Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Tackling Wasteful
Spending on Health
Learning from OECD countries’ experience
Mark Pearson
Delivering high value health ca...
Overview on wasteful spending in health systems
1. Wasteful clinical care
2. Operational waste
3. Governance-related waste...
Overview on wasteful spending
Waste in health systems
• Adverse events in 1/10 hospitalisation, add between 13 and
17% to ...
Up to a fifth of health spending could be channeled to better use
Difficult admission but:
Strategic: eliminating waste r...
Overview on wasteful spending (cont.)
From definition to solution
• A pragmatic definition of waste …
 Services and proce...
Overview on wasteful spending (cont.)
Identifying wasteful clinical care, operational and
governance-related waste
Waste
o...
1. Wasteful clinical care
Some UK numbers (but story far from unique)
• For every 10 000 British women aged 50 invited to
...
1. Wasteful clinical care (cont.)
Large variations in the volumes of services
delivered cannot be medically justified
8
Kn...
9
1. Wasteful clinical care (cont.)
Inappropriate use of antibiotics by type of health
care service is high, especially in...
 Information systems
 Clinical guidelines and protocols
 Behaviour change campaigns
Choosing Wisely® campaign in a thir...
2. Operational waste
The example of hospitals (an expensive care
setting –where the best data is available)
2. Operational waste (cont.)
Hospital admissions for chronic conditions
are often avoidable
Diabetes admissions per 1000 p...
13
2. Operational waste (cont.)
Delays in transferring patients from hospitals in
three OECD countries 2009-15
(Total numb...
Payments and financial incentives:
To promote day-surgery
Bundled or population-based payments (Best Practice tariffs in
E...
3. Governance-related waste
Administrative costs: a low hanging fruit?
Only represents 3% of THE on average
• Multiple-pay...
3. Governance-related waste (cont.)
A third of OECD citizens believe the health sector
is corrupt or very corrupt
Source: ...
3. Governance-related waste (cont.)
Country differ in their level of effort and approach
to tackling various forms of frau...
18
Tackling wasteful spending:
In sum
Acknowledge – that the problem exists
Inform – generate and publicize indicators on ...
OECD (2017), Tackling Wasteful Spending on Health,
OECD Publishing, Paris.
URL: oe.cd/tackling-wasteful-spending-on-health...
Upcoming SlideShare
Loading in …5
×

Tackling Wasteful Spending on Health: Presentation

22,217 views

Published on

This OECD report, launched on January 10, 2017, systematically reviews strategies put in place by countries to limit ineffective spending and waste. Further information: http://www.oecd.org/health/health-systems/tackling-wasteful-spending-on-health-9789264266414-en.htm.

Published in: Health & Medicine
  • My doctor told me that I am no longer diabetic, that I am free of diabetes and that I can stop all the medications. ▲▲▲ http://t.cn/A6vI6BAP
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Le British Medical Journal (BMJ) resume bien le rapport dans un article que vous trouverez ici : https://doi.org/10.1136/bmj.j215
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Tackling Wasteful Spending on Health: Presentation

