http://www.msss.gouv.qc.ca/ministere/observatoiresss/index.php?a-new-look-at-oecd-health-care-systems-typology-efficiency-and-policies

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Brief analytical summaries or syntheses #19

A new look at OECD health care systems:

Typology, efficiency and policies

Summary

This 2011 edition of the OECD’s Economic Policy Reforms features a chapter on health care (Chapter 6), a key contributor to individual wellbeing and an important driver of long-term economic growth. The OECD has assembled a new cross-country comparative data on health policies and health care system efficiency, which shows that there is room in all countries surveyed to improve the effectiveness of their public health care spending.

Background

Rising health care spending is putting pressure on government budgets. Governments will have to make their health systems more efficient if they are to maintain quality without putting further stress on public finances. The OECD has assembled new comparative data on health policies and health care system efficiency for its member countries. These show that all countries surveyed can improve the effectiveness of their health care spending. If all countries were to become as efficient as the best performers, life expectancy at birth could be raised by more than two years on average across the OECD, without increasing health care spending. There is no single type of health care system that performs systematically better in delivering cost-effective health care.

Analysis and results

Life expectancy at birth could be raised by more than two years on average across the OECD, without increasing health care spending, if all countries were to become as efficient as the best performers. By way of comparison, a 10% increase in health care spending would increase life expectancy by only three to four months.

Potential efficiency gains are the highest – extending life by over four years on average – in Denmark, Hungary, the Slovak Republic and the United States.

For more than one-third of countries, better efficiency could improve life expectancy as much in the 10 years to 2017 as in the previous 10 years, while keeping health care spending constant.

Improving efficiency would result in large public savings in most OECD countries, amounting to 1.9% of GDP on average by 2017. Savings would be over 3% of GDP for Greece, Ireland and the U.K.

According to a new health care system typology to investigate the links between policy settings and health system efficiency, no health care system is clearly superior in delivering gains in health status. Big bang approaches switching from one type of system to another may not necessarily improve efficiency much.

Conclusion

There is no single type of health care system that performs systematically better in delivering cost-effective health care, as both market-based and more centralized command-and-control systems have strengths and weaknesses. It seems to be less the type of system that matters, but rather how it is managed. Policy-makers should aim for policy coherence by adopting best practices from other health care systems and tailoring them to their own circumstances. By improving the efficiency of the health care system, public spending savings would be large, approaching 2% of GDP on average across the OECD.

Implications and recommendations

This international comparison highlights reforms that could be used to make health systems more efficient:

  • Improve coordination between bodies involved in health care management. Care coordination problems often appear at the interface between providers (hospitals and out-patient care), the transition into long-term care, and in countries where key health care decisions are fragmented across levels of government. This should be a particular area for investigation in Canada.
  • Introduce or reinforce physician gate-keeping to manage demand for specialized services and guarantee adequate access to different forms of care. Encouraging patients to register with a general practitioner could contribute to reducing the number of specialist consultations and/or hospital expenditures.
  • Increase out-of-pocket payments where these are low and combined with wide patient choice among providers since this may induce excessive demand.
  • Provide more information on quality and prices to enhance competitive pressure, and allow benchmarking of providers to help spread best practices.
  • Investigate the merits of reforming provider payment schemes in both in-patient and outpatient sectors. A better balance between activity-based and capitation remuneration models would enable many countries to better balance supply and demand of health care services. 
  • The regulations concerning the hospital workforce and equipment should be adjusted. These could be relaxed in countries where recently reformed hospital payment systems are now mainly based on activity and strict regulation reduces the flexibility to respond to the new set of incentives.
  • Better priority setting should be envisaged in those countries where there is no precise definition of the health benefit basket, no effective health technology assessment and no clear definition and monitoring of public health objectives. The most efficient countries tend to be those with the most rigorous priority setting.
  • Investigate the factors behind health inequalities so that policies can be developed to improve equality. More research is needed to know whether health inequalities are created by extensive reliance on private health insurance to cover services that are not, or only partially, covered by the basic insurance package (Canada and France) or high out-of-pocket payments (Finland, Hungary, Poland and Slovak Republic).

Source

Economic Policy Reforms 2011


Gouvernement du Québec
© Gouvernement du Québec, 2017