Santé et Services sociaux Québec.
Previous page Adjust text size


Search :

Here are the results of your research:

392 result(s) found

USA - Lessons Project Report Showcases Promising Pathways to Make Research More Accessible and Actionable

Promoting research synthesis, translation and dissemination, this report from a 2014 workshop identifies useful innovations and strategies from disciplines relevant to health services research communication. The report highlights the importance of relationships between researchers and policymakers for improving the uptake of research findings.

International - Delivering Universal Health Coverage: A Guide For Policymakers

Published in the UK, this review synthesizes the international research evidence on universal health coverage (UHC) and presents policy recommendations for politicians and policymakers. The review describes coverage, payment and implementation options, and notes that the redistribution of health benefits and financial burdens is a highly politicized process that often involves opponents from powerful interest groups.

UK - Implementing the NHS five year forward view: aligning policies with the plan

The Forward View, a 2014 strategic plan published by the UK National Health Service (NHS), outlined how NHS services must move towards care models that reflect Britain’s diversity. Written in response to the strategic plan, this paper warns that it will fail unless significant changes are made to policy and NHS leadership. The paper recommends new care models and implementation support.

International - Innovations in Health Care System Reform in OECD Countries

The Innovation Journal published this special issue on innovations in healthcare system reform within the 34 countries of the OECD. The special issue features articles on innovative healthcare reform in Canada, Greece, Finland, the UK and Germany, along with an essay on new policy directions in Saskatchewan.

International - How to reform western care payment systems according to physicians, policy makers, healthcare executives and researchers: a discrete choice experiment

Knowledge on how different groups of professional stakeholders trade off the merits and downsides of healthcare payment systems is limited. This study, published in BMC Health Services Research, asked physicians, policymakers, administrators and researchers from a number of countries, including Canada, to choose between different hypothetical payment profiles. It finds that value-based payments align better with stakeholders' overall objectives in most countries.

USA - Case studies in emergency medicine: Integrating care for the acutely ill and injured

The Brookings Institute offers this look at ways to improve emergency medicine in the US. While the authors find that the acute care itself is excellent, patient education and care coordination are not reimbursed and this works to the detriment of integration, follow-up and post-discharge services. Case studies highlight successful care models in emergency medicine developed for a May 2015 event by medical and health policy experts.

International - OECD outlines action for governments to tackle heavy cost of harmful drinking

Tackling Harmful Alcohol Use: Economics and Public Health Policy says that the increase of risky drinking behaviours is a worrying trend as it is associated with higher rates of traffic accidents and violence, as well as increased risk of acute and chronic health conditions. The report shows that several policies have the potential to reduce heavy drinking, regular or episodic, as well as alcohol dependence. Governments seeking to tackle binge drinking and other types of alcohol abuse can use a range of policies that have proven to be effective, including counselling heavy drinkers, stepping up enforcement of drinking-and-driving laws, as well as raising taxes, raising prices, and increasing the regulation of the marketing of alcoholic drinks.

Canada - Modelling helps Saskatchewan health care managers, policy makers make better, more informed decisions

The Health Quality Council's Measurement and Analysis Services team is now able to offer predictive modelling services to healthcare managers based on evidence around factors that affect the use of a service. Modeling holds the potential to help regions anticipate changes in demand.

UK - NHS finances: the challenge all political parties need to face

Britain’s troubled National Health Service (NHS) is sure to feature prominently in the country’s next election, scheduled for 2015. This briefing analyzes health funding issues raised by British political parties and describes various actors’ policy stances. It looks at NHS funding by the current government, makes projections, and provides international comparisons of spending on health services.

USA - Linking Costs to Health Outcomes for Allocating Scarce Public Health Resources

In the US, public health (PH) resources are scarce and policymakers face tough decisions on funding priorities. Accounting systems, which are ill equipped to link fiscal resources to PH outcomes, compound these difficulties. This paper examines the types of expenditures, services, and outcomes tracked at local and state PH levels. The authors provide recommendations for strengthening the linkage between expenditures and outcomes.

Europe - Public reporting in health and long-term care to facilitate provider choice

Public reporting is a term used to describe the publication of information and reports on the quality of health care and long-term care providers. This WHO summary looks at public reporting in Europe, examining national contexts, reporting system design and policy issues and implications.

International - The Changing Role of Government in Financing Health Care: An International Perspective

This paper explores the changing role of governments in health care financing internationally. It reviews the economic literature to analyze policy decisions and performance results in financing incentives, risk pooling, hospital competition, performance-related pay, and wait times. The paper says there is little international evidence that revenue collection mechanisms alone can manage care costs.

International - Money talks - Paying physicians for performance

Pay-for-performance (P4P) systems that tie physician payment to care quality are popular among healthcare policy makers. This study assessed the effects on patients and physicians of two pay systems: traditional fee‐for‐service, and a blend of fee‐for‐service and P4P incentives. Patients treated under the blended system were shown to receive better treatment.

Belgium - White paper on access to care

This white paper presents a set of operational recommendations to improve access to care for vulnerable populations. It is the result of a unique collaboration between stakeholders in the Belgian healthcare system, and Médecins du Monde, one of the organizations that provide medical assistance to vulnerable populations. They collaborated on an overview of the current situation and a series of round tables that formulated proposals in five areas: a policy of inclusion, strengthening existing measures, increasing investment in prevention, providing made-to-measure care and improving patient information.

UK - Using NICE’s approach to base policy decisions on evidence could help save billions

The National Institute for Health and Care Excellence (NICE) provides the UK National Health Service (NHS) with recommendations on evidence and best practices, and is known for rigour and objectivity. The British government is now applying the NICE model to public policymaking to variously help school principals, police chiefs, and other civil servants save billions of pounds of taxpayers’ money by using evidence-based decision making.

Canada - Comparative Review of the Policy Landscape of Team-based Primary Health Care Service Delivery in Western Canada

Conducted for Alberta Health Services (AHS), this review gives a snapshot of the policy landscape of team-based primary healthcare in British Columbia, Alberta and Saskatchewan. The review finds that policies in all three provinces reflect poor planning in primary care, and notes that guidance, metrics, resources and appropriate pay scales are often not available for team-based models.

Europe - Health, health systems and the crisis in six countries

These case studies published by the WHO examine the impact of the 2008 financial crisis on health systems and health in six European countries: Estonia, Greece, Ireland, Latvia, Lithuania and Portugal. The case studies examine how severe fiscal pressures on post-2008 health budgets have pushed policy makers to respond differently.

UK - The NICE way: lessons for social policy and practice from the National Institute for Health and Care Excellence

Known for its rigour and objectivity, Britain’s National Institute for Health and Care Excellence (NICE) provides recommendations on best practices for the UK health sector. This article looks at the possibility of applying NICE’s methods in social policy and describes its approach — a mix of research, public consultation and frontline professional expertise that remains at arm's length from government.

International - An Asian Flavour for Medicare Learning from Experiments in Japan, Korea, and Taiwan

This paper from the Macdonald-Laurier Institute looks to Asian countries as potential models for Canadian healthcare funding and delivery. The authors highlight these countries' willingness to learn from abroad, their frequent reviews of health policy, use of salaried hospital specialists, user fees and competition among private hospitals, along with well-developed long-term care systems.

New Zealand - Measuring health system performance: A new approach to accountability and quality improvement in New Zealand

A new whole-of-system approach to measuring health system performance, based on Triple Aim objectives, is being introduced in New Zealand. This article in Health Policy presents the features of the program, called the Integrated Performance and Incentive Framework (IPIF). Measures will be set at both national and district levels and will be applied first to primary health care before being expanded to other services.

Canada - Canadian governments must rethink healthcare on five areas of national priority, according to a new report from the C.D. Howe Institute

In “Challenging Vested Interests: National Priorities for Healthcare,” authors Åke Blomqvist and Colin Busby find that compared to the healthcare systems of a large group of peers, Canadian systems do not produce enough high-quality care for the money spent. The authors outline five healthcare policy priorities for 2016: 1. Policies to Improve Value for Money, 2. Gaps in Public and Private Coverage, 3. The Canada Health Transfer – Hold the Line and Tweak, 4. A New Health Accord, and 5. Direct Federal Health Programs

UK - Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use

Experts in the UK disagree about the meaning and role of cost-effectiveness thresholds in British health policy decision-making. This article dissects the main issues and highlights 16 key points. It says thresholds approached from the supply side (not the demand side) are preferable in deciding which interventions should be added to or subtracted from public insurance packages.

Sweden - Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden

This study set out to analyze two policies designed to improve health and social care in Sweden by empirically testing a new conceptual model for evidence-informed policy formulation and implementation. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, the model was found to provide insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies, and overlapping policy phases.

Canada - Policy Innovation is Needed to Match Health Care Delivery Reform: The Story of the Champlain BASE eConsult Service

This commentary says Canada needs to reform health services delivery and finds that the current lack of policy responsiveness hinders the expansion of innovations to improve patient care. To illustrate these challenges and how they might be overcome, the authors explore an innovative electronic specialist consultation start-up that is growing into an Ontario-wide service.

Ireland - From universal health insurance to universal healthcare? The shifting health policy landscape in Ireland since the economic crisis

Although Ireland experienced a severe economic crisis in 2008, its current government has promised a universal single-tiered health system beginning in 2016. This article assessing policy intent and practice argues that the government proposal is mostly rhetoric, saying years of austerity have resulted in poorer access to health care in Ireland and little extension of coverage.

Canada - Rolling-out Lean in the Saskatchewan Health Care System: Politics Derailing Policy

This paper examines the recent Lean management reform of Saskatchewan’s provincial healthcare system. Lean focuses on continuous improvement, employee engagement, and the elimination of waste. The paper says Saskatchewan’s reforms appear to have been derailed as key actors, and the public have challenged the goals and process of Lean methodology, as well as its costs.

Canada - McMaster Health Forum launches revamped Health Systems Evidence

Health Systems Evidence (HSE) has recently improved its ability to support policymakers, stakeholders and researchers who want access the best available research evidence in a timely manner. The site now features a number of enhancements, including: responsive design to optimize the interface on both desktop and mobile; a more powerful open search function; a guided search option to help inexperienced users quickly find what they need; and the ability to save preferred searches, save retrieved documents and exports results.

