Mark Pearson: Achieving Better Value for Money in Health Care
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This document summarizes strategies various countries have used to achieve better value for money in healthcare. It finds that while England's healthcare system efficiency is not great, no single model is clearly superior. Countries in economic crisis have cut prices and wages without apparent negative effects. Few structural reforms occurred, generally involving centralization. Payment reforms in some countries included activity-based funding and bundled payments. The document questions why more is not done to reform healthcare labor markets.
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Mark Pearson: Achieving Better Value for Money in Health Care
- 1. Achieving Better Value for Money in Health Care Nuffield Trust Health Policy Summit 2013 Mark PEARSON 7 March 2013
- 2. Groups of countries sharing broadly similar institutions
- 3. Efficiency varies more within groups of countries than across them Potential gains in life expectancy (years, DEA) 5 HUN 4 SVK DNK GRC FIN LUX GBR 3 IRL DEU BEL CZE NLD AUT OECD average NZL 2 CAN NOR SWE ESP POL FRA TUR PRT ITA MEX 1 JPN ISL CHE KOR AUS 0 0 1 2 3 4 5 6
- 4. Financing and revenues Czech R 30% cut in Ministerial budget Increase in alcohol, tobacco taxes Estonia 24% cut in Ministerial budget Increase in alcohol, tobacco taxes Ireland Health levy doubled to 4% if income<€75k; 5% otherwise 4
- 5. Coverage Czech HTA to define benefit package Exclusion of some foreigners Inpatient charge up by 66% Estonia Inpatient charges for nursing Greece Uninsured only at certain hospitals, only generics User charges up by 66% (some people protected) Ireland Cuts in dental coverage Income tests for free care for over 70s User charges up all around Portugal User charges more than doubled Coverage reduced Spain Exclusion of some foreigners, immigrants Copays up a lot 5
- 6. Wages and prices Czech 10% cut in salaries Hospital prices frozen Estonia Generics boosted for pharma Greece Salaries slashed Pharmacy margins cut Pharma prices cut Iceland Generics boosted Salaries, overtime cut Ireland Unilateral cuts in pharma prices Pharmacies squeezed Bit cuts in salaries, fees Portugal Pharma prices cut Salaries cut Spain Salaries cut Pharma prices cut 6
- 7. Quantities Greece Reduced staff Iceland Reduced staff Ireland No replacement of staff on leave; voluntary redundancies; reduced agency and locums Portugal 50% reduction in infrastructure Spain Reduced staff 7
- 8. Structural change Czech Reformed hospital payments Greece Positive list for pharma Output-based funding Merger of hospitals, regions Centralised procurement Iceland Merger of hospitals Portugal Reform of primary care payments Spain Centralised purchasing 8
- 9. Conclusions • England’s health system efficiency is not great • No ‘big picture’ model is obviously superior (but provider choice looks worthwhile) • Crisis countries have cut prices, wages without negative effects • Few structural reforms in crisis countries, generally centralising • Payment reform in a few countries (DRGs, Bundling experiments) • Why is no-one tackling the health labour market? 9