Health Policy Developments 12 -  - ebook

Health Policy Developments 12 ebook

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While care coordination and quality of care remain paramount policy topics everywhere, countries again turn to payment and efficiency challenges. Issue 12 of Health Policy Developments examines how health systems are trying to maximize value for money - exploring new avenues and mixing incentives. Preceding the value question there is a much simpler question: Where does the money come from? Clearly, someone needs to shoulder the burden of higher healthcare costs, but who should pay for what? Should it be private health insurers or the pharmaceutical industry as is happening in France and Australia, the whole population as it is in Finland or Canada, or should people above a certain body mass index be taxed, as in Alabama? Further topics in this issue are governance in Bismarckian systems, responsiveness of health systems to vulnerable groups, access and equity, and patient safety and quality. The International Network Health Policy and Reform aims to narrow the gap between health services research and health policy. Network partners are research institutions and health policy experts from 20 industrialized countries.

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Bibliographic information published by Die Deutsche Nationalbibliothek
Die Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic information is available online at http://dnb.d-nb.de
© 2010 E-Book-Ausgabe (EPUB) © 2009 Verlag Bertelsmann Stiftung, Gütersloh
Responsible: Sophia SchletteCopy editor: Celia BohannonProduction editor: Sabine ReimannCover design: Nadine HumannCover illustration: © Aperto AG, BerlinTypesetting and printing:Hans Kock Buch- und Offsetdruck GmbH, Bielefeld
ISBN : 978-3-86793-275-2
www.bertelsmann-stiftung.org/publications

