Finding Common Ground on Health Care Across 16 Countries

Steve Rohleder, chief executive of Accenture’s Health & Public Service Operating Group, writes that the US perception of health care delivery has more in common with their international counterparts than one might think. According to a 16-nation, 16,000 person survey, common beliefs about the need for health care access and public engagement in health care spending decisions exist in almost every country.

It is striking to discover how much people around the world have in common when it comes to health care delivery. They share, for example, a perception that their governments should be doing more to make health care accessible to the most vulnerable, and that their governments do not engage them enough when it comes to setting priorities for health care spending.

We learned this in a 16-nation study we unveiled recently at the 2010 World Health Care Congress near Washington, D.C. The Accenture Citizen Experience Study (ACES) was conducted to examine people’s views about the quality of health care and government’s role in improving it. We surveyed more than 16,000 people (adults at least 18 years old) in Australia, Brazil, Canada, France, Germany, Hong Kong, India, Ireland, Italy, Japan, Mexico, Norway, Singapore, Spain, the United Kingdom, and the United States.

We asked people questions on two dimensions – to rate the importance of specific actions related to their health care services, and how well their government is delivering on those actions. While there is great variation not only in the health systems, but also in the social, cultural and economic factors that determine people’s needs and expectations of government, the survey revealed a strong consensus among the participants about what they want from their health systems:

  • Fair, easy access to health care for all is a concern for a majority of people, regardless of where they live;
  • Citizens want their governments to intervene and help mediate when they have problems or difficulties with their health care;
  • Citizens feel disengaged from the decision-making process related to health care; and
  • People perceive large gaps between actions they value in health care and how well their respective governments work to ensure those actions happen.

These gaps are perhaps the most telling, and provide the best indication of where governments should concentrate their efforts. On average, 75 percent of respondents worldwide rate government help in resolving problems or difficulties in receiving health care as an essential or very important responsibility. Yet only 26 percent think their government is performing this well – a gap of almost 50 percent.

There are important differences among countries on more specific priorities. For instance, it comes as no surprise that in the United States, the cost of health care is a top concern, while citizens in many other countries list quality of care as their top issue.

People also draw a distinction between the impact of government policies on general health issues and individual health issues. Only two countries – Brazil and Ireland – prioritized the need for government to ensure that health services deliver real improvements in the health of the nation as a whole. Among the remaining locales, 70 percent rated this essential or very important, but not as important as other government actions. I take this to mean that while people value improved public health outcomes, they take a back seat to people having access to health services for themselves and their families and that everyone has the same opportunity to access quality health services when they’re needed.

It is easy to imagine how frustrated people are with their health care systems when they feel they have no voice in setting spending priorities or enlisting their government’s help in solving problems. Conversely, imagine what societies could gain if governments actively solicited their citizens’ views on what works and what doesn’t.

Our research represents a snapshot of citizen input and the message we heard is loud and clear – citizens want to be co-producers of public value to improve health care in their countries. Governments would be wise to take heed.

Steve Rohleder is chief executive of Accenture’s Health & Public Service Operating Group

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