Canada - The Public Health Care Monopoly on Trial: The Legal Challenges Aiming to Change Canada’s Health Care Policies

Yanick Labrie from the Montreal Economic Institute looks, in this article, at past and upcoming challenges in provincial courts to restrictions on private health care. He compares Canadian policies with those of other countries and discusses their impact on timeliness of care, principally for elective surgeries.

Canada - Policy Capacity for Health System Reform

This review analyzes dimensions of policy capacity that support effective policy making in health care. Examining the skills, competencies, and conditions required for productive policy results, the review notes that policy making is a social exchange process that requires organizational support for successful development.

France - Telemedicine : Report from the working group on e-health industrial strategy

Published by the Ministère des Affaires sociales, de la Santé et des Droits des femmes in France, the working group's report examines the emergence of an industrial strategy around e-health that supports of public health policy. The focus is on the development of non-financial measures to remove obstacles to the deployment of telemedicine in France and develop industrial capacity, R & D and exports in this field.

Europe - Competition among health care providers - Investigating policy options in the European Union

The European Union (EU) Expert Panel on Effective Investments in Health (EXPH) issued this report examining competition among healthcare providers as a way to improve the efficient use of resources. The report recognizes the importance of patient choice, saying it works best when patients can easily assess the quality of services.

Canada - Navigating the Evidence: Communicating Canadian Health Policy in the Media

Published by the University of Manitoba, this e-book is a compilation of newspaper commentaries published in 2014 by Canadian health policy experts. The Op-Eds highlight recent evidence on a wide range of topics, including population aging, healthcare sustainability, pharmaceutical policy, mental health, obesity, and the social determinants of health.

Europe - Strengthening health system accountability: a WHO European Region multi-country study

This WHO report summarizes European countries' experience with strengthening health system accountability in the context of the momentum created by the Tallinn Charter of 2008 and the Health 2020 policy framework of 2012. Countries have set rigorous goals and are measuring and reviewing health systems' performance, taking significant steps to improve health system accountability.

Switzerland - Federal Council looks at way to improve the status of patients

According to the Swiss Federal Council, patients should have more of a voice in health policy development. The Council took note of the report on patient rights and patient engagement in Switzerland, which highlights potential improvements for the benefit of all stakeholders, The Council instructed the Federal Department of the Interior to examine some potential solutions in greater depth, including greater transparency and clarity of the legal situation, and increased patient involvement in policy processes.

Europe - Recruitment and Retention of the Health Workforce in Europe

Funded by the European Union (EU), this study of health workforce recruitment and retention in Europe includes a literature review, eight case studies, and recommendations for policy makers, managers and health professionals. The authors identify innovative solutions to the challenges of recruiting and retaining health staff.

Australia - An analysis of policy levers used to implement mental health reform in Australia 1992-2012

Australia’s government reformed mental health services four times between 1992 and 2012. This study explores how the reforms were implemented using five policy levers (organization, regulation, community education, finance and payment). It finds that the use of levers changed over time, moving from a prescriptive use of regulation to the monitoring of service standards and consumer outcomes.

International - Universal health coverage programs that cover one-third of the world are transforming care for the poorest and most vulnerable: new World Bank Group report

This report from the World Bank Group was released at the United Nations General Assembly on September 25, 2015. It shows that more countries around the world are rolling out universal health coverage programs designed to expand access to health care and reduce the number of people impoverished by paying for the health care they need. The report looks at how policy makers in 24 countries are tackling five key challenges: covering people, expanding benefits, managing money, improving the supply of health care services and strengthening accountability.

USA - Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper

The American College of Physicians (ACP) has issued 23 policy recommendations on primary care telemedicine that buttress calls for its expansion, especially in established physician-patient relationships. The ACP supports government funding of the broadband infrastructure needed for telehealth and advocates lifting restrictions limiting the reimbursement of telemedicine services by US Medicare.

UK - Creating a better care system. Setting out key considerations for a reformed, sustainable Health, Wellbeing and Care system of the future

Published by Britain’s Local Government Association (LGA), this strategy document develops a framework for improving the UK health and social care system, defines systematic barriers to change, and describes key choices required for meaningful reform. The document calls for an integrated but devolved system supported by local infrastructure, pooled funding, and national policy mechanisms.

Europe - Everything you always wanted to know about European Union health policies but were afraid to ask

Published by the WHO, this 146-page book describes health policies enacted by the European Union (EU). The book focuses on four aspects of EU health policy: institutions, processes and powers related to health; health actions taken under EU mandates; non-health actions affecting health and health systems; and the impacts of EU financial governance on health.

Canada - Approaches to Accountability

This special issue of Healthcare Policy is dedicated to approaches to accountability in Canadian healthcare policy. The issue includes 15 research articles covering accountability in the context of internal hospital functioning, the primary care system, cancer care, long-term care, medical laboratories, funders and regulatory bodies.

Canada - The Path to Health Care Reform: Policy and Politics

In this monograph journalist and CIBC Scholar at the Conference Board of Canada, André Picard, takes a non-ideological look at the genesis of the modern health care system to understand what was constructed in previous generations and why. He explores the intersection between health policy and health politics and concludes with an optimistic view that universality - within practical limits - can continue.

Europe – The European Observatory on Health Systems and Policies launches new web platforms on health systems and financial crisis

The European Observatory on Health Systems and Policies has launched two web platforms to promote comparison and evidence-informed policies in health. The Health Systems and Policy Monitor (HSPM) tracks changes in European national health systems. A second platform, the Health and Financial Crisis Monitor (HFCM), collates evidence about the effects of the ongoing financial crisis on Europe’s health systems.

International - Health System Performance Comparison: New Directions in Research and Policy

Published by the WHO, this special issue of Health Policy draws attention to the growing field of international comparison and performance assessment of health systems. The issue covers five broad areas related to methodological issues, highlights the strengths of current performance comparisons, and outlines the field’s future potential.

USA - Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy

Gathering data from 30 physician practices in six US states, this RAND Corporation project analyzed factors influencing physician professional satisfaction. The study found that factors such as autonomy, collegiality and work quantity all strongly affected professional satisfaction, as did payment considerations, perceptions of care quality, and access to the use of electronic health records.

Canada - Reducing Wait Times for Health Care: What Canada Can Learn from Theory and International Experience

From the Fraser Institute, this new book on Canadian healthcare wait times assesses wait list policy issues such as health effects, costs and labour market consequences. The authors argue that Canada’s current policies will not improve timely healthcare provision.

Europe - Euro Health Consumer Index 2013

The Euro Health Consumer Index (EHCI) is produced annually by the Health Consumer Powerhouse to report on European healthcare systems from the perspective of consumers and patients. The EHCI offers reality checks for policy makers, empowerment to consumers, and an opportunity for stakeholders to highlight weak and strong aspects of health care.

International - Measuring and Comparing Health Care Waiting Times in OECD Countries

Waiting times for elective non-emergency treatments are a key health policy concern. This study provides comparative data on waiting times from twelve OECD countries. It presents trends in waiting times over the past decade, focusing on such common elective procedures as cataract surgery and hip and knee replacement.

International - Providing integrated care for older people with complex needs: lessons from seven international case studies

Synthesizing evidence from case study programs in seven countries (Canada, Australia, Holland, New Zealand, the UK and the US), this British report examines the delivery of integrated health and social care for older people with complex needs. The report identifies 10 lessons for policy-makers and service providers on how to improve care design and coordination.

Europe - Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems

In this study, Czech researchers compare mental health policies in seven formerly Communist Eastern European countries: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia. The study looks at overall healthcare financing, mental health services, and purchasing and policy measures. None of the countries observed has a separate mental healthcare budget.

Canada - Where you live matters: Canadian views on health care quality Results from the 2013 Commonwealth Fund International Health Policy Survey of the General Public

This final bulletin in the Health Council of Canada's Canadian Health Care Matters series presents Canadians’ views on and experiences with health care, based on the 2013 Commonwealth Fund Survey. It focuses on differences between provinces, comparisons among the 11 OECD countries participating in the survey, and changes in Canada’s performance over the past decade. Large variations between provinces in patient experiences, not only around wait times and coordination of care, but also in other areas including out-of-pocket expenses, patient safety, and preventive care, were identified.

Brazil - Learning from emerging economies

This HINNOVIC dossier looks at health innovations in Brazil, which has strong domestic capacity in health technology development and policy initiatives around population needs and health inequalities. Health sector commercial agreements with China and India are examined as are instances where more developed countries are looking to Brazilian models to better meet healthcare needs.

International - Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress

Universal health coverage (UHC) is a global health policy priority, but there remains limited evidence on UHC reforms in low- and middle-income countries. Published in Health Research Policy and Systems, the case studies accomplished as part of this study highlight the importance of increasing pre-payment funding through tax funding.

Canada - Capital Spending in Healthcare: A Missed Opportunity for Improvement?

Published by the Canadian Foundation for Healthcare Improvement, this report by Adalsteinn Brown et al calls on policy-makers and researchers to create new resources to support capital investment. They propose better ways to look at the returns on capital investments, skills development in capital planning and a regulatory framework that encourages integrated planning and allocation across sectors to encourage the delivery of the right care in the right place.

International - Assessing Quality in Cross-Country Comparisons of Health Systems and Policies: Towards a Set of Generic Quality Criteria

There is a growing body of cross-country comparisons in health systems and policy research. This paper from the RAND Corporation reviews methods of cross-country comparison to identify quality issues and assess generic quality criteria. The authors identify criteria such as the appropriate use of theory, design and research rigour, as well as attention to complexity.

Europe - Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

The harmonization of European health systems has created a new need for tools that standardize information on medical care. Standards and coding systems are necessary for the incorporation of local data into evidence-informed policy. This report from the eDESDE-Long Term Care (LTC) project describes the development of a standardizing tool and coding tool for LTC services across Europe.

International - Health systems in times of global economic crisis: an update of the situation in the WHO European Region. Report

This report was produced from a follow-up, held in April 2013, to an original meeting in 2009 on health and the financial crisis. The meeting reviewed the impact of the economic crisis on health and health systems, and focused on three themes: reinforcing equity, solidarity and universal coverage; and coping mechanisms, with a focus on efficiency and health system resilience. Policy recommendations were prepared for consideration by member states.

USA - Federal and State Policy to Promote the Integration of Primary Care and Community Resources

This document from the National Academy for State Health Policy in the US presents key themes that emerged from a consultation held with state and federal officials on potential measures each level of government could take to promote linkages between primary care and community services.

