on health treatment
• Pervasiveness of suicide and related mental conditions
10
System Failings
11
System Attitudes
• Broad view persists of crisis in healthcare systems.
• The general view is that management failings are the primary detractor moreso than underfunding.
• The European perspective is predominantly negative, even in ‘good’ systems: government or national handing invariably criticised.
• Healthcare as a sector clearly needs “better press”.
National Health System: Good Shape or Crisis
All Countries
Turkey
Finland
UK
Netherlands
Lithuania
France
Italy
Slovenia
Germany
Ireland
Hungary
Russia
Greece
Poland
Ukraine
Romania
33
68.585131894484
55.8
41.5699743799313
41.5349160376251
38.8059701492537
33.5415088271213
26.3873084647056
24.4013976286867
24.1108114272084
23.208883478029
18.9486812931646
16.5036604346406
12.4750499001996
11.8226600985222
8.77942478372566
6.36363636363636
3
12.2302158273381
2.8
1.36187123054457
5.60823740585097
0.199004975124379
3.79049131748338
2.22839180948735
0.604701373065815
1.76711932352374
2.33914228204746
0.135329054943597
0.50919432008147
0.998003992015968
0.0909090909090913
Very good shapeExcellent
Canada
Chile
USA
Colombia
Indonesia
Malaysia
India
Thailand
China
Pakistan
Egypt
Australia
51
24
18
8
81
66
66
62
51
23
7
48
3
0
1
0
20
8
14
6
4
3
5
Regional Healthcare System Evaluation
66
51
50
48
22
30
28
14
4
8
5
1
2
1
India
China
Asia + Africa
Australia
East / Central Europe
Western Europe
Americas
Very good shapeExcellent
All Countries
Turkey
Finland
Netherlands
UK
Hungary
Russia
France
Ireland
Slovenia
Lithuania
Italy
Greece
Germany
Poland
Ukraine
Romania
34
77.4580335731415
41.2
40.5581262935897
37.0474385105806
34.7185442957291
32.4174240531866
32.0164019560845
32.004733477558
24.374381062899
23.2835820895522
20.3882796331727
19.4610778443113
16.6172818816535
16.0098522167488
10.8233181443109
5.18181818181818
6
46.7625899280576
1.8
4.11457204654563
3.28747943233855
3.54824164058612
3.60471148857675
4.9780708708587
4.58556624419881
1.39197140151811
0.796019900497513
1.19843437715211
4.69061876247505
1.85529781496152
1.84729064039409
1.47174551962327
0.636363636363638
Somewhat approveStrongly approve
Approval of National Healthcare System Management
Canada
Chile
USA
Colombia
Indonesia
India
Malaysia
China
Thailand
Pakistan
Egypt
Australia
42
30
29
19
83
78
72
54
53
25
17
39
2
2
4
1
31
27
20
3
6
0
4
6
All Countries
Slovenia
Germany
Greece
Poland
Russia
Ireland
Lithuania
France
Netherlands
Romania
UK
Turkey
Ukraine
Italy
Finland
Hungary
63
86.9080893449865
84.2956590650471
79.1417165668663
74.2610837438426
67.1214188267392
64.4276040993688
60.7960199004975
59.0260921656071
57.9088583816875
57.6363636363636
57.1357309860779
50.3597122302159
49.5275656603674
46.645050906532
37
37.4241297941968
30
10
9.92985020601246
18.9620758483033
23.6453201970443
26.9123609323059
27.798700673251
37.8109452736318
33.8749950603492
42.0911416183123
42.3636363636362
37.2294540012978
24.4604316546762
41.4806492197418
35.1401429449845
47.4
51.8714070597911
Source of Problems in the Healthcare System
Colombia
Chile
USA
Canada
China
Indonesia
Thailand
India
Pakistan
Malaysia
Egypt
Australia
95
72
72
62
79
68
66
64
62
43
69
42
5
27
10
30
16
32
34
27
35
42
29
46
Inefficient management Not enough funding
All Countries
Turkey
Netherlands
Lithuania
Romania
UK
Greece
Finland
Hungary
Poland
Slovenia
Italy
Russia
Ireland
France
Ukraine
Germany
67
83.6930455635492
83.0893187855694
82.8855721393032
81.8181818181815
81.7675186298565
81.0379241516966
78
74.9397280255296
73.7684729064036
72.7042050816687
68.7221486085391
67.6075552908175
64.7820169182124
53.4775642603303
52.8982685386435
46.4106469439165
25
11.9904076738609
16.9106812144306
14.4278606965174
18
9.16853373240478
15.5688622754491
11.6
13.9400110596445
20.8128078817734
20.8865085474448
9.49911280099047
26.4800261322367
18.4649544683726
38.255844037757
40.6510103753466
43.8113745471978
Governments, through taxation Private individuals
Funding Preference: Health Expenses of Individuals
Canada
Columbia
Chile
USA
Malaysia
Indonesia
Pakistan
Thailand
India
China
Egypt
Australia
77
76
75
35
72
67
60
52
51
42
68
65
13
16
19
46
21
33
35
48
46
58
29
23
17
Health Contributors
18
Global Behavioural & Attitudinal Differences
• Interesting differences across continents in relation to tobacco, alcohol, diet and other perceived contributors.
