The document summarizes key elements of health care reforms in the Netherlands, including moving to a system of mandatory private health insurance in 2006. It discusses three waves of health care reforms across OECD countries focused on universal coverage, cost controls, and increased competition and incentives. The Dutch system aims to promote competition among private health insurers acting as purchasers of care on behalf of consumers. Regulations seek to ensure risk equalization, transparency, consumer choice and protection, and financial incentives for efficiency among insurers and providers. An evaluation found broad support for the reformed system and its effects like improved access, price competition, and quality focus.
FERMA's response to the Insurance Mediation Directive (IMD)FERMA
The Federation of European Risk Management Associations (FERMA) welcomes the oppotunity to contribute to the consultation launched by the Internal market and Servicdes Directorate General of the European Commission.
Der Stuttgarter Generationenvertrag für ein aktives Miteinander von Jung und AltLandeshauptstadt Stuttgart
Der Generationenvertrag ist eine Selbstverpflichtung der politisch Verantwortlichen ebenso wie von Organisationen, Vereinen und einzelnen Bürgern, um mit seinen zwölf Zielen die vielfältigen Veränderungen gemeinsam aktiv zu gestalten und die Zukunftsfähigkeit der Stadt Stuttgart zu verbessern.
NGG Automotive Solutions is a business excellence solutions group that provides knowledge, technology, management and learning solutions, organizational engineering solutions, business intelligence solutions, and information systems solutions. It has expertise in areas like customer strategy, sales and service, change management, performance improvement, supply chain management, leadership training, and more. The group has a global presence operating out of multiple countries worldwide.
El documento presenta actividades para niños de primer grado sobre sumas y restas utilizando material concreto como monedas. Los niños aprenden los procedimientos usuales para sumar y restar con apoyo de lápiz, papel y material concreto. También se les muestra un procedimiento alternativo para resolver sumas.
Zlatko Rajkovic is applying for the position of Senior Manager Business Process Outsourcing – Remote Manager. He has 15 years of experience working as a manager, project manager, and currency trader for large companies and private investors in emerging markets. Rajkovic believes his background, experience, and qualifications make him a strong fit for the requirements of the position. He would bring skills in managing outsourcing strategies, identifying areas for performance improvement, and working well with others. Rajkovic's resume provides more details on his abilities and he is available for an interview.
RowingChat with Kirsten Barnes - Kirsten's slidesrowperfect
Kirsten Barnes, an Olympian rower and sports pyschologist/ mental performance consultant, joined us on our podcast RowingChat (https://soundcloud.com/rowperfect) to talk about the mental toughness needed to perform in a sport like rowing. Here are her slides on the topic. Listen to her chat at https://soundcloud.com/rowperfect/rowingchat-with-kirsten-barnes for more!
Este documento apresenta uma série de cursos oferecidos pela empresa evarejo para profissionais do varejo. Os cursos cobrem tópicos como prevenção de perdas, reposição de mercadorias, empacotamento, atendimento ao cliente, recebimento de mercadorias e operação de caixa. A evarejo é uma empresa de treinamento e consultoria para o setor varejista.
FERMA's response to the Insurance Mediation Directive (IMD)FERMA
The Federation of European Risk Management Associations (FERMA) welcomes the oppotunity to contribute to the consultation launched by the Internal market and Servicdes Directorate General of the European Commission.
Der Stuttgarter Generationenvertrag für ein aktives Miteinander von Jung und AltLandeshauptstadt Stuttgart
Der Generationenvertrag ist eine Selbstverpflichtung der politisch Verantwortlichen ebenso wie von Organisationen, Vereinen und einzelnen Bürgern, um mit seinen zwölf Zielen die vielfältigen Veränderungen gemeinsam aktiv zu gestalten und die Zukunftsfähigkeit der Stadt Stuttgart zu verbessern.
NGG Automotive Solutions is a business excellence solutions group that provides knowledge, technology, management and learning solutions, organizational engineering solutions, business intelligence solutions, and information systems solutions. It has expertise in areas like customer strategy, sales and service, change management, performance improvement, supply chain management, leadership training, and more. The group has a global presence operating out of multiple countries worldwide.