Europe - Health 2020 policy framework and strategy

In 2012, the WHO Regional Committee for Europe approved Health 2020 in two forms. This publication gives both. The shorter policy framework provides European politicians and policy-makers with Health 2020’s main values and principles, and key strategic advice to support action for health and well-being. The longer policy framework and strategy give more detail in terms of evidence and practice.

Europe - Building resilient and innovative health systems

This issue of Eurohealth focuses on themes discussed at the recent European Health Forum Gastein 2013. The Forum explored innovative suggestions for health policy in Europe that respond to European values as well as market realities. Resilience, the ability to cope with internal and external shocks, emerged as a key theme.

Canada - Debunking the Myths. A Broader Perspective of the Canada Health Act

This monograph published by the MacDonald-Laurier Institute points to the danger that misinterpreting the nature of the Canada Health Act leads legislators to fail to consider and implement essential changes.

International - Investing in Health Infrastructure: How Decentralization Matters

A researcher from the Université de Montréal is a co-author on this joint Swiss-Québec paper published by Georgia State University. It examines the decentralization of infrastructure in health services. The paper presents international evidence on health service decentralization and infrastructure spending, and analyzes case studies and policy choices in the US, Canada, and Switzerland.

France - User representation in health institutions: Claire Compagnon submits her report to Health Minister Marisol Touraine

The mission entrusted to Claire Compagnon embodies the desire for renewal at the heart of the national health strategy now in design. It spells a new era of health democracy to strengthen the individual and collective rights of health system users. In her report, Claire Companion provides an overview of user representation, contextualizes it within a broader vision of health democracy and stresses the need for a genuine co-construction of health policy that involves users.

International - Advancing the application of systems thinking in health

This series published by Health Research Policy and Systems aims to support the shift from abstract concepts to actual applications and experiences of systems thinking in health. It was coordinated by the WHO Alliance for Health Policy and Systems Research and focuses on low- and middle-income countries.

International - Health, austerity and economic crisis: assessing the short-term impact in OECD countries

This paper looks at the impact of economic crisis on health and health care. It summarises findings from the published literature on the effects of economic crisis that took place over the past few decades and also describes recent health policy reforms, focusing on those countries where the economic crisis has hit hardest. Finally, this paper analyses the empirical relationship between unemployment and health care use, quality and health outcomes, using data from OECD Health Statistics. In doing so, it investigates whether the effects of unemployment on health outcomes have been extenuated by austerity measures.

UK – Future organisational models for the NHS. Perspectives for the Dalton review

In 2014, the UK government instituted the Dalton Review, investigating how the best-performing organizations within the country's National Health Service (NHS) could establish national groups of hospitals and services as centres of excellence. This report from the Kings Fund solicits the views of British healthcare policymakers, academics and experts on the mandate and aims of the Dalton Review.

Europe - Economic crisis, health systems and health in Europe: impact and implications for policy

The European Observatory on Health Systems and Policies monitors the effects of the economic crisis on health systems and health. This report, undertaken jointly with the WHO Europe, analyses the impact of the crisis between 2008 and 2013 on government and household finances, spending on health, health coverage, health system performance and population health.

International - International responses to austerity

Undertaken to support the report, “More than Money: closing the NHS quality gap”, this evidence scan provides information on austerity and health care from an international perspective. The scan uses a case study approach to examine health system policy responses to financial crises in six countries: Canada, Denmark, Ireland, the Netherlands, Portugal and Spain.

USA - The Role of Physician Assistants in Health Care Delivery

The role of physician assistant (PA) was created in the 1960s to relieve a shortage of doctors and is a versatile component of the US health care workforce. This brief describes the contemporary functions of PAs and barriers that may still prevent their maximum usage. The authors conclude with specific policy considerations for US state health officials.

Sweden - Why Public Health Services? Experiences From Profit-Driven Health Care Reforms In Sweden

Market-oriented reforms have been carried out in Sweden’s publicly funded health system since 1990. This study examines the effects of these reforms and finds that efficiency and care quality have been reduced, while geographical and social inequities have increased. Policy options to promote the development of a non-profit healthcare system are highlighted.

International - The impact of cost-containment policies on health expenditure : Evidence from recent OECD experiences

This article, published in the OECD Journal on Budgeting, assesses the most robust empirical evidence on the public spending effects of different health policy alternatives to contain excess cost growth in the system. Evidence indicates that there are various alternative policies to cost-containment in a government’s toolkit that can be combined to achieve cost control in the health system.

Canada - Scan of Mental Health Strategies across Canada

The scan produced by the National Collaborating Centre for Healthy Public Policy is presented in the form of a table that is divided into 6 sections. It presents provincial and territorial strategies in mental health whose objectives target different dimensions of mental well being and mental illness; foundational documents in the field of population mental health; social policies that target the determinants of mental health; strategies and reports related to suicide prevention; public health-related strategies; and federal mental health-related strategies.

Australia - Can we improve the health system with pay-for-performance?

This Deeble Institute for Health Policy Research Issues brief traces the partial implementation of pay-for-performance models in Australia, looks at experience in other countries and reviews the evidence on, finding mixed results. The author concludes that it is uncertain whether pay-for-performance delivers better value for money and emphasizes that no single measure will improve care, ensure financial sustainability and increase accountability.

Canada - Building better health care: Policy opportunities for Ontario

The province of Ontario’s healthcare performance is uncompetitive among international peers, many of which spend less to achieve better outcomes. This paper urges Ontario to confront its main healthcare cost drivers (technology, drugs, increased service utilization and physician compensation), and recommends abolishing the tax subsidy for employer health insurance benefits.

International - Geographic Imbalances in Doctor Supply and Policy Responses

Doctors are distributed unequally across urban and rural areas in virtually all of the 34 OECD countries. This paper examines what drives physicians to choose an urban practice location and assesses policy responses in 15 OECD countries.

USA - mHealth in China and the United States: How Mobile Technology is Transforming Health Care in the World’s Two Largest Economies

Rising costs, unequal access and aging populations are increasing pressure on many countries’ healthcare systems. This article suggests that policy-makers look to the US and China, where mobile health technology, or mHealth, is boosting productivity, encouraging better data collection and analysis, and helping providers improve affordability, access and treatment. The authors suggest a number of ideas to speed the international adoption of mHealth.

Canada - Progress report 2003-2013: Highlights of health care reform

The Health Council of Canada recently released Progress timeline 2003-2013: Highlights of health care reform. With almost $2 trillion spent, from both public and private sources, on health care in Canada over this period, Canadians should demand accountability for their investments in the health care system. This report outlines key national, provincial and territorial policy reforms since 2003, in addition to the Health Council's contributions over this period.

Canada - Canada’s lagging healthcare productivity: Lost efficiencies and missed economic opportunities

Distributed by Canadian Health Policy (CHP), this paper discusses lost efficiencies and missed economic opportunities caused by lagging productivity in Canada’s healthcare sector. The paper discusses factors that affect productivity growth, such as organizational culture, incentives and technology.

UK - Healthcare and the economy 2: Going with the flow

The future of the National Health Service (NHS) is frequently debated by British politicians, policymakers and economists. This paper identifies themes apparent in the current debate and looks beyond politicized perspectives to consider changes to the system’s funding and delivery model. Among many recommendations, the authors call for the development of specialized hospitals.

Canada - Health Quality Council of Alberta releases two reports that address continuing care in Alberta

On June 5, 2014, the Health Quality Council of Alberta (HQCA) released findings and recommendations from two separate reviews that focused on the quality of continuing care in Alberta. The first report examined the quality and patient safety implications of Alberta Health Services’ (AHS) policy on continuing care wait lists. The second report looked at the structures and processes that support quality assurance of publicly funded continuing care services in Alberta, including home care, supportive living, and long-term care. A need to provide more fairness, some degree of choice and improve demand modeling are among the recommendations.

International - Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain

Dutch researchers systematically reviewed task reallocation from physicians to nurse practitioners and attempted to analyse facilitators and barriers. They conclude that introducing nurse practitioners in health care requires organizational redesign and the reframing of professional boundaries. The study was published in Health Policy.

USA - Controlling Health Care Spending: Can Consensus Drive Policy?

American strategies to contain healthcare costs have prompted a move away from the fee-for-service payment model. This article reviews alternative cost-containment approaches developed by 10 US health policy organizations and coalitions. It identifies barriers to effective strategies and argues in favour of consensus-driven policies that pinpoint specific areas for spending controls.

Italy - The Veneto model – a regional approach to tackling global and European health challenges, 2016

This WHO report addresses health policy and practice in the northern Veneto region of Italy around the city of Venice. The report examines how Veneto promotes and provides health and social care with an emphasis on community and home care, and describes how the region’s autonomous healthcare system was developed.

International - The Drivers of Public Health Spending: Integrating Policies and Institutions

This economic working paper from the OECD investigates the impact of policies and institutions on health expenditures for a large panel of OECD countries for the period 2000-2010. It uses a set of 20 policy and institutional indicators characterising supply-side, demand-side, and public management, coordination and financing features of health systems. The analysis helps to explain inter-country variations in health spending.

Europe - Headline Indicators for Structured Monitoring of Health System Performance in Europe

Published by EuroHealth, this article proposes using a prioritized set of indicators identified from 43 health system performance assessments (HSPA) to inform comparative analysis of policy impacts. The set of 95 indicators were assessed for relevance to HSPA domains of access, efficiency, equity and quality of care. Indicators to monitor performance on key public health objectives in were identified.

International - How Much Do OECD Countries Spend on Prevention?

Using data from across the 35 member-countries of the OECD, this study examines differences in spending on prevention at both aggregate and detailed levels. Time series data is scrutinized alongside developments in policy and public health to try to identify drivers behind the observed trends in spending on prevention. Policy implications and directions for improvement are discussed.

France – Government adopts the 2018-2022National Health Strategy

The national strategy, adopted in autumn 2017, will be implemented in national plans and in programs and projects defined by regional health agencies (ARS) on each territory. It focuses on four priority areas: the development of a health promotion policy; the fight against unequal access to health; quality, safety and pertinence of care; and innovation to transform the system by reasserting the role of users.