• European and American obsessiveness or fastidiousness.
• Asian ignorance in relation to some key contributors.
• Key implications for public health initiatives.
92
89
88
88
88
87
86
84
84
78
77
52
56
49
51
44
54
47
43
43
54
44
Level of physical exercise
Contaminants that affect one’s water and food supply
Insufficient or poor quality sleep
The diet one chooses on a regular basis
Family’s health history or genetics
Stress and anxiety
Air pollution
Use of prescribed medications
Outlook on life
Use of tobacco
The amount of alcohol consumed on a regular basis
Somewhat importantVery important
Factors Contributing to Health
Global India China Asia + Africa Australia
East /Central Europe
Western Europe Americas
TOTAL 22490 1056 1000 2266 910 4956 9137 3165
Contaminants that affect one’s water and food supply 56% 40% 54% 63% 41% 61% 55% 58%
Stress and anxiety 54% 16% 46% 37% 52% 59% 56% 69%
Use of tobacco 54% 9% 40% 31% 60% 54% 60% 71%
Level of physical exercise 52% 54% 39% 62% 46% 52% 47% 61%
The diet one chooses on a regular basis 51% 67% 53% 56% 56% 47% 47% 60%
Insufficient or poor quality sleep 49% 36% 52% 51% 47% 52% 46% 56%
Air pollution 47% 40% 40% 58% 27% 53% 44% 48%
Family’s health history or genetics 44% 38% 44% 42% 38% 46% 42% 51%
The amount of alcohol consumed on a regular basis 44% 9% 28% 26% 47% 47% 49% 53%
Use of prescribed medications 43% 60% 22% 54% 34% 42% 40% 48%
Outlook on life 43% 43% 30% 44% 42% 42% 39% 57%
Very Important Contributors to Health by Region
Tobacco as a Health Contributor x Region
94
86
86
80
76
47
17
71
60
40
54
60
31
9
Americas
Western Europe
China
East / Central Europe
Australia
Asia + Africa
India
Somewhat importantVery important
Alcohol Consumption as a Health Contributor
93
85
81
80
79
44
16
53
49
28
47
47
26
9
Americas
Western Europe
China
Australia
East / Central Europe
Asia + Africa
India
Somewhat importantVery important
23
Good Doctor/Bad System?
24
A Health Paradox
• A relatively poor perspective of the health system is accepted.
• In contrast, the family physician is very positively perceived.
• Suggests a common hardware/software conundrum, or perhaps an explicable manager/carer issue.
• Is the public simplistic in its analysis? Should the system be more obviously managed by HCPs rather than bureaucrats.
Family GP in public system
Pharmacists
Specialists in the public system
Physicians in the private health system
Nurse
Physiotherapists
Dietician/Nutritionist
Psychologist
Social worker
59
45
43
24
19
13
7
7
4
65
36
18
13
15
10
3
2
2
68
38
33
9
39
16
6
5
5
UKIrelandGlobal
Usage of Key HCPs for Health Related Services in Past Year
All Countries
Netherlands
France
Ireland
Hungary
UK
Turkey
Lithuania
Romania
Germany
Slovenia
Greece
Italy
Poland
Finland
Ukraine
Russia
84
95.336270757785994.555087141643293.672127358706291.858562740554489.35977855011
2188.435374149659687.79527559055187.18905472636
8283.457965533242281.44156447600
4577.840909090909177.360031214626676.065573770491574.829931972788765.05176814277
0457.3100456113028
34
56.076550750582645.37027483418
4165.164537842295347.45020679393
6846.235734809259856.46258503401
369.4488188976377940.67164179104
4726.451623293181621.96372291198
5831.818181818181820.40655526828
0110.163934426229520.40816326530
619.0127201211510512.98920903326
29China was not included in this question
Satisfied at allVery satisfied
Satisfaction with the Family Physician
Canada
USA
Chile
Colombia
India
Indonesia
Malaysia
Pakistan
Thailand
Egypt
Australia
93
91
48
42
93
89
82
81
80
58
92
46
54
7
2
53
38
19
43
15
10
48
27
Search & Information Behaviour
28
Finding out about Health
• Primary information sources are predictable HCPs, but extent of consultation with less generalist physicians varies very widely.
