elizabeth docteur european health forum gastein 7 october 2004 towards high-performing health...

Elizabeth Docteur

European Health Forum Gastein

7 October 2004

Towards High-Performing Health Systems: Challenges and Opportunities for Reform

2

Gains in life expectancy at birth, total population,1960–2000

2.73

.54.44.5

4.55

.16.06

.66.76.86.97.0

7.07.18

.08.18.2

8.28.48.6

8.68.7

8.79.39.6

9.6

12

.213

.4

16

.6

19

.8

23

.1

0

5

10

15

20

25

Slo

vak R

epublic

Hungary

Czech R

epublic

Denm

ark

Neth

erlands

Norw

ay

Pola

nd

Sw

eden

Irela

nd

Icela

nd

Unite

d S

tate

s

New

Zeala

nd

Unite

d K

ingdom

Belg

ium

Canada

Germ

any

Gre

ece

Sw

itzerland

Austr

alia

Fin

land

OE

CD

avera

ge

Fra

nce

Luxem

bourg

Spain

Austr

ia

Italy

Port

ugal

Japan

Mexic

o

Turk

ey

Kore

a

years

Source: OECD Health Data 2003.

3

Infant mortality, 2000 and average annual declines in infant mortality, 1970-2000

IcelandJapan

SwedenFinlandNorwaySpain

Czech RepublicGermany

ItalyFranceAustriaBelgium

SwitzerlandLuxembourgNetherlands

AustraliaCanada

DenmarkPortugal

United KingdomNew Zealand*

GreeceIrelandKorea*

United StatesOECD Average

PolandSlovak Republic

HungaryMexicoTurkey


3

3.2

3.4

3.8

3.8

3.9

4.1

4.4

4.5

4.6

4.8

4.8

4.9

5.1

5.1

5.2

5.3

5.3

5.5

5.6

5.8

6.1

6.2

6.2

6.9

7.013333333

8.1

8.6

9.2

23.3

39.7

010203040

-4.8

-4.6

-3.8

-4.1

-3.9

-6.4

-5.2

-5.3

-6.1

-4.5

-5.5

-4.8

-3.7

-5.1

-3.0

-4.0

-4.1

-3.2

-7.4

-3.9

-3.6

-5.1

-3.7

-6.6

-3.5

-4.6

-4.9

-3.6

-4.4

-4.0

-4.2

-8-6-4-2

Deaths per 1 000 live births % change*1999.

4

Factors driving health improvements

Economic expansion and related factors– e.g. increased educational attainment

Improvements in health care and health systems– Advances in medicine and technical capability– Improvements in access to care and health care systems

(e.g., universal coverage attained in most OECD countries)– Successful public health initiatives (vaccination, initiatives

and policies to reduce tobacco consumption)

5

“Health systems are victims of their own success.”

Julio Frenk

Health Minister, MexicoOECD Health Ministerial Meeting, May 2004

6

Growing health spending as a share of GDP,1970 and 2002

Source: OECD Health Data 2004, 2nd edition.

6.9

5.4

6.2

4.7 5.

4

7.0

6.1

2.6

6.9

5.5

4.0

6.9

8.0

4.4 5.

1

5.2

4.5 5.

3

4.5

3.6

5.6

5.1

2.4

3.6

14.6

11.210.9

9.9 9.7 9.6 9.5 9.3 9.2 9.1 9.1 9.1 8.8 8.7 8.5 8.5 8.47.8 7.8 7.7 7.7 7.6 7.4 7.3 7.3

6.66.2 6.1 6.1 5.9 5.7

0

2

4

6

8

10

12

14

16U

nite

d S

tate

s

Sw

itzer

land

Ger

man

y*

Icel

and

Fra

nce

Can

ada

Gre

ece

Por

tuga

l

Sw

eden

Aus

tral

ia**

Bel

gium

Net

herla

nds

Den

mar

k

Nor

way Ita

ly

New

Zea

land

OE

CD

Ave

rage

Hun

gary

Japa

n**

Aus

tria

Uni

ted

Kin

gdom

Spa

in

Cze

ch R

epub

lic

Fin

land

Irel

and

Tur

key*

**

Luxe

mbo

urg

Mex

ico

Pol

and

Kor

ea**

Slo

vak

Rep

ublic

1970 2002

% of GDP

* 1970 data refer to West Germany. ** 2002 data refer to 2001. *** 2002 data refer to 2000.