International - Nurses in advanced roles in primary care. Policy levers for implementation

Many countries have introduced advanced roles for primary care nurses to improve access and care while reducing costs. This paper from the OECD provides an analysis of nursing reforms in 37 OECD countries. The paper notes three trends: the development of advanced practice nursing roles; the introduction of supplementary nursing roles; and increases in nursing education programs.

International - The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review

Conducted by Malaysian researchers, this systematic review of 21 articles evaluates the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in health care. It finds that workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making. The authors conceptualize interrelated factors associated with effective strategies to implement research findings.

Canada - Qualitative analysis of the dynamics of policy design and implementation in hospital funding reform

Like healthcare jurisdictions elsewhere, Canada’s provinces have begun shifting away from global hospital budgets. This evaluation focuses on Ontario’s implementation of quality-based procedures (QBPs), a funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. The evaluation concludes that implementation of QBPs has suffered from policy drift, and says the funding mechanism remains misunderstood in Ontario’s healthcare system.

International - World Health Innovation Network Releases Ground breaking Innovation Procurement Cases

The World Health Innovation Network (WIN) has published a series of case studies providing real-world evidence of the impact of innovation in procurement practices. The case studies can be used to inform policy, build health system capacity to adopt innovation, and as educational tools for organizations involved with evaluation and scalability in health systems.

Europe - How to make sense of health system efficiency comparisons?

Improving health system efficiency is a compelling policy goal, especially in systems facing serious resource constraints. This policy brief from the European Observatory on Health Systems and Policies proposes an analytic framework for understanding and interpreting the most common healthcare efficiency indicators.

France - Health system transformation strategy

On February 13, 2018, the French government launched the consultation phase of its health system transformation. Consultations will run from March to May and will conclude with the presentation of a detailed roadmap. Five major projects will be discussed: the quality and appropriateness of care and services; financing and remuneration; digital health care; human resources; and territorial organization.

International - Healthy people, healthy planet. The role of health systems in promoting healthier lifestyles and a greener future

This document was produced by the OECD for the 2017 meeting of the G7 Ministers of Health. It provides an overview of policy actions health authorities can use to improve population health while decreasing pressure on the environment. The report encourages waste reduction, healthier food consumption, and cleaner energy generation in hospitals and nursing homes.

Europe - A resource for developing an evidence synthesis report for policy-making

This 50th edition of the Health Evidence Network (HEN) Synthesis Reports summarizes the best available global findings on public health questions from peer-reviewed and grey literature, and proposes general directions, strategies and actions for consideration. The resource has been developed to outline key approaches, methods and considerations supporting the systematic use of the best available evidence for public health policymaking.

Europe - Key policies for addressing the social determinants of health and health inequities

Evidence indicates that four areas (early child development, employment, security and the living environment) have the greatest effect on social determinants of health and health inequities. This WHO briefing identifies practical policy options for action that focus on early childhood education and care; child poverty; labour market programs; working conditions; social cash transfers; and regulatory mechanisms to improve air quality.

Canada - Lack of Sustainable Funding a Barrier to Physician Assistant Employment in Canada

Although largely an area of untapped potential in most provinces, physician assistants (PAs) can help address many service gaps and health system policy goals, including improved continuity care, access, equity, and sustainability. But a new Conference Board of Canada report finds that the absence of sustainable funding models is a significant barrier for the expansion of PA employment across Canada.

Europe - Health diplomacy: European perspectives

Health diplomacy is central to health governance at global and regional levels, and integral to foreign policy in many countries. This book published by the WHO presents case studies of health diplomacy in action in Europe. Chapters review road safety in Russia; experience with integrated health diplomacy in Malta and Switzerland; and efforts by the Balkan countries to improve capacity.

Europe - Report shows progress towards Health 2020 targets

The WHO reports that Europe is moving towards the WHO Health 2020 goals. Forty-three European countries have now aligned national policies with Health 2020 priorities and defined targets and indicators. Health 2020 focuses on health inequities and their social determinants to improve health and well-being.

USA - A Roadmap for Promoting Health Equity and Eliminating Disparities

The National Quality Forum (NQF) has created a roadmap to reduce US health disparities through performance measurement and policy levers. Focused on cardiovascular and kidney disease, cancer, diabetes, infant mortality and mental illness, the roadmap prioritizes identifying disparities and implementing interventions, making investments in assessment measures, and providing incentives to reduce disparities.

Europe - Health system performance assessment. Reporting and Communicating. Practical guide for policy makers

Published by the European Union (EU), this paper is for policymakers conducting health system performance assessments and provides practical tips and advice on ways to effectively report and communicate their findings. Four steps in the process are described: defining performance assessment goals, identifying target audiences, determining methodology, and implementing monitoring to provide evaluation and effective feedback. Examples are provided for each step.

Europe - Evidence on mechanisms and tools for use of health information for decision-making

Published by WHO Europe, this report describes tools and mechanisms to increase the use of health information in policy development. It describes synthesis methods, information packaging, and tools for using surveillance data and modelling. The dissemination and communication tools discussed include health information-sharing platforms and social media.

Canada - Value of Physician Assistants: Recommandations for Action

Published by the Conference Board of Canada, this briefing is the last in a series of four reports on physician assistants (PAs) in Canadian healthcare settings. It provides five policy recommendations for optimizing PA roles, including developing appropriate funding models; addressing regulation and data tracking challenges; expanding supply and training; and enhancing evidence and understanding of the importance of PAs.

International - OECD Reviews of Public Health

Reporting on the public health systems of the 34 countries in the OECD, these Reviews of Public Health provide analysis and policy recommendations that highlight best practices and innovation. Topics include obesity, harmful alcohol use, health checks, preventive screening, public health emergencies, and more.

Australia - New framework lays the foundation for Indigenous mental health reforms

The Australian government has published a five-year strategic framework for Aboriginal and Torres Strait Islander mental health and wellbeing. It sets out a culturally appropriate stepped-care model to guide and support Indigenous mental health policy and act as a resource for policymakers, advocates, service providers, clients, consumers and researchers.

Canada - How Canadian Health Care Differs from Other Systems

Canada’s approach to health policy is much more restrictive than in other developed countries with more successful universal health-care systems, notably on the use of the private sector and patient cost-sharing, finds a new study released by the Fraser Institute.

France – 25 key measures in the prevention policy to help people in France stay healthy throughout their lives

On March 26, 2018, the government of France announced initiatives aimed at producing an environment favourable to health at different ages. The actions cover the four stages of life: healthy pregnancy and the first 1,000 days of life; child and youth health; healthy living from age 25 to 65; and aging well and preventing loss of autonomy beyond 65. In total, the actions anticipated in the prevention policy represent an investment of 400 million euros over five years.

UK - Risk and reward sharing for NHS integrated care systems

Risk and reward sharing (RRS) allows healthcare policymakers to incentivize providers to moderate demand by sharing in savings or cost overruns. This paper traces the application of RRS, first in American accountable care organization, and then within integrated care in the UK National Health Service (NHS). It warns that the NHS must be aware of the complexities inherent in RRS as well as the benefits.

UK - Horizontal or Vertical: Which way to integrate? Approaches to community services integration and consequences for emergency hospital activity. A case study based on the Transforming Community Services Policy

In 2010, the UK government’s Transforming Community Services Policy required a complete break between policy/funding and provider functions in emergency hospitals. Eight years later, this case study explores the impact this choice had on the use of emergency hospital by older Britons and considers the wider implications for the National Health Service (NHS) as it develops new models of care and integrated care systems.

Canada - Healthcare system needs to catch up to the requirements of the Google Generation

Findings released by the Canadian Medical Association (CMA) show that the so-called Google Generation of young adults are Canada’s most eager adopters of technologies to manage their own health. The CMA warns that to address the impact of this generation, policy changes are urgently needed to scale up technology adoption in health care.

Ireland - Minister Harris publishes Sláintecare Implementation Strategy marking important milestone towards delivering health reform

The Irish Ministry of Health has published an implementation strategy providing a framework for the planned reform of health services in the country. Reforms will include a reorganization of health services administration, a focus on community care, investments in mental health, a national clinical strategy for hospitals, and a rollout of eHealth systems and infrastructure.

UK - Paying for Efficiency: Incentivising same-day discharges in the English NHS

Since 2010, hospitals in the English National Health Service (NHS) have received more remuneration for same-day discharge patients than for overnight stays. This study analyzed data for patients treated for 191 same-day discharge conditions between 2006 and 2014. It finds that the payment policy had a statistically significant positive effect in about a third of conditions. Results were more mixed for emergency conditions.

International - Lancet Commission Stresses Need for High-Quality Health Systems for SDGs

The Lancet Global Health Commission (LGHC), a group of academics and policymakers from 18 countries, has published recommendations on ways to develop health systems capable of reaching sustainable development goals (SDGs). Health systems dedicated to high quality care that can respond to changing population needs are required to produce better health outcomes and greater social value.

Canada - Organizational factors influencing successful primary care and public health collaboration

This study identifies factors in primary care and public health organizations that influence successful collaboration between the two. Findings are based on interviews with policy makers, managers and service providers. Five major organizational factors that influence collaboration were identified: clear mandates and goals; coordination and communication mechanisms; collaborative organizational culture; optimal use of resources; and collaborative approaches to programs and service delivery.

Sweden - Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care

Achieving sustainability can be difficult in integrated healthcare. This Swedish study gained insight into sustainable changes in health and social care through a 20-year analysis (1995-2005) of local health system actions triggered by the institution of a national psychiatric policy. The study found that inter-organizational cooperation at service level was key to ongoing quality improvement and learning based on the needs of the service user.

Europe - Leapfrogging health systems responses to noncommunicable diseases

This special edition of EuroHealth features two articles on ways to buttress and speed up European health system response to non-communicable diseases (NCDs). One article proposes policy responses to NCDs, while the other concentrates on interventions involving rapid adoption of innovation. Both articles explore areas that play an important role in tackling chronic conditions: public health, primary care, the health workforce, and information technology.

International - Implementing parallel spreadsheet models for health policy decisions: The impact of unintentional errors on model projections

Spreadsheet software is increasingly used to implement systems science models informing health policy decisions, even though spreadsheet models are often prone to unintentional errors. The case study illustrates the impact of unintentional errors on model projections by implementing and analyzing parallel model versions. It determines that standard error-checking techniques do not identify all errors in spreadsheet-based models.