• Variation in online usage is enormous: British internet use highly developed while Irish levels are much lower.
• Sites such as Wikipedia have enormous cachet.
Consulted In Past Year On Health Issues That Concern You MostUsed To Get Information On Health Issues That Concern You Most
Own family GP in public system
Specialists
Family & friends
Pharmacists
Other GPs/physicians
Others with the condition
Non-doctor healthcare professionals
Social networking contacts
Spiritual/religious
Patient advocacy groups
57
38
35
30
19
12
9
6
3
3
61
12
23
29
7
4
3
3
1
2
67
28
28
23
5
12
8
4
1
0
Websites
TV/radio programme
Magazines or newspaper
Pamphlets in GP clinics
Books
Blogs/chatrooms
(Any) social media
Pamphlets mailed to you
Telephone information lines
Smartphone apps
DVD/CDs
51
26
24
21
19
8
7
6
3
2
2
37
11
12
12
13
1
4
4
2
1
*
71
13
14
25
14
3
4
5
5
*
1
UKIrelandGlobal
Consulted in past year Used as way to get information
The internet is a significant secondary source but much higher in some countries (Germany & UK 71%, USA 79%, China 69%)
China (12%)
Web-sites
TV or radio
Magazines or newspapers
Brochures from
physicians’ offices or
clinics Books
Blogs and/or chat rooms on
the internet
Social media
(Facebook, Twitter etc)
Global 51 26 24 21 19 8 7
India 7 51 33 7 21 1 2
China 69 61 47 23 53 23 25
Asia + Africa 40 46 38 23 23 9 18
Australia 70 14 14 28 18 8 5
East / Central Europe 47 28 26 21 18 10 5
Western Europe 48 18 18 19 14 6 4
Americas 77 18 20 27 21 8 5
Secondary Sources by Region
31
The Assertive Patient
32
Input to Treatment
• Indicated as one of the significant coming trends.
• Desired control of own treatment more in evidence where there are better treatment choices or options (Netherlands).
• Evidently a middle aged, mid/upper class, affluent, better educated phenomenon.
All Countries
Hungary
Slovenia
Germany
France
Poland
Greece
Finland
UK
Ireland
Ukraine
Netherlands
Italy
Russia
Turkey
Lithuania
Romania
11
8.58774288662363
7.15057875646391
7.2232584674573
6.25082633602106
8.00492610837437
4.59081836327345
1.8
8.99057554148066
10.0272086791417
6.14949108199321
23.1396643671221
7.68860256538758
16.4325653786291
5.515587529976
14.228855721393
8.0909090909091
51
79.0989535141751
75.0256337315117
74.6122922596271
68.7792196230923
63.5467980295567
62.7744510978043
62.2
61.1302056823595
53.7432229365714
52.8909240385456
50.8027460003629
49.3869112351513
47.5760428876122
39.568345323741
30.2487562189054
27.6363636363636
35
11.0665014929996
17.1825232661667
17.2717964629633
24.3357951299785
26.4778325123152
31.1377245508982
33.4
28.1811134627632
34.8749817746491
36.904779825397
26.0575896325148
27.937431805296
32.1272793651403
53.4772182254197
52.6368159203981
64.272727272727
Patient Input into Treatment Decisions
You decide Work with physician Physician makes decision
USA
Canada
Chile
Colombia
Thailand
Malaysia
China
Pakistan
Indonesia
India
Egypt
Australia
5
7
10
11
11
25
24
24
22
30
7
10
82
75
37
36
50
45
31
24
20
9
30
56
12
16
54
50
39
27
45
48
58
61
61
25
34
Actual & Perceived Health
35
Actual/Perceived Health Patterns
• Many feel that they are in good general health: perceived health measures are strong.
• Claimed incidences of long term serious conditions vary very substantially.
• Inter-relationship of perceived and actual health data illustrates some broad relationships but equally some more perplexing conundrums.
• We can categorise a First World Paradox of high incidence/high health but equally the probability of poorer detection (Ireland).