El documento presenta actividades para niños de primer grado sobre sumas y restas utilizando material concreto como monedas. Los niños aprenden los procedimientos usuales para sumar y restar con apoyo de lápiz, papel y material concreto. También se les muestra un procedimiento alternativo para resolver sumas.
Zlatko Rajkovic is applying for the position of Senior Manager Business Process Outsourcing – Remote Manager. He has 15 years of experience working as a manager, project manager, and currency trader for large companies and private investors in emerging markets. Rajkovic believes his background, experience, and qualifications make him a strong fit for the requirements of the position. He would bring skills in managing outsourcing strategies, identifying areas for performance improvement, and working well with others. Rajkovic's resume provides more details on his abilities and he is available for an interview.
RowingChat with Kirsten Barnes - Kirsten's slidesrowperfect
Kirsten Barnes, an Olympian rower and sports pyschologist/ mental performance consultant, joined us on our podcast RowingChat (https://soundcloud.com/rowperfect) to talk about the mental toughness needed to perform in a sport like rowing. Here are her slides on the topic. Listen to her chat at https://soundcloud.com/rowperfect/rowingchat-with-kirsten-barnes for more!
Este documento apresenta uma série de cursos oferecidos pela empresa evarejo para profissionais do varejo. Os cursos cobrem tópicos como prevenção de perdas, reposição de mercadorias, empacotamento, atendimento ao cliente, recebimento de mercadorias e operação de caixa. A evarejo é uma empresa de treinamento e consultoria para o setor varejista.
Wynand van de Ven: A perspective on risk from the NetherlandsNuffield Trust
The document discusses risk sharing and risk pooling in the Dutch health care system. It notes that over the past 20 years, the Dutch government has gradually reduced risk sharing and risk pooling arrangements between health insurers. As a result, the financial risk that insurers take on for exceeding their predicted health care budgets has increased from 0% in 1992 to around 90% in 2012. The document contrasts the Dutch system of budgetholding insurers with that of commissioning entities in England, noting some differences that could lead to interesting policy discussions.
The Dutch health care system has struggled to control costs under universal health insurance. The introduction of regulated competition in 2006 through the Health Insurance Act aimed to increase incentives for efficiency. However, costs have continued to rise due to factors such as increased medicalization and supplier-induced demand from providers paid based on services rather than outcomes. Further reforms are needed such as reducing ex-post compensation for insurers, tying provider payments to health outcomes, and empowering purchasers and consumers to contain costs through more choice and transparency.
The document provides an overview of the Dutch healthcare system, including its financing, regulation, and introduction of competition in certain markets. Key points:
- The system relies on private health insurers and providers but with extensive government regulation focused on accessibility, affordability, and quality.
- A Dutch Healthcare Authority regulates insurers and providers to mitigate dominant market positions and initiate market reforms where possible.
- Competition was introduced for some elective hospital procedures, leading to price reductions in the competitive segment compared to the regulated segment.
- Long-term care is also being reformed, with ideas to introduce more private insurance or shift more to local government and consumer choice models.
Wynand van de Ven: Risk Adjustment in the NetherlandsNuffield Trust
The document discusses risk adjustment in the Netherlands' health insurance system. It provides background on the country's mandatory health insurance system and private insurers. Risk adjustment is crucial to prevent insurers from engaging in risk selection given community rating requirements. The document outlines the Netherlands' risk equalization fund and payment formula. It also discusses the criteria and current risk adjusters used, including age, gender, income, and socioeconomic status.
The swiss healthcare system without the health care financesRafael Rodriguez
The document summarizes key aspects of Switzerland's healthcare system. It outlines that the system is governed by the 1996 Health Insurance Law (LAMal) which mandates universal basic health insurance coverage. It describes the basic insurance package that covers hospital stays, outpatient care, nursing care, and other services. Supplementary private insurance can provide additional benefits. Healthcare is provided through independent general practitioners, specialists, and public or private hospitals. Insurers must provide basic policies and premiums are regulated, though deductibles and premium costs still vary between plans and regions.
Collective redress in the EU 19.09.2013 FERMA presentation by Julien Bedhouch...FERMA
This presentation given at the Belrim/CRE event about claims management on 19 September 2013 is dealing with with the consequences of the Recommendation published last June by the European Commission to the member states.