Europe - Strengthening the measurement framework

The adoption of Health 2020, the European policy framework for health and wellbeing, marked a shift towards a values-based approach to health that has since proved complex to measure and report on. In response, the WHO convened an expert group to investigate ways to enhance Health 2020 monitoring and reporting. This report outlines recommendations made by the expert group.

Canada - Fit for Purpose: Findings and Recommendations of the External Review of the Pan-Canadian Health Organizations - Summary Report

Presenting the analysis and recommendations of the federal government-appointed independent External Review of Pan-Canadian Health Organizations (PCHOs), this summary report discusses the Review's mandate and context, the federal role in health policy, and a vision for 21st century health systems. The report sets out criteria for meeting the needs of Canada's health systems and assesses the current configuration of PCHOs against those criteria.

Canada - Is the Canada Health Act a Barrier to Reform?

The Canada Health Act (CHA) prevents provinces from implementing proven health-care reforms that would improve the system and shorten wait times, finds a new study released recently by the Fraser Institute.

Australia - A review of the Australian healthcare system: A policy perspective

This article compares Australia’s healthcare system to similar systems internationally in order to highlight major challenges, including resource allocation and improvements to performance and patient outcomes. The article recommends that bureaucratic capacity models be applied to health care to optimize outcomes. It calls for a re-evaluation of current reimbursement methods, along with increased scrutiny of the appropriateness of care.

International - Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries

Countries rely on out-of-pocket (OOP) health spending to different degrees and also employ varying techniques. The article examines OOP spending in 10 high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US), and analyzes its relationship to access to healthcare services. The study finds a great deal of variation in per capita OOP spending.

Europe - Varieties of Health Care Devolution: “Systems or Federacies”?

Some European countries have devolved healthcare services to subnational units. This paper examines broad trends in two types of devolution: a federacy model, where only a few territories obtain healthcare responsibilities (seen in the UK), and a systems model, where the whole health system is devolved to subnational units (such as in Spain). Findings suggest that the systems model gives rise to significant policy interdependence.

UK - Improving staff retention. A collection of practical resources to help NHS organisations to improve staff retention

Set up by the National Health Service (NHS), this website gathers a large collection of resources to help NHS organizations improve staff retention. It includes staff retention guides, government policy documents and case studies of NHS organization. It also features advice from NHS human resources directors, medical and nursing directors, and NHS providers to help promote best practices and optimum learning.

Canada - Advancing team-based primary health care: a comparative analysis of policies in western Canada

This study compares primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to see how they inform the design and implementation of team-based PHC service delivery. The concept of team-based PHC varies widely across and within the three provinces. The study noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care.

Europe - Competition policy in five European countries. What can be learned for health policy in England?

This Health Foundation working paper is the final report of a project that produced case studies of competition policies in France, Portugal, Germany, The Netherlands and Norway. It finds that patient choice policies are increasingly common, that the process to determine hospital tariffs differs across countries, and that introducing GP competition is controversial.

USA - Rising to the Challenge. The Commonwealth Fund Scorecard on Local Health System Performance, 2016 Edition

Assessing 36 indicators of access, quality, avoidable hospitalization, cost and outcomes across 306 local health systems, this report finds wide variation in health and healthcare across American communities. Overall, health care improve in the period observed (2013-15), and improvement often corresponded to public policy implementation, notably the Affordable Care Act ("Obamacare").

International - Better Ways to Pay for Health Care

Published by the OECD, this briefing document looks at policies used internationally to improve healthcare quality, efficiency, and cost-effectiveness. Many policy efforts now align payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting, which could bolster a patient-centred focus to improve sustainable healthcare delivery and performance in the long-run.

Canada - The Naylor Report and Health Policy: Canada Needs a New Model

The federal government should recognize the limited success of past attempts to achieve healthcare reform with conditional transfers to the provinces and instead focus more on independent initiatives, according to a new C.D. Howe Institute report. In “The Naylor Report and Health Policy: Canada Needs a New Model,” authors Åke Blomqvist and Colin Busby suggest a variety of initiatives including the promotion of better information technology dissemination to providers and patients, and more systematic cost-effectiveness evaluations of new drugs and devices.

Australia - The case of national health promotion policy in Australia: where to now?

Australia’s federal government has recently introduced major funding cuts to health promotion and prevention. This paper discusses strategies to move forward within the context of recent disinvestments, such as the abolition of the Australian National Preventive Health Agency (ANPHA), the cessation of activities by the National Partnership Agreement on Preventive Health, and significant cuts to prevention programs for indigenous Australians.

Europe - Typology of health policy reforms and framework for evaluating reform effects

This report from the European Commission's Expert Panel on Effective Ways of Investing in Health develops a typology of reforms that can be used to assess the impact and progress on areas such as coverage, equity, efficiency, quality and sustainability.

Ireland - Ministers Launch “A Healthy Weight for Ireland: Obesity Policy and Action Plan 2016-2025″

In September 2016, Ireland’s Ministries of Health and Children’s Affairs launched a 10-year action plan that aims to reverse obesity trends and reduce health burdens for individuals, families, the healthcare system and wider society. The plan contains 60 policies to reduce obesity and increase healthy eating and physical activity.

Europe - Health system efficiency: How to make measurement matter for policy and management

In this 242-page book, five authors explore efficiency measurement in health systems and offer insights into the pitfalls and potential associated with various measurement techniques. The authors use examples from various countries to examine how policy-makers and healthcare managers use efficiency measurement and suggest ways to make better use of efficiency measurement in the future.

Canada - Bilateral Health Agreements between the Federal and Provincial/Territorial Governments in Canada

According to this study, bilateral health transfer agreements between Ottawa and the provinces could increase innovation and enhance performance in Canada’s health system. Released by the Institute for Research on Public Policy (IRPP), the study notes that bilateral agreements can be tailored to provinces’ needs or used to promote innovation. The federal government is providing $3 billion through bilateral agreements over the next four years.

Canada - Ontario Establishing Patient and Family Advisory Council

Ontario is creating a Patient and Family Advisory Council to advise the province on health policy priorities impacting patient care. The council will involve patients, families and caregivers throughout the policy development process. Council members will be chosen by a public process to nominate suitable candidates taking place in 2017.

Europe - Voluntary health insurance in Europe: country experience

Published by the WHO, this 160-page book contains short, structured profiles of markets for voluntary health insurance (VHI) in 34 European countries. Each profile, written by local experts, identifies gaps in publicly financed health coverage, describes the role VHI plays, outlines how the market for VHI operates, summarizes public policy towards VHI, and highlights national debates and challenges.

Germany - The Health Care Strengthening Act: The next level of integrated care in Germany

Although Germany has traditionally followed a decentralized approach to healthcare services, the government has now introduced legislation to foster the integration of healthcare services. This article describes the change in policy and the annual innovation fund of €300 million ($440 million Cdn) that has been established to start up integrated care programs.

Canada - Policy Approaches to Reducing Health Inequalities

The National Collaborating Centre for Healthy Public Policy produced this briefing note to help actors more easily distinguish between broad approaches to reducing health inequalities. It illustrates the difference between social determinants of health and social determinants of health inequalities and helps to see what impact might be had with different strategies.

International - Public reporting on quality, waiting times and patient experience in 11 high-income countries

This article published in Health Policy maps current approaches to public reporting on waiting times, patient experience and aggregate measures of quality and safety in 11 high-income countries (Australia, Canada, England, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States). Using a questionnaire-based survey of key national informants, the authors found that the data most commonly made available to the public are on waiting times for hospital treatment, with Information on patient experience at hospital level also made available in many countries.

International - A new OECD series to understand your country's health care system

The OECD will begin publishing a new series to provide two-page summaries on healthcare systems in different countries. Each country snapshot will focus on pertinent health and care issues, will feature fresh data and key statistics, and include brief policy recommendations.

UK - Catalyst or distraction? The evolution of devolution in the English NHS

Devolution, the transfer of power from higher to lower levels of government, is a key policy of the current UK government, especially with regards to the funding, administration and structure of the National Health Service (NHS) in England. This report considers the potential outcomes of healthcare devolution and how policy could best evolve.

Europe - So What? Strategies across Europe to assess quality of care

Prepared by a European Union (EU) Expert Group, this report shares examples of best practices in healthcare quality assessment implemented by EU countries and analyses them to draw general conclusions for policy development. The report presents a list of methodologies developed to support national policy-makers but does not compare quality of care across countries, regions or healthcare providers.

UK - The health of the nation: averting the demise of universal healthcare

Published by a private institute, this report on the future preservation of universal health care in the UK is made up of commentaries by 11 healthcare academics, managers, clinicians, patient representatives and policymakers. Contributions consider funding and costs; health system, services, and hospital organization; workforce issues; decentralization and local government; public health and preventive medicine; and the role of the voluntary sector.

Canada - Ontario’s Health System: Key Insights for Engaged Citizens, Professionals and Policymakers

Edited by the McMaster Health Forum’s director, John Lavis, this book aims to help make the Ontario healthcare system more understandable to the citizens who pay for it and are served by it, the professionals who work in it, and the policymakers who govern it. The book begins by providing historical context and ends by examining current goals and improvement strategies. Each of the 11 chapters begins with key messages for each of these groups.

USA - Lessons from States on Advancing Evidence-based State Health Policymaking for the Effective Stewardship of Healthcare Resources

Published by the National Academy for State Health Policy (NASHP), this briefing provides US states with actionable information on evidence-based policymaking. It describes why states should work with evidence, and presents key considerations for developing an evidence-based policymaking process, along with strategies for engaging patients and consumers.

UK - The cost-effectiveness of population Health Checks: have the NHS Health Checks been unfairly maligned?

The National Health Service (NHS) provides primary care Health Checks to identify adult patients at risk of disease. This study is the first to use NHS data to consider whether the Checks represent a cost-effective use of resources. It finds the Checks are associated with a reduction in patient body mass index (BMI). Coupled with the procedure’s low cost, findings suggests that Health Checks are a cost-effective policy.

International - Through the looking glass: A practical path to improving healthcare through transparency

Transparency in health care is considered important, but has failed to transform quality or costs. Often, progress has been symbolic and given rise to disputes between policymakers, providers and professionals. Awash with data, some systems are now finding it more difficult to work out what is going on. This study suggests there is considerable potential still waiting to be unlocked in the strategic use of health system data to achieve transparency.