All Countries
Ireland
Germany
Netherlands
Slovenia
Romania
France
Greece
UK
Lithuania
Italy
Finland
Hungary
Poland
Turkey
Ukraine
Russia
70
84.286933766644682.37996307728
7473.352595542092172.40144062269772.18181818181
8272.179792695246472.155688622754169.26844206730
9468.756218905472662.95904780516
8262.8
57.043871759811956.403940886699556.3549160671461
53.6747473823352.57575466441
23
14
33.04125601771898.817257239330
0511.889832095782312.293024459360317.45454545454
5514.938807503053514.570858283433111.62370800719
0920.09950248756216.392829371076
87810.93855044105
155.9113300492610815.10791366906
4711.92285615897145.270641584843
31
GoodExcellent
Perceived Personal Health Assessment
USA
Colombia
Canada
Chile
Pakistan
Indonesia
India
Malaysia
Thailand
China
Egypt
Australia
85
84
76
57
87
85
73
70
63
60
66
65
19
17
15
3
38
23
15
9
13
9
12
13
Top 5 Chronic Conditions by Region
16
14
11
11
10
8
5
8
10
9
5
4
5
6
4
4
5
2
2
1
5
5
6
3
4
4
3
4
5
7
2
3
2
1
Western Europe
Americas
Australia
East /Central Europe
China
Asia + Africa
India
High blood pressure High cholesterol Heart condition Diabetes Asthma
All Countries
Hungary
Germany
Finland
France
Turkey
Netherlands
Italy
Poland
UK
Russia
Slovenia
Romania
Greece
Lithuania
Ireland
Ukraine
13
27.2401504595011
25.5942719053246
19.8
19.3142362510952
17.7458033573141
17.7392004711123
14.723833656805
14.6551724137931
11.5743623097075
11.3483081298157
11.1917987548184
10.4545454545455
7.58483033932134
7.56218905472637
5.03673301864309
4.31472255752963
7
6.45276861982408
9.9004908622008
13.2
9.23513090235043
10.0719424460432
11.8128608991692
7.66758547191573
8.00492610837437
7.6153743116159
2.67278980842764
5.90319637112988
2.52280524813582
0.153975668719675
5
10.9471220445315
6.70483535916024
5.8
9.48684539477796
6.95443645083933
8.2321138804775
4.77320770577417
6.65024630541872
5.5315412178914
8.87727456142035
3.20597691792508
4.72727272727273
3.39321357285429
3.681592039801
3.61963719873256
4.70781922943757
5
7.04066485850994
7.86425556661857
7.2
6.11230777603111
7.67386091127098
8.77944818219711
4.62484411059205
4.43349753694581
4.80337995502764
3.00328574448053
2.82998811057932
3.90909090909091
2.69461077844312
1.39303482587065
2.14446900546143
1.32904251772057
4
2.80348313821416
6.04542519264239
8.2
7.17109129280745
4.07673860911271
7.54255867225525
2.41691382807736
3.32512315270936
4.25342678307524
3.41308629089476
1
1.89620758483034
0.796019900497513
1.808312943685
1.25063985000853
Chronic Conditions by Country (Top 5)
Canada
USA
Chile
Colombia
Thailand
China
Pakistan
India
Malaysia
Indonesia
Egypt
Australia
20
16
10
5
19
10
9
5
4
3
6
11
15
13
4
3
13
4
1
0
3
2
1
9
6
4
3
0
5
2
1
1
1
1
1
4
8
6
4
1
9
4
2
3
3
1
4
6
10
3
3
1
4
3
1
4
1
1
7
High blood pressure High cholesterol Heart condition Diabetes Asthma
HIGHER INCIDENCE /POORER SELF PERCEPTION
HIGHER INCIDENCE /BETTER SELF PERCEPTION
LOWER INCIDENCE /POORER SELF PERCEPTION
LOWER INCIDENCE /BETTER SELF PERCEPTION
GLOBAL AVERAGE
33%
70%
HungaryFinland
China
TurkeyPolandRussia
Chile
ThailandAustralia
ItalyUK
GreeceUkraine
Egypt
CanadaFrance
Nederlands
USA
Germany
Slovenia
Romania
MalaysiaIndia
ColombiaIreland
PakistanIndonesia
Lithuania
PERSONAL HEALTH PERCEPTION
Actual & Perceived Health Contrast
ANY SERIOUS ILLNESS
INCIDENCE
40
Key Thoughts
41
Key Thoughts
• Global variation in need but with much basic commonality.
• Study helps to better illustrate global threats posed by local ignorance and the need for better regulation.
• Transformative effect of online.
• The rise of the assertive patient.
• Differences in detection rates and in HCP use.
• Need for better PR for health systems.
Larry RyanCouncil Member, IRISDirector, B&Awww.banda.ie