First part was dedicated to the theory on consumer redress (how to define redress? How to define collective actions? How to enforce consumer redress?) and the reasons why it is so popular in the US. Then the second part presented the situation of consumer redress in 8 EU countries and explained how the recommendation in June should be interpreted and what the key points were for FERMA.
Group 2 Module 5 Project - Small devices, BIG impact. How wearable health dev...Sam Botting
The document discusses how wearable health devices could disrupt the UK medical insurance industry by partnering with device manufacturers. It recommends a three-phase strategy: 1) establishing partnerships, 2) conducting patient trials to collect and analyze data, and 3) fully implementing reduced premiums and insurance packages in exchange for using devices. This would help reverse declining private insurance rates by enabling preventative care and more accurate risk assessment.
mHealth Israel_French Health Insurance Overview_AXA NextLevi Shapiro
French Health Insurance Overview presentation by Romain Champetier, AXA Next Labs, and Gregory Moscovici, Health Lead, AXA Innovation, for mHealth Israel, April 2, 2020.
This document presents a design for reimbursement framework to overcome the "second valley of death" in medical device development. The framework shifts development from a linear to parallel process by frontloading important steps like estimating chances of reimbursement success or failure. Extensive research including literature reviews and expert interviews revealed that the second valley of death poses a problem for medical device developers. The framework provides guidance on parallelizing steps from unmet need validation through reimbursement and implementation to estimate the 80% of the path to commercial success that can be prepared upfront.
Design for reimbursement in medical device developmentAmber Hol Horeman
In medical device development it is essential to start with reimbursement strategy from day one to enhance the chance to successful implementation in the healthcare system. This presentation shows the outcomes of a 5 month graduation project to the role of reimbursement in medical device development. The design for reimbursement framework proposed provides an overview for starting entrepreneurs in the complex field of medical devices.
Presentatie Leers Augustus 2007 Tbv Chinese Delegation Jppcmarusjkalestrade
I. The Dutch healthcare system is facing challenges as healthcare expenditures rise and the population ages, resulting in a shift from acute to chronic conditions. Healthcare performance is poor due to the planning and financing system.
II. Government intervention in prices and quantities has led to insufficient cost and quality awareness, lack of innovation, and waiting lists.
III. Stimulation of the healthcare system is needed to improve performance. This includes introducing more market forces, countervailing power between insurers and providers, and less government involvement.
Jan-Kees Helderman on NHS reform - a Dutch perspective The King's Fund
Jan-Kees Helderman, assistant professor in Comparative Governance and Public Policy at Radbouyd University Nijmegan, outlines how the Dutch health care system operates and reflects on the English health reforms.
This document discusses disease management and financial alignment in the Netherlands' healthcare system. It provides background on the rise of chronic diseases and the need for coordinated care models. The Netherlands is moving towards a new "functional pricing" model for outpatient chronic care, representing the next step in disease management. The document outlines the Dutch healthcare system and trends towards vertically integrated care networks. It also discusses the history of disease management approaches in the Netherlands from early transmural care programs to the current emphasis on patient-centered chronic condition management.
The occupational health system in the Netherlands has changed over time. Originally, employers were required to contract certified occupational health services to provide occupational health assistance. However, deregulation has occurred, giving employers more freedom to choose certified services or hire individual experts. For many years, Dutch occupational health services focused mainly on sickness absence guidance rather than prevention. Additionally, the quality and evidence-based foundation of some service programs has been questioned. To address these issues, practice guidelines are being developed to assist practitioner decisions and improve occupational healthcare.
Ferma Position Paper on the 2013 Green Paper on Disaster InsuranceFERMA
This document summarizes FERMA's position on the European Commission's Green Paper on the Insurance of Natural and Man-made disasters. FERMA represents large companies that potentially face major disasters. They do not see the need for mandatory disaster insurance frameworks. Their key points are: (1) Large companies are already aware of disaster risks and buy insurance; (2) Existing insurance market capacities and national systems already provide options to improve coverage; (3) Any EU-level mechanism to classify disasters risks delays for clients to claim payments. FERMA worries about differing safety standards among countries being tied to a mandatory EU disaster mechanism. Overall they believe existing private market solutions and risk prevention practices are sufficient without EU intervention.