7

Is spending growth a problem?

Some evidence to suggest that benefits from medical advances exceed costs, at least for some conditions (e.g. Cutler and McClellan 2001)

Health is a vibrant economic sector providing good employment, high-tech industry

But…spending must be financed!

8

Pressures on public budgets and private

resources THE by source of funding, 2001

Note: Countries are ranked from left (highest) to right (lowest) according to level of per capita health expenditure. THE = total health expenditure.


63

45

72

89

54

69

91

71

767676

82

76

6968

83

76

8379

70

9085

57

45

2853281137289241720121720181916101711158143214

0%

20%

40%

60%

80%

100%

Tur

key

Mex

ico

Pol

and

Slo

vak

Rep

ublic

Kor

ea

Hun

gary

Cze

ch R

epub

lic

Spa

in

New

Zea

land

Fin

land

Irel

and

Japa

n

Italy

Aus

tria

Aus

tral

ia

Den

mar

k

Fra

nce

Icel

and

Ger

man

y

Can

ada

Luxe

mbo

urg

Nor

way

Sw

itzer

land

Uni

ted

Sta

tes

Public expenditure on health Private insurance All other private funds Out-of-pocket payments

9

Countries should expect continued cost and financing pressure in the health sector.

10

Cost pressures due to ageing

Growing proportion of over 80

Ageing populations expected to raise demand for care

Long-term care costs relatively low but growing


Figure 14. Share of the population aged 80 and over, 2000

0.60.6

1.0

1.9

2.0

2.4

2.6

2.6

2.8

2.8

2.9

3.0

3.0

3.1

3.2

3.4

3.4

3.4

3.5

3.5

3.6

3.7

3.7

3.8

3.8

4.0

4.0

4.0

4.0

4.3

5.0

0 1 2 3 4 5

MexicoTurkeyKorea

Slovak RepublicPoland

Czech RepublicHungary

IrelandIceland

New ZealandAustraliaCanada

LuxembourgOECD average

NetherlandsUnited States

FinlandPortugal

AustriaGreece

BelgiumFrance

GermanyJapanSpain

DenmarkItaly

SwitzerlandUnited Kingdom

NorwaySweden

(%)

11

Health expenditure linked to GDP, although spending varies for given income level, 2002


USA

AUSAUT

BEL

CAN

CZE

DNK

FIN

FRADEU

GRC

HUN

ISL

IRLITA

J PN

KOR

LUX

MEX

NLD

NZL

NOR

POL

PRT

SVK

ESP

SWE

CHE

TUR

GBR

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

5500

0 10,000 20,000 30,000 40,000 50,000

GDP per capita (US$ PPP)

Health expenditure per capita (US$ PPP)

12

There are very great opportunitiesto further improve health and theperformance of health systems.