International - Value in Healthcare. Laying the Foundation for Health System Transformation

Synthesizing the preliminary findings of the World Economic Forum’s Value in Healthcare project, this report focuses on concepts and definitions while developing a value-based health system framework and system transformation roadmap that emphasize public policy priorities. It advises tracking patient outcomes and associated costs across the cycle of care to develop customized interventions that improve value for specific populations.

Canada - A Better Prescription: Advice for a National Strategy on Pharmaceutical Policy in Canada

Building on published research and international frameworks, this article proposes that the pharmaceutical policies of federal, provincial, and territorial governments be coordinated around a core health-focused goal. It strongly suggests policy action on four core objectives: universal access to necessary medicines; appropriate prescribing and use of medicines; value for money spent on medicines; and patient safety.

Australia - The Australian Government has released a public discussion paper to help inform future care at home reforms

Health policy reforms in Australia have aimed to give consumers more control over their care and, most recently, their home care. Government prepared a discussion paper and initiated a public consultation earlier this summer that is open for submissions until August 21. Feedback will be used to inform government decisions on an integrated care at home program.

Europe - Measuring efficiency in health care

Efficiency measures are vital for assessing the performance of health systems. This issue of the Eurohealth Observer features two articles that explore issues related to measuring the performance of European health systems. One article identifies the causes of inefficiencies in the continent’s health systems, while the other examines the challenges of using European cross-country comparisons of efficiency to inform national health policy.

New Zealand - New Zealand’s first Health Research Strategy launched

New Zealand has launched a strategy to increase government investment in health research. Bringing together health science, research and innovation to form a more cohesive system, the new strategy establishes four priorities: invest in excellence; create a vibrant environment; improve translation to policy and practice; and advance innovative ideas and commercial opportunities.

Europe - Building resilience: a key pillar of Health 2020 and the Sustainable Development Goals – Examples from the WHO Small Countries Initiative

Strengthening resilience is central to Health 2020, the WHO European policy framework for health and well-being. This publication explains the concept of resilience and its implications for health at three levels (individual, community and system/society). It presents knowledge gained from three countries participating in the WHO Small Countries Initiative (Iceland, Malta and San Marino).

International - Using media to impact health policy-making: an integrative systematic review

Media interventions can play a role in influencing health policies. This systematic review of three qualitative studies, seven quantitative studies, and 11 case studies assesses the effects of planned media interventions, including social media, on the health policy process. The review concludes there is a lack of reliable evidence to guide decisions on the use of media interventions to influence policy-making.

Europe - The Europeanization of Health Care Coverage Decisions. EU-Regulation, Policy Learning and Cooperation in Decision-Making

This German paper presents two cases of Europeanization in health policy, traditionally controlled by national governments and unaffected by European integration. The first case deals with how European Union (EU) transparency directives have forced member states to establish formal healthcare coverage decision-making procedures. The second case looks at health technology assessment and how the EU has successfully promoted the field.

Canada - Canadians continue to report longer wait times for care

A new international survey shows that Canadians continue to report some of the longest wait times for doctors, specialists and emergency department visits compared with citizens in peer countries. However, once they do get medical care, Canadians generally report experiences with their regular providers that are better than the international average. These and more insights come from How Canada Compares: Results From The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries, released by the Canadian Institute for Health Information (CIHI) in partnership with the Canadian Institutes of Health Research.

USA - NAM Releases Publication on How to Improve Nation's Health System

This paper from the National Academy of Medicine presents a policy framework for US health system improvement. It describes eight actions and infrastructure priorities to significantly advance American health, health care, and science. This publication is part of the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative, which called on more than 150 leading researchers, scientists, and policy makers from across the United States to assess and provide expert guidance on 19 priority issues for U.S. health policy.

Ireland - Minister Harris addresses Future of Health Care Committee on future direction of Health Policy

Ireland’s Health Minister, Simon Harris, laid out his government’s health policies in a speech to the parliamentary Future of Health Care Committee. The minister said primary care and system capacity are priorities, as is the provision of a statutory basis for hospitals to operate as integrated delivery systems.

USA - State Policy Capacity and Leadership for Health Reform

The aim of the study was to understand how policy capacity was defined and managed by state health leaders in different political environments during the implementation of the ACA. The authors of the study have developed a capacity checklist for policymakers to use as they embark on new health reform initiatives.

Europe - How can structured cooperation between countries address health workforce challenges related to highly specialized health care?

This policy paper by the WHO draws on the experience of different cross-border collaborations in specialized health care to address health workforce challenges in European countries. It identifies factors that enable or block structured cooperation, describes the institutional framework in place, and examines policy implications for the European Union (EU).

Europe - Culture matters: using a cultural contexts of health approach to enhance policy-making

Published by the WHO, this policy brief explores the three key public health areas of nutrition, migration and the environment. It demonstrates how cultural awareness is central to understanding health, wellbeing, and the development of effective and equitable health policies. The brief argues that public health policy-making should apply research from the humanities and social sciences.

Canada - Health care reforms not keeping pace with needs of Canadians, says report

The Health Council of Canada progress report highlights five key areas: wait times, primary health care and electronic health records, pharmaceuticals management, disease prevention/health promotion and Aboriginal health. It finds significant variability across Canada and shortcomings in many areas. To achieve better health care for all Canadians, the report calls for governments to set clear policy goals with clear lines of responsibility, to continue the spread of innovative practices, and to support collaborative efforts across all jurisdictions, including the federal government.

China - Evaluation of Responsiveness of Community Health Services in Urban China: A Quantitative Study in Wuhan City

China’s ongoing health reforms are intended to move most care to the community level, with community health service (CHS) centres becoming the gateways to the healthcare system. This study published in PLOS One evaluates the organization and distribution of centres in an urban setting in order to develop policy advice on improvements to CHS responsiveness.

Canada — Physician assistants in Canada. Update on health policy initiatives

The objective of this article is to analyze the health policies related to physician assistants (PAs) and to understand the factors influencing this medical work force movement. The historical development of the role of PAs in Canada spans 2 decades. There are now more than 250 PAs, most working in family medicine and emergency medicine. Enabling legislation for PAs has been formalized in Manitoba, and 3 provinces have recognized PAs in various policy statements or initiatives. Three universities and 1 military training centre have enrolled more than 120 students in PA programs. Retired PAs of the Canadian Forces, returning ex-patriot Canadians who had trained as PAs in PA programs in the United States, and American immigrants are working as PAs in Canada. Demonstration projects are under way to better understand the usefulness of PAs in various medical settings.

USA — Re-Forming Health Care Delivery Systems: A Summary of a Forum for States and Health Centers

In June 2010, the National Academy for State Health Policy (NASHP) convened a forum to examine evolving model approaches as well as surface new strategies that could be promoted with federal and state policymakers, foundations and the health center community to help progression toward reformed health systems. This paper presents the vision laid out at the forum for a transformed delivery system. In addition, it offers specific examples of organizations, regions and states that are designing and implementing approaches aligned with this vision, and outlines the strategies identified by participants as important in moving towards a reformed delivery system.

Europe — Launch of a two-year process that will shape Health 2020, the new European policy for health

In Andorra, the first meeting of the European Health Policy Forum of High-level Government Officials opened on 9 March 2011, to launch a two-year process that will shape Health 2020, the new European policy for health. Four working papers have been submitted for discussions: Developing the new European policy for health – Health 2020, Interim report on implementation of the Tallinn Charter, Strengthening Public Health Capacities and Services in Europe: A Framework for Action, and Assessing System Performance for Health Governance.

How health systems make available information on service providers: experience in seven countries

Brief analytical summaries or syntheses #16 How health systems make available information on service providers experience in seven countries Summary This technical report examines seven countries' experience with systems that release information on the performance of healthcare providers. It is meant to guide the further development of quality information systems in Britain's NHS. Systems in Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States are reviewed. Background There is growing interest in the public release of information on the performance of healthcare providers as a means to improve the quality of care and promote transparency and accountability. Countries have made considerable investments in creating systems to make available such information. However, there is lack of systematic comparative assessment of such systems. The report aims to help fill the gap by reviewing the information systems reporting on the quality of healthcare provision in seven countries. Analysis and results The…

Canada — Curing the Chronic Healthcare Spending Disease: Four Tough Choices for Canadians

The amount Canadians spend on healthcare is set to rise rapidly over the next two decades and Canadians need to face up to tough choices to deal with this “spending disease,” according to a new C.D. Howe Institute study by David A. Dodge, former Governor of the Bank of Canada, and Richard Dion, a former economist at the Bank of Canada. The study examines the trajectory of total healthcare spending – public and private – in Canada and the policy choices Canadians must make in response.

Europe — Cross-border health care in the European Union. Mapping and analysing practices and policies

Cross-border health care is a growing phenomenon in the European Union. This book explores this trend, looks at the legal framework and examines the legal uncertainties surrounding rights, access, reimbursement, quality and safety. The information and analysis presented mark an important step in the continuing debate on a legal framework for cross-border health care and will be of considerable use to policy-makers and those with an interest in key aspects of cross-border health care.

Canada — The Response of Ontario Primary Care Physicians to Pay-for-Performance Incentives

Beginning in 1999, Ontario introduced pay-for-performance incentives for selected preventive primary care services and defined sets of other services provided by family physicians, with the goal of improving the quality of patient care. These performance incentives were considerably expanded in 2004. At the request of the Ministry and as part of the collaborative research program between the Ontario Ministry of Health and Long-Term Care (MOHLTC) and the Centre for Health Economics and Policy Analysis (CHEPA), CHEPA researchers undertook an evaluation of the effect of performance incentives on service provision in Ontario. This report presents the results of that evaluation.

A new look at OECD health care systems: Typology, efficiency and policies

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…

Predicting social care costs. A feasibility study

Brief analytical summaries or syntheses #17 Predicting social care costs. A feasibility study Summary This study explores whether statistical models can be used to predict a person’s future need for intensive social care. Aside from the predictive models developed, this work points to the important potential of linked health and social-care data to support policy analysis and to guide the planning and delivery of services. Background The social care and healthcare costs of people with complex needs are set to rise steeply in the U.K. over the medium term, due to the ageing population and the growing number of people living with long-term medical conditions. It will become increasingly important to find ways of helping local councils and health services take earlier action to support people so they can remain independent and at home as long as possible. The ability to identify these people would be helpful so that they…

Europe — Health Systems Governance in Europe: The Role of EU Law and Policy

The study looks into different areas of EU policy and law-making that have an impact on national healthcare systems. It provides policy-makers with a compelling and rigorous analysis of the real and potential impacts of EU integration on the organisation of healthcare provision and the protection of public health, highlighting the need to balance economic and social imperatives.