Healthcare systems and market access Germany and Denmark Carsten FrankeCarsten_Franke
With >20 years international sales and marketing strategies Carsten Franke is an expert in helping companies to develop go-to-market strategies enter European healthcare markets.
As German he lived 8 years in Denmark and now 2 years in Finland he is an expert in the European healthcare systems, especially Denmark and Germany.
The document provides an overview of the German healthcare system. It describes how the system is based on both public and private insurance, with public insurance covering around 88% of the population. Public insurance is funded through income-related contributions from employers and employees. The system aims to provide equal coverage to all citizens regardless of income or age. It covers a wide range of medical services and utilizes various strategies to ensure quality of care and reduce disparities.
The document discusses healthcare compliance in the EU and outlines best practices for companies. It notes that soft law from industry groups like EUCOMED, EDMA and COCIR help reinforce compliance through guidelines and codes of conduct. Companies should adopt compliance programs that include written policies, compliance officers, training, reporting mechanisms, and oversight. Following soft law recommendations and having strong internal programs are important for companies to meet their compliance obligations.
This document outlines a proposal for an ideal health insurance plan. It argues that traditional models are obsolete due to technological advances and increased patient knowledge. It proposes a plan where each person pays a premium equal to their expected costs, and premiums are not changed at renewal based on health status. Some services like preventative care and diagnostic tests would be paid for directly rather than through insurance due to issues of moral hazard. Universal HSAs are proposed as a way to help people finance irregular medical costs through savings accounts. The document explores how to design a plan where some decisions are individual and some collective.
Carolyn Hughs Tuohy: A tale of three healthcare reformsNuffield Trust
This document discusses healthcare reforms in four nations - the UK, Netherlands, US, and Canada - from the 1980s to 2010. It analyzes how each country transitioned from an "ideal type" system in the 1980s to a hybrid system by 2010. The UK moved from a Beveridge-style hierarchical system to an internal market. The Netherlands shifted from Bismarck-style sickness funds to managed competition. The US changed from a residual system to a dual system. Canada maintained a single-payer system but with increased provincial variation. It argues that policy cycling is normal in healthcare systems as they seek to balance control between hierarchies, markets, and professionals over time.
Wynand van de Ven: A perspective on risk from the NetherlandsNuffield Trust
The document discusses risk sharing and risk pooling in the Dutch health care system. It notes that over the past 20 years, the Dutch government has gradually reduced risk sharing and risk pooling arrangements between health insurers. As a result, the financial risk that insurers take on for exceeding their predicted health care budgets has increased from 0% in 1992 to around 90% in 2012. The document contrasts the Dutch system of budgetholding insurers with that of commissioning entities in England, noting some differences that could lead to interesting policy discussions.
The Dutch health care system has struggled to control costs under universal health insurance. The introduction of regulated competition in 2006 through the Health Insurance Act aimed to increase incentives for efficiency. However, costs have continued to rise due to factors such as increased medicalization and supplier-induced demand from providers paid based on services rather than outcomes. Further reforms are needed such as reducing ex-post compensation for insurers, tying provider payments to health outcomes, and empowering purchasers and consumers to contain costs through more choice and transparency.
The document provides an overview of the Dutch healthcare system, including its financing, regulation, and introduction of competition in certain markets. Key points:
- The system relies on private health insurers and providers but with extensive government regulation focused on accessibility, affordability, and quality.
- A Dutch Healthcare Authority regulates insurers and providers to mitigate dominant market positions and initiate market reforms where possible.
- Competition was introduced for some elective hospital procedures, leading to price reductions in the competitive segment compared to the regulated segment.
- Long-term care is also being reformed, with ideas to introduce more private insurance or shift more to local government and consumer choice models.
Wynand van de Ven: Risk Adjustment in the NetherlandsNuffield Trust
The document discusses risk adjustment in the Netherlands' health insurance system. It provides background on the country's mandatory health insurance system and private insurers. Risk adjustment is crucial to prevent insurers from engaging in risk selection given community rating requirements. The document outlines the Netherlands' risk equalization fund and payment formula. It also discusses the criteria and current risk adjusters used, including age, gender, income, and socioeconomic status.
