Health Care Systems in Ten Developed Countries: The U.S. System Is Most Unpopular and Dutch System the Most Popular

Several recent surveys by Harris Interactive^®, including the latest Financial Times/Harris Poll, asked an identical question of cross-sections of adults in ten developed countries about their own health care systems. This research finds that the United States has the most unpopular system:

• Fully 33 percent of Americans believe that the American system "has so much wrong with it that we need to completely rebuild it", and a further 50 percent think that "fundamental changes are needed to make it work better";
• In the other nine countries those who believe they need to completely rebuild their systems vary from only nine percent in The Netherlands and 12 percent in Spain to 15 percent in France, 17 percent in New Zealand, 18 percent in Australia and 20 percent in Italy; all well below the 33 percent in this country.

The data for this ten-country comparison comes from three different sources, published separately. The data for France, Italy, Spain and Germany come from an FT/Harris Poll conducted in June 2008 for the Financial Times. The data for the United States and Great Britain come from a Harris Interactive survey conducted for the International Herald Tribune and France 24 in May 2008. The data for The Netherlands, Canada, New Zealand and Australia come from a Harris Interactive survey conducted for The Commonwealth Fund between March and May 2007.

In every country just over 1,000 adults were surveyed either by telephone (the Netherlands, Canada, Australia and New Zealand) or online (the USA, Britain, France, Italy, Spain and Germany). Using these survey results, there are at least two ways to rank the popularity of the systems in these ten countries. One way is based on those who want to "completely rebuild" the system, as follows:

Alternatively they can be ranked by those giving "the most popular" response – that "the system works pretty well and only minor changes are necessary."

Overall, because the United States system has by far the largest number of harsh critics (33% versus 20% or less in other countries) it is fair to describe the U.S. as the most unpopular.

The FT/Harris Poll conducted in June also asked several other interesting questions in the five largest European countries (but not the United States or the other countries included in Table A).

• In Germany a large 69 to 15 percent majority feel that "access to health care in Germany depends on the patient’s ability to pay for it";
• In the other four European countries between 25 percent and 38 percent agree with this statement while about half of all adults, from 55 percent in Spain to 48 percent in France and Italy disagree;
• Majorities of all adults in France (70%) and Britain (59%) believe their health care systems are "the envy of the world";
• Only minorities in Spain (38%), Germany (32%) and Italy (20%) feel this way about their systems.

Another question in the FT/Harris Poll asked only in Britain also produced an interesting response. A large 69 percent majority of the British adults believes that the British National Health Service (NHS) is "crucial to British Society and we must do everything to maintain it." A 24 percent minority feels that the NHS is a "great enterprise but we probably cannot maintain it in its current form."

In all countries that Harris Interactive has surveyed two things appear to be true:

1. Regardless of what system a country has it falls far short of satisfying public expectations. Most systems always seem to be in a crisis or near crisis.
2. Governments in all countries are either changing or debating how to change their systems.

"Which of the following statements comes closest to expressing your overall view of the health care system in (respondent’s country)?"

Base: All adults in each country

Note: Percentages may not add up to 100% due to rounding.

Sources:

• The data from France, Italy, Spain and Germany came from the FT/Harris Interactive survey conducted online in June 2008.
• The data from USA and Britain came from the IHT/France 24/Harris Interactive survey conducted online in May 2008.
• The data from the Netherlands, Canada, New Zealand and Australia came from the Commonwealth Fund/Harris Interactive Health Policy survey conducted by telephone between March and May 2007.

"For the following statements, please say how much you agree or disagree with each. Access to health care in [Great Britain, France, Italy, Spain, Germany] depends on the patient’s ability to pay for it."

Base: All EU adults in five countries

Note: Percentages may not add up to 100% due to rounding

Source: FT/Harris Poll June 2008.

"For the following statements, please say how much you agree or disagree with each. The health care system in [France, Italy, Spain, Germany] is the envy of the world."

Base: All EU adults in five countries

Notes: Percentages may not add up to 100% due to rounding

In Britain, the statement with which respondents were asked to agree or disagree was "The National Health Service (NHS) is the envy of the world."

Source: FT/Harris Poll June 2008.

"Thinking about the place of the National Health Society (NHS) in British society, which statement best represents your views?"

Base: British adults

Source: FT/Harris Poll June 2008.

The Financial Times/Harris Poll was conducted online by Harris Interactive among a total of 5,104 adults (aged 16-64) within France (1,013), Germany (1,005), Great Britain (1,059), and Spain (1,010), and adults (aged 18-64) in Italy (1,017) between May 28 and June 9, 2008. The Harris Interactive/France 24/International Herald Tribune study was conducted online by Harris Interactive among adults (aged 16-64) within Great Britain (1,088), and the United States (1,046) between April 30 and May 12, 2008. Figures for age, sex, education, region and Internet usage were weighted where necessary to bring them into line with their actual proportions in the population. Propensity score weighting was used to adjust for respondents’ propensity to be online.

All sample surveys and polls, whether or not they use probability sampling, are subject to multiple sources of error which are most often not possible to quantify or estimate, including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. Therefore, Harris Interactive avoids the words "margin of error" as they are misleading. All that can be calculated are different possible sampling errors with different probabilities for pure, unweighted, random samples with 100% response rates. These are only theoretical because no published polls come close to this ideal.

Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the adult populations of the respective countries. Because the sample is based on those who agreed to participate in the Harris Interactive panel, no estimates of theoretical sampling error can be calculated.