VIP Call Girls Pune Vani 9907093804 Short 1500 Night 6000 Best call girls Ser...
Sherry Glied: Health reforms in the OECD
1. Health Reforms in the
OECD
Nuffield Trust
Health Strategy Summit, March 2009
Sherry Glied
Mailman School of Public
Health
Columbia University
Thanks to the Commonwealth Fund and especially Robin Osborn.
2. Non-US OECD Health Care
Systems
Misconception
• Uniform
• Stable and unchanging
Reality
• Variable (except with respect to
coverage)
• Intermittent significant reforms and
frequent incremental modifications
• Struggling with value for money
2
3. Pop’n GDP Health
Denmark 5,435 $35,000 $3,349
France 61,353 31,000 3,449
Germany 82,368 32,000 3,371
Netherlands 16,346 37,000 3,391
Sweden 9,081 35,000 3,202
Switzerland 7,484 38,000 4,311
UK 60,587 33,000 2,760
2007. Per capita GDP and Health spending – PPP adjusted US$. 3
4. Commonalities: Organization
Universal or near universal coverage
Defined, comprehensive benefit
package
Spending between 8-11% of GDP
Free choice of primary care provider
Low cost sharing, with exempt
populations
Limited private insurance to
complement/supplement defined
benefits 4
5. Variations: Organization
Automatic Enroll with fund
enrollment Community rated
General/earmark premiums
tax financed Private purchasers
Public purchasers No waiting times
Waiting times
5
6. Push toward greater equity
Mandates for coverage
Growing public share of spending
Risk adjustment across purchasers
Nationally pooled financing
Low income subsidies
6
7. Financing and Purchasing
Risk adjusted capitated financing to
insurance funds or regional
purchasers
• Defined benefits
• Regulated provider fees
• Regulated, community rated premiums
• Very little selective contracting
7
8. Physicians
UK, Denmark, Netherlands, (Sweden)
• Primary/specialty care
Direct service provision
Care coordination and navigation
Gatekeeping
Mainly capitated or salaried payment
France, Germany, Switzerland, (Sweden)
• Outpatient/inpatient
Some gatekeeping incentives
Fee-for-service practice
8
9. Increased use of non-MDs
Particularly in gatekeeping countries
• Not all nurse-practitioners – chronic
care nurses, pharmacists, etc.
• Rx, immunizations, care coordination,
outpatient clinics, chronic care clinics
9
10. Quality and satisfaction
Routine patient feedback
Integration
Recertification of providers
Performance reporting
P4P in UK
• Quality, organization, experience
Extra pay for
• After hours, home visits, prevention
• Capitated pay for disease management
10
11. Information technology
National IT strategy
Main element is EHRs
• Centralized
UK
• Local development, central coordination
Denmark, Netherlands, Sweden
Standards, portals, cards, etc. to
facilitate interoperability
11
12. Commonality: Financing
Provider pays (except UK)
• Some direct subsidies
• Some enhanced fees
Costly national efforts
• Evidence for cost-saving is meager
12
13. Commonality: Privacy
Issue everywhere
EU rules and national rules
Access to own records, discretion as
to what is included
13
14. Variability: Extent of e-use
EHRs
Decision support, drug alerts
• E-prescribing
E-labs, E-radiology
• E-mail with patients
E-referrals
∗ E-discharge notes
14
15. Pharmaceuticals
Health technology assessment
• Effectiveness and cost-effectiveness
Reference pricing within a
therapeutic class
• Very broad
Marketing restrictions
• No DTCA
• Limits on provider promotion
15
16. Common Challenges
Speeding up drug approval process
• EU rules
• High priority drugs
Involving stakeholders
Delisting existing drugs
16
17. Innovations
Sweden
• Value-based pricing for drugs
• Compared to therapeutic class
UK
• Velcade risk sharing agreement
17
18. Watch this space
IT expansions
Further primary care innovations
• Physician- and nurse-led disease
management
Purchasing and financing
Costs are growing faster than
incomes
• Rising share of health care in GDP
18