The swiss healthcare system without the health care financesRafael Rodriguez
The document summarizes key aspects of Switzerland's healthcare system. It outlines that the system is governed by the 1996 Health Insurance Law (LAMal) which mandates universal basic health insurance coverage. It describes the basic insurance package that covers hospital stays, outpatient care, nursing care, and other services. Supplementary private insurance can provide additional benefits. Healthcare is provided through independent general practitioners, specialists, and public or private hospitals. Insurers must provide basic policies and premiums are regulated, though deductibles and premium costs still vary between plans and regions.
Collective redress in the EU 19.09.2013 FERMA presentation by Julien Bedhouch...FERMA
This presentation given at the Belrim/CRE event about claims management on 19 September 2013 is dealing with with the consequences of the Recommendation published last June by the European Commission to the member states.
First part was dedicated to the theory on consumer redress (how to define redress? How to define collective actions? How to enforce consumer redress?) and the reasons why it is so popular in the US. Then the second part presented the situation of consumer redress in 8 EU countries and explained how the recommendation in June should be interpreted and what the key points were for FERMA.
Group 2 Module 5 Project - Small devices, BIG impact. How wearable health dev...Sam Botting
The document discusses how wearable health devices could disrupt the UK medical insurance industry by partnering with device manufacturers. It recommends a three-phase strategy: 1) establishing partnerships, 2) conducting patient trials to collect and analyze data, and 3) fully implementing reduced premiums and insurance packages in exchange for using devices. This would help reverse declining private insurance rates by enabling preventative care and more accurate risk assessment.
mHealth Israel_French Health Insurance Overview_AXA NextLevi Shapiro
French Health Insurance Overview presentation by Romain Champetier, AXA Next Labs, and Gregory Moscovici, Health Lead, AXA Innovation, for mHealth Israel, April 2, 2020.
This document presents a design for reimbursement framework to overcome the "second valley of death" in medical device development. The framework shifts development from a linear to parallel process by frontloading important steps like estimating chances of reimbursement success or failure. Extensive research including literature reviews and expert interviews revealed that the second valley of death poses a problem for medical device developers. The framework provides guidance on parallelizing steps from unmet need validation through reimbursement and implementation to estimate the 80% of the path to commercial success that can be prepared upfront.
Design for reimbursement in medical device developmentAmber Hol Horeman
In medical device development it is essential to start with reimbursement strategy from day one to enhance the chance to successful implementation in the healthcare system. This presentation shows the outcomes of a 5 month graduation project to the role of reimbursement in medical device development. The design for reimbursement framework proposed provides an overview for starting entrepreneurs in the complex field of medical devices.
Presentatie Leers Augustus 2007 Tbv Chinese Delegation Jppcmarusjkalestrade
I. The Dutch healthcare system is facing challenges as healthcare expenditures rise and the population ages, resulting in a shift from acute to chronic conditions. Healthcare performance is poor due to the planning and financing system.
II. Government intervention in prices and quantities has led to insufficient cost and quality awareness, lack of innovation, and waiting lists.
III. Stimulation of the healthcare system is needed to improve performance. This includes introducing more market forces, countervailing power between insurers and providers, and less government involvement.
Jan-Kees Helderman on NHS reform - a Dutch perspective The King's Fund
Jan-Kees Helderman, assistant professor in Comparative Governance and Public Policy at Radbouyd University Nijmegan, outlines how the Dutch health care system operates and reflects on the English health reforms.
This document discusses disease management and financial alignment in the Netherlands' healthcare system. It provides background on the rise of chronic diseases and the need for coordinated care models. The Netherlands is moving towards a new "functional pricing" model for outpatient chronic care, representing the next step in disease management. The document outlines the Dutch healthcare system and trends towards vertically integrated care networks. It also discusses the history of disease management approaches in the Netherlands from early transmural care programs to the current emphasis on patient-centered chronic condition management.