www.bertelsmann-stiftung.de/verlag

Inhaltsverzeichnis
Titel
Impressum
Preface
Value for money?
United Kingdom: Value for money from public health care
United Kingdom: Personal financial incentives for healthy behavior
Australia: Personal financial disincentives to drinking
Estonia: Paying for physician performance
United States: The high cost of “biologics”
Who should pay for what?
France: Raising taxes on private health insurers
Finland: Raising out-of-pocket payments for individuals
Canada: Privatization as a way of forging financial sustainability?
Alabama: Raising insurance premiums for high-risk people
Australia: Raising user fees for industry, to assess value for money
Governance in Bismarckian Systems
Switzerland: Who should control outpatient supply after 2009?
France: New regional health governance
Estonia: Payer acts as player in disease prevention and health promotion
Responsiveness
South Korea, Singapore, Japan: Responding to the needs of the dying
South Korea: Responding to the needs of those with disabilities
Slovenia: Responding to the needs of those with mental illnesses
Spotlight on access and equity around the world
Finland: Laws succeed in reducing wait times and improving access
Finland: An action plan to reduce health inequalities
France: Regulating nurse settlement for better access
Israel: Charities funding co-payments for the chronically ill
United States: Overcoming the first barrier to access- insurance coverage
New Zealand: A tool to measure impact on health inequalities
Patient safety and quality
Denmark: The National Indicator Project
Spain: The Atlas of Variability in Medical Practice
Austria: The pharmaceutical safety belt
New Zealand: Quality improvement on two fronts
Care Coordination News
Canada: PRISMA-Integrating care for the elderly
Spain: Innovative reform in Catalonia hits a wall
United States: Hospital at Home
Update
The Netherlands: Nurse practitioners now institutionalized
The International Network Health Policy and Reform
Survey preparation and proceedings
Reporting criteria
Policy ratings
Project management
Reform tracker countries
Reform tracker health policy topics
Preface
Dear readers,
Well into its sixth year of existence, the International Network Health Policy & Reform is alive and thriving. With no signs of age or wearing out, we continue to develop ourselves further and venture for new partnerships and cooperations.
For this most recent issue number 12 of our biannual series Health Policy Developments, we-the long-time editors-take great pride in introducing our new author, Ray Moynihan, from Byron Bay, New South Wales, Australia. Though thousands of miles apart, we discovered that we are following the same key themes of health policy, particularly around issues such as access, affordability, and equity, as well as determinants of health and governance issues. Following Ray’s suggestion, we also produced a companion video and a short promo film to disseminate the book’s key messages the virtual way (watch at www.hpm.org in the download section).
New author Ray Moynihan
We are equally delighted to announce our new partner institute and liaison person from Spain, Joan Gené Badia. Based at the University of Barcelona, Joan is an experienced expert on primary care advancements and international developments. With him on board we are somewhat shifting focus from a health economics perspective, so well presented by our former partners from Universidad Pompeu Fabra, to a health services research focus, so active a community these days in Spain.
New partner in Spain
So what is number 12 all about? Departing from the primary care and care coordination focus of the previous volume, this current issue focuses more on economic aspects. Quite interestingly, we see this as a re-emerging pattern across the 20 countries that we observe. While care coordination remains high on the agenda everywhere, countries again turn to funding and efficiency questions. In chapter 1, we examine how health systems are trying to maximize value for money, going beyond traditional avenues. In the United Kingdom, for instance, the National Institute for Health and Clinical Excellence no longer just assesses drugs and procedures but now asks how well public health interventions work-and which ones offer value for money.
What should we spend the money on...
However, preceding the value question there is a much simpler question: Where does the money come from in the first place? As rising cost is one of the most consistent pressures on health systems everywhere, cost containment has long been one of the more salient themes in health policy discussions. Chapter 2 therefore looks at debates around who should pay for what? How much of total expenditure on health care should originate from general taxation, (social) health insurance, or out-of-pocket? And what should be the share of voluntary or private health insurance? Even in Canada, where this has long been a taboo, some see growing privatization as a way of reducing the costs to the public purse. France, on the other hand, has decided to increase taxes for private health insurers to help fund rising national health expenditure.
... and who should pay for what?
With blurring roles between the private and public sphere and more and more cross-system learnings between classic Bismarckian and Beveridge type healthcare systems taking place, the former continue to suffer from their somewhat inbuilt paradox: Bismarckian systems, while tightly controlled by the state, are based on privately owned and operated funds. The paradox remains, as we will see in chapter 3 on governance. For example, in Switzerland, the unresolved question is whether the introduction of more competition will result in a reduction in solidarity if the sick ultimately have to pay a lot more for their premiums than the healthy. And in France, the debate turns the other way: Will decentralized control of purchasing hospital care result in more privatization in provision?
Governance in Bismarckian systems
In Asia, nations as diverse as Japan, South Korea and Singapore are responding to the needs of aging populations and the ethical challenges of demographic change. As will be illustrated in chapter 4, a common theme is enabling people to die with dignity at home or in hospice care, rather than in big hospitals. Countries need to balance how much care is being provided in institutions and how much at home, or in intermediary settings. At the same time, countries have to be cautious: If structures in patients’ living environments are not well prepared, sending people home to die might be a simple way to get rid of costly and needy patients (also see our video on www.hpm.org in the download section).
Responding to patients’ needs
Last but not least, questions of how to ensure access and equity, and how to guarantee patient safety and quality of care, and how to organize healthcare services do remain high on the policy implementation agenda in the countries we observe. We present the latest measures addressing these questions in chapters 5, 6 and 7.
Organizing healthcare services
The sources of information for this book were the expert reports of the International Network for Health Policy & Reform and other materials cited at the end of each chapters. The current volume presents the results of the twelfth half-yearly survey which covers the period from May 2008 to September 2008. From the 82 reports received, we have selected 33 for inclusion in this report.
Reporting period spring to autumn 2008
Our thanks go to all experts from the partner institutions and their external co-authors: Ain Ain Aaviksoo, Gerard Anderson, Toni Ashton, Chantal Cases, Elena Conis, Fiona Cram, Luca Crivelli, Asher Elhayany, Patricia Fernandez-Vandellos, Gisselle Gallego, Joan Gené Badia, Peter P. Groenewegen, Revital Gross, Maria M. Hofmarcher, Jessica Holzer, Soonman Kwon, Margaret MacAdam, Stephanie MacKenzie, Jan Mainz, Ryozo Matsuda, Lim Meng Kin, Julien Mousques, Michel Naidich, Adam Oliver, Zeynep Or, Gerli Paat, Hannele Palosuo Tanaz Petigara, Rade Pribakovic Brinovec, Marita Sihto, Taro Tomizuka, Lauri Vuorenkoski.
We hope you enjoy the read and as always look forward to receiving your feedback and suggestions.
Kerstin Blum, Reinhard Busse, Sophia Schlette
Value for money?
Are we getting value for money in health care? As perplexing as it is important, this monster of a question casts its shadow over almost every debate in health policy, whether we have the temerity to ask it or not. But perhaps an even more frightening question is its lesser-known cousin: How do we know that we are getting value for money in health care? In this opening chapter we look at how some health systems are facing up to these questions and in some cases starting to look for answers.
One of the first countries to build this question of cost-effectiveness into the very infrastructure of its healthcare system was Australia. Following changes to the national laws in the early 1990s, all new prescription medicines would be assessed for their benefits, harms and “cost-effectiveness” before they were added to the national list of subsidized drugs, the Pharmaceutical Benefits Scheme (Harris 2008; see also , p. 71). The approach involves independent committees of experts- notably the Pharmaceutical Benefits Advisory Committee- assessing at what price (if any) a new drug might offer value for money, and making a recommendation to the federal health minister to add the drug to the schedule of the Pharmaceutical Benefits Scheme. Initially unhappy with many aspects of the new approach, the pharmaceutical industry has slowly accepted the reality of this method. Moreover, in recent years improvements in transparency have meant that extracts from the cost-effectiveness deliberations are routinely made public.

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