13

Further health gains are possible Life expectancy at age 65, 2002

JapanFrance

SwitzerlandAustraliaCanadaSpainItaly

IcelandSweden

LuxembourgNew Zealand

NorwayBelgiumAustria

GermanyFinland

United StatesNetherlands

PortugalUnited Kingdom

GreeceIrelandMexicoKorea

DenmarkPoland

Czech RepublicSlovak Republic

HungaryTurkey14.3

17.017.0

17.417.9

18.318.418.518.618.7

18.919.0

19.319.4

19.619.619.719.719.719.819.920.0

20.320.420.4

20.620.8

21.021.3

23.0

10152025

12.713.113.3

14.014.0

15.414.6

17.015.3

16.315.715.615.6

16.415.816.016.3

15.816.216.5

15.916.9

17.616.516.5

17.117.417.4

16.918.0

10 15 20 25Years Years

Females Males

Source: OECD Health Data 2004, 1st edition

14

Increasing obesity rates among the adult population in OECD countries


2

5

78

7

15

2

57

6

9

6 6 6

88 7

11

13

11 11

14

23

3

79 9 9 9 9 10

1112 13

15 15

17

2122

31

0

10

20

30

40

Japa

n (8

0,90

,01)

Sw

itzer

land

(92

,97)

Italy

(94

,00)

Fra

nce

(90,

00)

Aus

tria

(91

,99)

Sw

eden

(89

,01)

Net

herla

nds

(81,

90,0

1)

Den

mar

k (8

7,00

)

Fin

land

(80

,90,

01)

Icel

and

(90,

02)

Spa

in (

87,0

1)

Cze

ch R

epub

lic (

93,0

2)

Can

ada

(94,

01)

New

Zea

land

(89

,97)

Aus

tral

ia (

80,8

9,99

)

Uni

ted

Kin

gdom

(80

,91,

01)

US

(76

-80,

88-9

4,99

-00)

Percent

15

Increasing awareness of serious problems with health care quality

Needed services not always provided– Aspirin and beta blockers after a heart attack

Services are provided that are not clinically appropriate for a patient– Antibiotics for colds

Errors in health-care delivery are not uncommon– Wrong-site surgeries, wrong medicine or dosage

16

Cross-country differences in careImmunisation against influenza, 2000

Source: OECD Health Data 2004

74

65 65 64 63 62

49

0

10

20

30

40

50

60

70

80

Austra

lia UK

Franc

e US

Canad

a NZ

OECD a

vg.

% of population 65+

17

One-year case-fatality rates for ischaemic stroke, 1998

Note: Canadian data are from Alberta and Ontario, United Kingdom data are from the Oxford region, and United States data are from Medicare data only.

Source: OECD (2003), A Disease-Based Comparison of Health Systems.

% of patients who died within the first year following admission

0

10

20

30

40

50

60

Canada (Ont.) Canada (Alb.) Denmark Sweden UnitedKingdom (Oxf.)

USA (Med.)

M 40-64 F 40-64 M 65-74 F 65-74 M 75+ F 75+

18

Other pressures to improve health-system performance

Excessive waiting times for elective surgery are a policy issue in about ½ of OECD countries

Disparities in access to care, service use, or health status across population groups

19

Efficiency of OECD health systems: what do we know?

Complexity, market failures, extent of government intervention suggest potential for distortions that reduce efficiency

Very large cross-country variation in resources, activity and health system performance– Highest spending and activity levels do not always translate

into best results (e.g. health-care outcomes, waiting times, patient and consumer satisfaction, equitable access to care)

– This suggests that it is not just how much you spend, but how you spend it that matters

– Suggests that there is opportunity to learn from comparison

20

The Challenges

Improving performance without increasing cost pressure

Finding ways to reduce spending that do not hurt performance

Reducing financing pressure while maintaining equity

21

Some Lessons

International comparisons provide valuable guidance– Monitoring and benchmarking are essential

Even armed with knowledge, improving health-system performance is never easy

Trade-offs across policy goals are inevitable

Making real change can be difficult– Need to involve stakeholders– Reform is an iterative process

22

OECD Health Project products

Towards High-Performing Health Systems Final Report to Ministers Summary Report

Policy Studies compendium

Private Health Insurance in OECD Countries

Health Technologies and Decision Making

Long-Term Care for Older People

New OECD Health Working Papers series (16 releases to date)

23

For more information:

www.oecd.org/health

www.oecd.org/healthmin2004

elizabeth docteur european health forum gastein 7 october 2004 towards high-performing health...

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