  1. 1. Tackling Wasteful Spending on Health Learning from OECD countries’ experience Mark Pearson Delivering high value health care King’s Fund, London January 10, 2017, Paris
  2. 2. Overview on wasteful spending in health systems 1. Wasteful clinical care 2. Operational waste 3. Governance-related waste Tacking wasteful spending: in sum 2 Outline
  3. 3. Overview on wasteful spending Waste in health systems • Adverse events in 1/10 hospitalisation, add between 13 and 17% to hospital costs and up to 70% could be avoided • Geographic variations in rates of cardiac procedures (x3) and knee replacements (x5) are largely unwarranted • Up to 50% of antimicrobial prescriptions are unnecessary • 12% to 56% of emergency department visits inappropriate • Share of generics varies between 10% and 80% • Administrative expenditure varies more than seven-fold • Loss to fraud and error averages 6% of payments A significant share of health spending in OECD countries is at best ineffective and at worst, wasteful
  4. 4. Up to a fifth of health spending could be channeled to better use Difficult admission but: Strategic: eliminating waste releases resources Transformative: puts value at the core of the policy debate Necessary: paves the way for re-engineering of health systems: patient centeredness, streamlined hospital infrastructure, etc. 4 Overview on wasteful spending (cont.) Tackling waste: A smart move
  5. 5. Overview on wasteful spending (cont.) From definition to solution • A pragmatic definition of waste …  Services and processes which are harmful or do not deliver benefits;  Excess costs which could be avoided by replacing them with cheaper alternatives with same benefits. • … Suggests two strategic principles for tackling the problem  STOP doing things that do not bring value  SWAP when equivalent but less pricy alternatives exist
  6. 6. Overview on wasteful spending (cont.) Identifying wasteful clinical care, operational and governance-related waste Waste occurs when … Patients do not receive the right care Duplication of tests and services Low-value care: ineffective, inappropriate, not cost-effective Avoidable adverse events Benefits could be obtained with fewer resources Discarded inputs, e.g. purchased drugs Overpriced input (e.g. generic vs brand) High cost inputs used unnecessarily (HR, hospital care) Resources are unnecessarily taken away from patient care Administrative waste Fraud, abuse and corruption
  7. 7. 1. Wasteful clinical care Some UK numbers (but story far from unique) • For every 10 000 British women aged 50 invited to screening for the next 20 years: – 43 deaths from breast cancer will be prevented – 129 cases will be over-diagnosed and treated • An Organisation with a Memory: – Adverse events occur in 10% of admissions in NHS England hospitals, half may be avoidable • Cost: GBP 2 billion per year – Hospital-acquired infections (15% of which avoidable) • Cost: GBP 1 billion every year
  8. 8. 1. Wasteful clinical care (cont.) Large variations in the volumes of services delivered cannot be medically justified 8 Knee replacement rate across and within selected OECD countries, 2011 (or latest year). Source: OECD (2014).
  9. 9. 9 1. Wasteful clinical care (cont.) Inappropriate use of antibiotics by type of health care service is high, especially in general practice 0 10 20 30 40 50 60 70 80 90 100 Dialysis [3] Pediatric [9] Critical care [5] Ambulatory [4] Hospital/Tertiary [27] Long-term care [13] General practice [4] %Inappropriateuse Estimates of the proportion of inappropriate use based on literature by service (range) Numbers in squared parentheses indicate the number of studies available.
  10. 10.  Information systems  Clinical guidelines and protocols  Behaviour change campaigns Choosing Wisely® campaign in a third of OECD countries Antimicrobial stewardship programme. Kaiser Permanente’s obtained 45% drop in prescriptions Safety campaigns: WHO SAVE LIVES: Clean Your Hands initiative, active in 174 countries  Financial incentives and nudges 10 1. Wasteful clinical care (cont.) Combination of policy levers to tackle wasteful care
  11. 11. 2. Operational waste The example of hospitals (an expensive care setting –where the best data is available)
  12. 12. 2. Operational waste (cont.) Hospital admissions for chronic conditions are often avoidable Diabetes admissions per 1000 patients with diabetes Source: OECD Health Statistics. 12
  13. 13. 13 2. Operational waste (cont.) Delays in transferring patients from hospitals in three OECD countries 2009-15 (Total number of days per year per 1 000 population). Only 3 countries collect the numbers. Denmark England Norway 0 10 20 30 40 2009 2010 2011 2012 2013 2014 2015 2009 2010 2011 2012 2013 2014 2015 0 10 20 30 40 2009 2010 2011 2012 2013 2014 2015
  14. 14. Payments and financial incentives: To promote day-surgery Bundled or population-based payments (Best Practice tariffs in England, Sweden) Behaviour change for providers and patients: Clinical guidelines, disease management Self-management by patients, education campaigns Strengthening of alternative services: Out of hour care can be provided by on-call physicians, (SOS médecins France), larger PHC facilities (Norway), community services (US rapid access clinics) Hospital at home (France) 14 2. Operational waste (cont.) Policy levers to better target hospital use (examples)
  15. 15. 3. Governance-related waste Administrative costs: a low hanging fruit? Only represents 3% of THE on average • Multiple-payer systems cost more than single-payer ones • Free choice multi-payer systems cost more than automatic affiliation ones • Private insurance has higher administrative costs Functional reviews (Australia) or multi-stakeholders reviews of processes (Germany, the Netherlands) help identify administrative processes and structures that add little value
  16. 16. 3. Governance-related waste (cont.) A third of OECD citizens believe the health sector is corrupt or very corrupt Source: Transparency International.
  17. 17. 3. Governance-related waste (cont.) Country differ in their level of effort and approach to tackling various forms of fraud and corruption • Detection, prevention and response to fraud in the delivery and financing of care: – Dedicated and specialized department – Data mining, campaigns targeted at specific areas susceptible to abuse • To combat inappropriate business practices – Countries mostly rely on self-regulation – Increasingly, some practices are being regulated (e.g. Sunshine-type of regulations which mandate disclosure of financial ties: US, France)
  18. 18. 18 Tackling wasteful spending: In sum Acknowledge – that the problem exists Inform – generate and publicize indicators on waste more systematically Persuade - patients and clinicians must be persuaded that the better option is the least wasteful one Pay – reward the provision of the right care in the right setting
  19. 19. OECD (2017), Tackling Wasteful Spending on Health, OECD Publishing, Paris. URL: oe.cd/tackling-wasteful-spending-on-health Contacts: Mark.Pearson@oecd.org Agnes.Couffinhal@oecd.org Website: www.oecd.org/health Follow us on Twitter: @OECD_Social 19 Read more about this work

×