The occupational health system in the Netherlands has changed over time. Originally, employers were required to contract certified occupational health services to provide occupational health assistance. However, deregulation has occurred, giving employers more freedom to choose certified services or hire individual experts. For many years, Dutch occupational health services focused mainly on sickness absence guidance rather than prevention. Additionally, the quality and evidence-based foundation of some service programs has been questioned. To address these issues, practice guidelines are being developed to assist practitioner decisions and improve occupational healthcare.
Ferma Position Paper on the 2013 Green Paper on Disaster InsuranceFERMA
This document summarizes FERMA's position on the European Commission's Green Paper on the Insurance of Natural and Man-made disasters. FERMA represents large companies that potentially face major disasters. They do not see the need for mandatory disaster insurance frameworks. Their key points are: (1) Large companies are already aware of disaster risks and buy insurance; (2) Existing insurance market capacities and national systems already provide options to improve coverage; (3) Any EU-level mechanism to classify disasters risks delays for clients to claim payments. FERMA worries about differing safety standards among countries being tied to a mandatory EU disaster mechanism. Overall they believe existing private market solutions and risk prevention practices are sufficient without EU intervention.
Healthcare systems and market access Germany and Denmark Carsten FrankeCarsten_Franke
With >20 years international sales and marketing strategies Carsten Franke is an expert in helping companies to develop go-to-market strategies enter European healthcare markets.
As German he lived 8 years in Denmark and now 2 years in Finland he is an expert in the European healthcare systems, especially Denmark and Germany.
The document provides an overview of the German healthcare system. It describes how the system is based on both public and private insurance, with public insurance covering around 88% of the population. Public insurance is funded through income-related contributions from employers and employees. The system aims to provide equal coverage to all citizens regardless of income or age. It covers a wide range of medical services and utilizes various strategies to ensure quality of care and reduce disparities.
The document discusses healthcare compliance in the EU and outlines best practices for companies. It notes that soft law from industry groups like EUCOMED, EDMA and COCIR help reinforce compliance through guidelines and codes of conduct. Companies should adopt compliance programs that include written policies, compliance officers, training, reporting mechanisms, and oversight. Following soft law recommendations and having strong internal programs are important for companies to meet their compliance obligations.
This document outlines a proposal for an ideal health insurance plan. It argues that traditional models are obsolete due to technological advances and increased patient knowledge. It proposes a plan where each person pays a premium equal to their expected costs, and premiums are not changed at renewal based on health status. Some services like preventative care and diagnostic tests would be paid for directly rather than through insurance due to issues of moral hazard. Universal HSAs are proposed as a way to help people finance irregular medical costs through savings accounts. The document explores how to design a plan where some decisions are individual and some collective.
Carolyn Hughs Tuohy: A tale of three healthcare reformsNuffield Trust
This document discusses healthcare reforms in four nations - the UK, Netherlands, US, and Canada - from the 1980s to 2010. It analyzes how each country transitioned from an "ideal type" system in the 1980s to a hybrid system by 2010. The UK moved from a Beveridge-style hierarchical system to an internal market. The Netherlands shifted from Bismarck-style sickness funds to managed competition. The US changed from a residual system to a dual system. Canada maintained a single-payer system but with increased provincial variation. It argues that policy cycling is normal in healthcare systems as they seek to balance control between hierarchies, markets, and professionals over time.
Similar to Wynand Van Der Ven: Competition among commissioners (20)
This document discusses the potential impacts of automation on healthcare employment and discusses alternative views beyond job loss. It notes that automation may lead to reconfiguring of healthcare work rather than outright job loss. Examples of existing technologies that have automated tasks in healthcare like pharmacy automation and emerging technologies like decision support systems and personal health tracking are provided. The document advocates that automation could lead to a virtuous cycle in healthcare if it allows workers to focus on tasks that require human skills and judgment.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
This document summarizes the findings of evaluations of the Integrated Care and Support Pioneers Programme in the UK. The evaluations found that while Pioneers aspired to comprehensive system change, their activities focused more narrowly on initiatives like risk stratification and care coordination teams. Progress was difficult to measure against indicators and Pioneers faced challenges from financial pressures and competing priorities. The evaluations concluded that further integration will be challenging under increasing demands on the health system.
The document discusses lessons learned from the Southwark and Lambeth Integrated Care (SLIC) program in London. Key points:
- SLIC aimed to reduce hospital admissions and care home placements for older adults through risk stratification, holistic assessments, and care management.