Do quality improvements in primary care reduce secondary care costs ?

Brief analytical summaries or syntheses #15 Do quality improvements in primary care reduce secondary care costs ? Summary The introduction in 2004 of the Quality and Outcomes Framework (QOF) in general practice in the United Kingdom represents one of the most ambitious efforts to measure and incentivise quality improvements in primary care. The report takes advantage of a database of over 50 million English citizens to determine whether quality and outcomes efforts in general practice have led to improvements in two major outcomes mortality and the costs of hospital inpatient and outpatient use. The study finds that primary care performance improvements are associated with some modest but measurable improvements in outcomes and costs. Background The report seeks to determine whether the levels of QOF attainment in general practice have led to quality improvements in two major indicators mortality and the costs of hospital inpatient and outpatient care. The NHS faces…

UK — Predicting social care costs: a feasibility study

This report describes a study that explored whether statistical models can be used to predict an individual person’s future need for intensive social care. Aside from the predictive models developed, this work generated important lessons about the potential of linked health and social care data to support policy analysis and to guide the planning and commissioning of services.

Opportunities and challenges in measuring the quality of care in England

Brief analytical summaries or syntheses #5 Opportunities and challenges in measuring the quality of care in England Summary Greater use of quality measurement in the National Health Service (NHS) has real potential for improving quality of care, efficiency and productivity. Changes in the economic climate in England since the publication of the NHS Next Stage Review in 2008 are challenging healthcare authorities to achieve demonstrable improvements in outcomes for patients but also greater productivity and efficiency. This paper sets out the issues that need to be considered in developing and using indicators to measure quality. It attempts to define what is meant by ‘quality’ in health care, examine initiatives likely to improve quality and identify not only the potential benefits of quality indicators, but also the complexities and challenges involved in their implementation. Background The transition from an NHS focused on targets, activity volumes and waiting times to one focused…

The role of information and communication technologies in improving health sector efficiency

Brief analytical summaries or syntheses #6 The role of information and communication technologies in improving health sector efficiency Summary This OECD health policy study provides advice on a range of policy options, conditions and practices that policymakers can adapt to their own national circumstances to accelerate adoption and effective use of information and communication technologies (ICTs) in health care. It analyses the incentives and institutional mechanisms used to encourage the adoption of these technologies in six OECD countries (Australia, Canada, The Netherlands, Spain, Sweden, and the United States). It presents an analysis of the range of incentives and institutional mechanisms that have been applied to influence introduction and successful adoption of ICTs, examines the results of these initiatives, looks at some of the new technologies in health care and helps identify the challenges in securing cooperation from the different stakeholders involved. Background Policymakers in OECD countries are faced with ever-increasing…

Financing long-term care in Scandinavian countries

Brief analytical summaries or syntheses #7 Financing long-term care in Scandinavian countries Summary This paper by two researchers from the Department of Health Management and Health Economics at Oslo University compares and analyzes the systems for financing long-term care for older people in Scandinavian countries (Denmark, Norway and Sweden). The institutional setup is almost identical in the three countries local government carries the main responsibility for the funding and provision of long-term care, and national government defines general goals and principles for the locally provided services. The study shows that individuals are highly dependent on their savings to pay for long-term care services, which does not correspond to aspirations of accessibility. As well, there is significant regional variation in the level of services provided, which is in direct contrast with the political goals of universality in these countries. Background Policy objectives The three Scandinavian countries share common political traditions of…

The impact of global processes on health systems in Europe

Brief analytical summaries or syntheses #11 The impact of global processes on health systems in Europe Summary The relationship between globalization and health systems is a complex one, where both positive and negative influences are reported. This unsystematic literature review explores the impact of globalization on European health systems and emphasizes the need for national policy-makers and leaders to consider global processes when designing national health systems. Background The world is changing rapidly with increasing life expectancies and improving child survival rates. Globalization has contributed to economic growth. In addition to global economic integration, globalization entails the mobility of capital, goods, services and labour, and can be said to be part of an ideological process justifying neo-liberal economic policies. Globalization is also a dynamic process of global interconnectedness influenced by a number of driving and constraining forces such as technological developments, political influences, economic pressures, changing ideas, and greater awareness…

Reforming health sector resource allocation and financing in Ireland

Brief analytical summaries or syntheses #4 Reforming health sector resource allocation and financing in Ireland Summary This report from the Expert Group on Resource Allocation and Financing in the Health Sector examines how the health system can be changed to support core objectives of the health reform program. The report presents 34 recommendations grouped under seven guiding principles. Background Like most other developed countries, Ireland is grappling with the challenges of providing health care for it's population at a cost it can afford. This report shows how these challenges are set in a context of a growing and aging population; rising individual expectations in relation to healthcare provision; rising incidence of chronic disease; greater provision of first-line care in the community; the need for people to be involved in the management of their own health alongside health professionals. The response to these issues across developed countries has been to develop…

International - Improved Quality and Access to Health Data Essential to Global Health

The World Economic Forum recently launches an ambitious project to advance global health through improved data collection and management. The Global Health Data Charter recognizes that accurate health data is essential for effective and efficient health management. The Charter aims to enable individuals and patients, health professionals and policy-makers to make more informed decisions through secure access to comprehensive, quality data.

Canada — Research synthesis on cost drivers in the health sectors and proposed policy options

This synthesis and the concluding policy options represent a starting place for more in-depth exploration by CHSRF, and will inform policy dialogues on how best to ensure accessible, high-quality and sustainable healthcare for Canadians. This report synthesizes the current body of knowledge on cost drivers in Canadian healthcare. Cost drivers are factors that bring about increased spending on healthcare. Thus, a comprehensive understanding of cost drivers is essential to a productive debate on the sustainability of Canada’s publicly funded healthcare systems.

Strengthening primary and chronic care: state innovations to transform and link small practices

Brief analytical summaries or syntheses #14 Strengthening primary and chronic care state innovations to transform and link small practices Summary This report examines the roles states are playing to reorganize the delivery of primary and chronic care to produce more efficient and effective care. Through short case studies developed via interviews with state officials and physicians in Colorado, Michigan, North Carolina, Oklahoma, Pennsylvania, and Vermont, the authors highlight several state-based initiatives that seek to create high-performing health systems by targeting local and regional strengths. Background Although most of the debate preceding the passage of the Affordable Care Act in March 2010 was focused on improving access to care, it is widely agreed that without equal attention to reforms that address cost and quality, the United States is destined to continue its path of uncontrolled, spiralling costs and poor overall performance. The issues are complex, and there is no silver bullet…

Europe - Putting our own house in order: examples of health-system action on socially determined health inequalities

This publication will give policy advisers, policy entrepreneurs and those who work in health systems a better understanding of the keys to taking action on socially determined health inequalities. It shows how to systematically generate and use evidence-informed options for action from a selection of case studies. It also contains a checklist of generic principles that can be put into practice or used to review existing examples of health-system actions and that can assist in designing and developing a tailored policy response. The publication illustrates the wide range of actual and potential actions that the health system can take to “put its own house in order”: ensuring equity of access to health services and improving the investment in and approach to working with other sectors so that the health system is instrumental in creating the conditions for health for all groups in the population.

Slovakia — Slovakia: Health system review. Health systems in transition, 2011

The Slovak health system is a system in progress. Major health reform in the period 2002-2006 introduced a new approach based on managed competition. Although large improvements have been made since the 1990s (for example in life expectancy and infant mortality), health outcomes are generally still substantially worse than the average for the EU15. This report provides a detailed description of the health system and of policy initiatives in progress or under development in Slovakia.

Decentralization in health care

Brief analytical summaries or syntheses #18 Decentralization in health care Summary The Spring issue of Euro Observer looks at decentralization as a governance tool in health care. Case studies on Norway, Spain and the United Kingdom (U.K.) highlight how decentralized arrangements work in practice in these countries. Background A common challenge across most countries in Europe is finding the appropriate level for the making and implementation of policy and administration, particularly in health care. Many countries have decentralized, recentralized and then decentralized again in an ongoing cycle, searching the right balance of efficiency and responsiveness in their health care system. Looking at the arguments for and against, in many cases the same reasons are used to justify movement in opposite directions. This issue of Euro Observer looks at whether decentralization is purely a politically driven phenomenon or the wrong instrument used for the right objective. The debate about decentralization is…

Portugal - Portugal: Health system review. 2011

This European Observatory Country Profile provides a detailed description of the health system and of policy initiatives in progress or under development in Portugal. It shows a population that enjoys good health and increasing life expectancy, a health system that has not undergone any major changes on the financing side since the early 1990s, and a steady growth in public health expenditure. The system is financed largely through taxation, but co-payments have been increasing, primarily for pharmaceuticals. Recent measures have aimed to improve performance.

Did changing primary care delivery models change performance? A population based study using health administrative data

Brief analytical summaries or syntheses #24 Did changing primary care delivery models change performance? A population based study using health administrative data Summary Primary care reform in Ontario started with the introduction of new enrolment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups. Background It has been increasingly recognized that health care systems with a strong primary care component are more efficient and better able to handle current and future health care pressures. This has led to several primary care reform strategies in the U.K., Australia, the U.S. and Canada. Common to all of these reform strategies is a movement away from providing service based on…

International - Towards Improved Measurement of Financial Protection in Health

This article published in the September edition of PloS Medicine discusses the health system’s failure to offer citizens adequate financial protection. The authors attribute this failure to insufficient financial risk pooling and prepayment mechanisms. According to the authors, broader metrics are required to better inform policy development.

USA - Aspirin, Angioplasty, and Proton Beam Therapy: The Economics Of Smarter Health Care Spending

This paper from researchers at the Harvard School of Public Health was presented at the Jackson Hole Economic Policy Symposium in September 2011. The paper looks at inefficiencies and unsustainable spending levels within the U.S. healthcare system. It contrasts the under-use of cost-effective treatments like aspirin and immunizations with the use of treatments that are inappropriate, such as angioplasty, or non evidence-based, such as proton beam therapy.