- Success required agreement on the problem, dedicated teams, funding shifts to support community care, and leadership development.
- Future programs need a strong business case, co-design with citizens, and a dedicated "engine room" team to drive local transformation.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
This document discusses measurement for quality improvement. It explains that measurement in improvement aims to provide a basis for action to improve processes and outcomes, rather than just estimating parameters. Improvement measures should be simple, specific, and available in real-time. Statistical process control methods are important to separate normal variation from changes resulting from interventions. Examples are provided of run charts measuring improvements in recording BMI for mental health patients and compliance with care bundles. The document advocates making the theories behind improvement efforts more explicit.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
This document discusses using statistical process control (CUSUM) charts to monitor mortality rates at the level of individual general practitioners and health authorities. It describes how CUSUM charts could potentially have detected Harold Shipman, a GP who murdered over 200 patients, by spotting outliers in the routine mortality data. The document also discusses challenges in risk adjusting outcomes to account for differences in patient characteristics and casemix between providers. Accurately adjusting for factors like age, comorbidities, and emergency status is important for fair comparisons but difficult using only administrative data.
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
- Real-time monitoring of healthcare services requires defining both a reporting window and data window to accurately capture demand, activity, and wait times.
- Using only a reporting window (e.g. a single month) to request data can result in invalid or misleading performance metrics, as it does not account for patients with long wait times.
- Defining a larger data window that includes all patients requested before the end of the reporting window and reported after the start avoids this problem, but requires a counterintuitive data request.
- Without properly defining both windows, real-time monitoring can provide an inaccurate picture of service performance and falsely suggest the need for more resources.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Outbreak management including quarantine, isolation, contact.pptx
Wynand Van Der Ven: Competition among commissioners
1. Competition among commissioners:
experience from the Netherlands
Erasmus University Rotterdam
Nuffield Health Strategy Summit
24-25 March 2010
Wynand P.M.M. van de Ven
Erasmus University Rotterdam
vandeven@bmg.eur.nl
Competition among commissioners: evidence from the Netherlands 1
2. The Netherlands
• Kaartje Europe
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Competition among commissioners: evidence from the Netherlands 2
3. Three waves of health care reforms
In many OECD-countries three consecutive
waves of health care reforms can be
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discerned:
1. Universal coverage and equal access;
2. Controls, rationing, and expenditure caps;
3. Incentives and competition.
David Cutler, Journal of Economic Literature 2002(40) 881-906.
Competition among commissioners: evidence from the Netherlands 3
4. Key elements of reform debate
1.Who is the purchaser of care on behalf
on the consumer?
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2.Yes/No competition among:
– Providers of care?
– Purchasers of care (= insurers)?
3.Which benefits package?
Which premium structure?
Competition among commissioners: evidence from the Netherlands 4
5. Dutch health care system
• Health care costs 2006: 10% GDP;
• Much private initiative and private
enterprise: physicians, hospitals, insurers;
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• Still much (detailed) government regulation;
• GP-gatekeeper;
• Health insurance before 2006 a mixture of:
mandatory public insurance (67%),
voluntary private insurance (33%).
• From 2006: mandatory private insurance (100%).
Competition among commissioners: evidence from the Netherlands 5
6. Reforms since the early 1990s
The core of the reforms is that:
Risk-bearing insurers will be the
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purchasers of care on behalf on their
members;
Government will deregulate existing
price- and capacity-controls;
Government will “set the rules of the
game” to achieve public goals.
Competition among commissioners: evidence from the Netherlands 6
7. Health Insurance Act (2006)
• Mandate for everyone in the Netherlands
to buy individual private health insurance;
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• Standard benefits package: described in terms
of functions of care;
• Broad coverage: e.g. physician services,
hospital care, drugs, medical devices,
rehabilitation, prevention, mental care, dental
care (children);
• Mandatory deductible: €165 per person (18+)
per year.
Competition among commissioners: evidence from the Netherlands 7
8. Consumer choice
• Annual consumer choice of insurer
and choice of insurance contract:
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– in kind, or reimbursement, or a
combination;
– preferred provider arrangement;
– voluntary higher deductible: at most
€650 per person (18+) per year;
– premium rebate (<10%) for groups.
• Voluntary supplementary insurance.
Competition among commissioners: evidence from the Netherlands 8
9. Health Insurance Act (2)
• Much flexibility in defining the consumer’s
concrete insurance entitlements;
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• Selective contracting and vertical integration in
principle allowed;
• Open enrolment & ‘community rating per
insurer’ for each type of health insurance
contract;
• Subsidies make health insurance affordable for
everyone;
• Risk equalization.
Competition among commissioners: evidence from the Netherlands 9
10. Evaluation Health Insurance Act dec09
The HI Act-2006 is a succes in the sense
that:
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• No political party or interest group has
argued for a return to the former system
with a distinction between sickness fund
and private health insurance.
• There is broad support for the option to
annually choose another insurer or health
insurance contract.
Competition among commissioners: evidence from the Netherlands 10
11. Positive effects
• Good system of cross-subsidies (‘solidarity’);
• Standard benefits package available for everyone,
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without health-related premium;
• Annual choice of insurer/contract;
• Strong price competition among the insurers;
• Increasing information about price and quality of
insurers and providers of care);
• Increasing insurers’ activities in purchasing care;
• Quality of care is on top of the agenda.
Competition among commissioners: evidence from the Netherlands 11
12. Preconditions managed competition
1. Risk equalization
2. Market regulation:
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a. Competition Authority;
b. Quality Authority;
c. Solvency Authority;
d. Consumer Protection Authority;
3. Transparency
a. Insurance products
(Mandatory Health Insurance &
Voluntary Supplementary Insurance)
b. Medical products
Competition among commissioners: evidence from the Netherlands 12
13. Preconditions managed competition
4. Consumer information;
5. Freedom to contract;
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6. Consumer choice of insurer;
7. Financial incentives for efficiency;
a. Insurers;
b. Providers of care;
c. Consumers;
8. Contestable markets:
a. (sufficient) insurers;
b. (sufficient) providers of care.
Competition among commissioners: evidence from the Netherlands 13
14. Are the preconditions fulfilled?
Precondition 1990 (SF) 2010
Risk equalization -- +
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Market regulation:
Competition Authority; - ++
Quality Authority; + +
Solvency Authority; NA ++
Consumer Protection Authority; NA +
Transparency
Mandatory Health Insurance ++ +
Voluntary Supplementary Insurance - -
Medical products -- -/+
Competition among commissioners: evidence from the Netherlands 14
15. Are the preconditions fulfilled?
Precondition 1990 (SF) 2010
Consumer information -- -/+
Freedom to contract -- -/+
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Consumer choice of insurer -- +
Financial incentives for efficiency:
Insurers; -- -/+
Providers of care; - -/+
Consumers; -- +
Contestable markets:
(sufficient) insurers; -- ++
(sufficient) providers of care. -- -/+
Competition among commissioners: evidence from the Netherlands 15
16. Key issues
• Insurers are reluctant to selectively contract
because of a lack of information on the quality
of the (selected) providers of care;
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• Good risk equalization is a precondition to
make insurers responsive to the preferences of
the chronically ill people;
• Who bears responsibility if a hospital goes
bankrupt: government or the insurers?
• Supplementary insurance should not hinder
chronically ill people to switch insurer;
• Managed competition under a global budget?
Competition among commissioners: evidence from the Netherlands 16
17. Conclusions
• Evaluation of Health Insurance Act:
On balance positive,
despite some serious problems.
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• So far the reforms have been focussed on the
health insurance market;
• Although insurers have some degree of
freedom to contract with providers of care,
there is still a lot of government regulation
with respect to prices.
• The next years the reforms will focus on the
provider market.
Competition among commissioners: evidence from the Netherlands 17
18. Conclusions
• The Dutch health care reforms: still
work-in-progress & too early for a full
evaluation;
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• The implementation of the Dutch health
care reforms is very difficult and lengthy.
It is like dancing the Dutch procession of
Echternach (or worse): three steps
forward, then two back, so that five steps
are required in order to advance one pace.
Competition among commissioners: evidence from the Netherlands 18