Canada - Return on Investment: Mental Health Promotion and Mental Illness Prevention

The Canadian Population Health Initiative (CPHI) of the Canadian Institute for Health Information (CIHI) commissioned the Canadian Policy Network at the University of Western Ontario to complete a scoping study that examines the return on investment and cost effectiveness of mental health promotion. It found that there is research showing a return on investment for some mental health promotion/illness prevention interventions, especially those targeting children and youth.

Estonia - Responding to the challenge of financial sustainability in Estonia’s health system: one year on

This WHO follow-up report looks at changes in Estonian health care financing one year after a comprehensive WHO analysis. It reviews developments in four areas where policy recommendations had been made.

Europe - Health professional mobility and health systems. Evidence from 17 European countries

Published in the journal European Observatory on Health Systems and Policies, this study presents research conducted within the framework of the European Commission’s Health PROMEtheus project. It gives a comprehensive analysis of mobility patterns, migration impacts on health systems, and their relevance for policy-making and responses across Europe.

The U.S. Health System in Perspective:A Comparison of Twelve Industrialized Nations

Brief analytical summaries or syntheses #26 The U.S. Health System in Perspective A Comparison of Twelve Industrialized Nations Summary This paper analyzes 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Health care spending in the U.S. towers over the other countries and findings suggest opportunities for cross-national learning to improve health system performance. Background Findings from this cross-national comparison of health care systems can inform public policy, highlight areas where nations could improve, and yield benchmarks for high performance. The Organization for Economic Cooperation and Development (OECD) annually tracks and reports on more than 1,200 health-system measures across 34 industrialized countries, ranging from population health status and non-medical determinants of health, to health care resources and utilization. Since 1998, The Commonwealth Fund has sponsored an analysis of cross-national health systems based on OECD health data…

Assessing initiatives to transform healthcare systems:Lessons for the Canadian healthcare system

Brief analytical summaries or syntheses #25 Assessing initiatives to transform healthcare systems Lessons for the Canadian healthcare system Summary Canada has invested significant financial resources and energy (including numerous federal and provincial commissions) in efforts to make the healthcare system more responsive to evolving needs. Nonetheless, there is general consensus that Canada’s healthcare systems have been too slow to adapt. This paper suggests avenues that governments can take to support the transformation of the healthcare system to provide better care and services. Background This paper suggests that money alone cannot improve healthcare. A clear vision and a coherent set of strategies are required to transform the system and achieve better alignment between the care offered and the care the population needs today (primary healthcare, more effective management of chronic diseases, mental health, etc.). Canada has invested significant financial resources and energy (including numerous federal and provincial commissions) in efforts to…

International - Is There A Health-Care Problem in Western Societies

This working paper from the International Centre for Economic Research (ICER) discusses how today’s health policymakers are striving to reduce healthcare expenditures in ways compatible with universal access and social justice.

USA - The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

This paper in the July 2011 issue of the Commonwealth Fund publication Issues in International Health Policy analyzes 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Health care spending in the U.S. towers over the other countries and findings suggest opportunities for cross-national learning to improve health system performance.

UK - In it for the long haul: The challenge for public health

With local government assuming responsibility for public health and the wider health landscape set to change significantly as a result of the Health and Social Care Bill, public health is at a crossroads. This report by the Institute for Public Policy Research explores the key opportunities and challenges facing public health in its new landscape.

Canada — Can We Get Better for Less: Value for Money in Canadian Health Care

Injecting tens of billions of dollars into Canadian hospitals with no value measures in place is an inefficient approach to health care spending, says a report from the Certified General Accountants Association of Canada (CGA-Canada). Before committing to investment in additional physician capacity, hospital beds or diagnostic technology, policy makers could establish consistent and transparent value-for-money measures that reflect access to and quality of care, patient health outcomes and costs, and are monitored and tracked regularly over time and compared across institutions. Uniformly computed and publicly reported value-for-money metrics for all hospitals could enable comparison and allow sharing of best practices.

Brazil — Human resources for health and decentralization policy in the Brazilian health System

The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level.

UK — New website to gather evidence on effects of UK health service reforms launches

The Lancet has teamed up with academics from the London School of Hygiene & Tropical Medicine and University College London to launch an innovative source of online evidence on health policy. The journal's UK Policy Matters micro site aims to summarise current UK health policy and allow posting and reading of evidence summaries from the front line, to be provided by both health professionals and members of the public.

Performance Measurement for Health System Improvement

Brief analytical summaries or syntheses #20 Performance Measurement for Health System Improvement Experiences, Challenges and Prospects Summary Given the increasing demand for measurement of health provider performance, there is a need to better define what role measurement can play in securing health system improvement. This volume, first published in 2009 and now free to download, meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand. Background Performance measurement instruments have two goals to promote accountability and to improve the performance of the health system. The modern health system is immensely complex, comprising diverse agents such as insurers, provider organizations, health-care professionals and central and local governments. Measurement of the actions and outcomes of these agents is a necessary condition if the health system is to be held properly to account by citizens and patients. That accountability may…

International — Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies

In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. The authors of this study summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries.

Governance in the health sector: a strategy for measuring determinants and performance

Brief analytical summaries or syntheses #22 Governance in the health sector a strategy for measuring determinants and performance Summary Governance in the health sector a strategy for measuring determiMany different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also looked at whether improvements in the way health care services are governed could make a difference. These approaches ask which factors, such as rules and institutions, influence the behaviour of the system, its performance and outcomes. The paper proposes specific measures of governance determinants and performance and describes the instruments available to collect and interpret them. Background While the term “governance” is increasingly being used to draw attention to a number of factors that affect the quality, effectiveness and reach of social services, no consensus has emerged on definitions, frameworks and, in particular, how it applies…

Canada - Will Paying the Piper Change the Tune?

This article, published in Volume 6 Number 4 of Healthcare Policy, questions the rapid push to adopt activity-based funding (ABF) models in Canadian hospitals. Co-authored by Jason Sutherland, Morris Barer, Robert Evans and Trafford Crump, the paper examines the objectives, the mechanisms of action, experiences elsewhere and implementation challenges with ABF.

Ireland - A Policy Framework for a Healthier Ireland 2012 – 2020

A major new initiative, aimed at improving the general standard of health, has being launched recently by four government ministers The aim is to develop a high-level policy framework for public health, to cover the period from 2012 to 2020. It is envisaged that an initial draft report will be submitted to the Department of Health and Children’s Management Advisory Committee by the end of third quarter of this year, with a view to having a finalised report prepared to accompany a memo to Government by the end of 2011.

Canada — Registered nurses launch Expert Commission on health system renewal

The Canadian Nurses Association recently launched its National Expert Commission on health system improvement, entitled The Health of Our Nation — The Future of Our Health System. The Commission’s mandate is to generate policy solutions that contribute to a transformed health system — one that is better equipped to meet the changing health needs of Canada’s population.

Europe - Heath Policy in Europe: Contemporary Dilemmas & Challenges

This book is an effort to describe and critically analyse the recent experience of various European countries and discuss the dilemmas and challenges that confront health policy and policy-makers in this period of time and geopolitical setting, providing concrete evidence from various countries. Specific chapters address issues in Germany, Sweden, the United Kingdom, Croatia, the Republic of Macedonia, Serbia, Greece, Turkey, and Palestine, with an additional comparative study of the situation in the market-dominated health care system in the United States.

Spain – Spain: Health system review. Health Systems in Transition, 2010

The new Spanish HiT was launched as part of the Spanish Presidency of the EU. It focuses on the consequences of the totally devolved status of the health system, consolidated in 2002, and the implementation of the road map established by the 2003 Spanish National Health System (SNS) Cohesion and Quality Act. The reforms have paved the way for a brand new consensus-based policy-making process grounded in knowledge management, the effects of which are progressively starting to be evident.

USA - Federal Government Will Pick Up Nearly All Costs Of Health Reform’s Medicaid Expansion

Health reform’s critics argue that states will bear a significant share of the new law’s costs for Medicaid expansion, placing an unaffordable financial burden on states. The argument does not withstand scrutiny according to the Center of Budget and Policy Priority. In its first five years, the Medicaid expansion will add just 1.25 percent to what states had budgeted for Medicaid over that period in the absence of health reform, while providing health coverage to 16 million more low-income adults and children.

USA – Implementing State Health Reform: Lessons for Policymakers

Ce rapport détermine les principales questions auxquelles les concepteurs de politiques doivent réfléchir lors de l’implantation des réformes dans le secteur de la santé et fournit une série d’idées, particulièrement sur ce qui doit arriver sur le plan opérationnel avant et après l’implantation.

OCDE - Achieving Efficiency Improvements in the Health Sector through ICTs - Final report

This report presents an analysis of OECD countries’ efforts to implement information and communication technologies (ICTs) in health care systems. It provides advice on the range of policy options, conditions and practices that policy makers can adapt to their own national circumstances to accelerate adoption and effective use of these technologies.

Canada - Maximizing Community Health Nursing Capacity in Canada: A Research Summary for Decision Makers

This research summary is a valuable resource for health administrators, planners and policy-makers who – in the face of rising demand for improved home care, public health, primary healthcare and other community care services – are tasked with developing HR policies for community health.

Canada - Mental Health Report Focuses on Multicultural Groups

The Mental Health Commission of Canada has released a report addressing the needs of multicultural, immigrant and refugee groups. The study is part of its mandate to improve mental healthcare across all areas of Canadian society. The document, entitled ‘Improving Mental Health Services for Immigrant, Refugee, Ethno‐cultural and Racialized (IRER) Groups,’ outlines factors that policy makers and service providers may want to consider when working to improve mental health services for these groups. The 16 recommendations in the report are firmly rooted in the goals of the Mental Health Strategy for Canada. The recommendations fit into one of three main areas, including: better coordination of policy, knowledge and accountability, the involvement of communities, families, and people with lived experience, and more appropriate and improved services.

International - Effective Ways to Realise Policy Reforms in Health Systems

Sometimes it is argued that the timing of a proposal; the way in which a reform is presented; the discussions with stakeholders; and a multitude of other factors, are more important in determining whether or not it receives public and legislative approval than the content of the reform in itself. The OECD has a crosscutting project on these issues, entitled Making Reform Happen. Several OECD directorates are considering the factors lying behind successful implementation of reforms in their different policy areas, including tax, environment, agriculture, trade, competition, education, health, pensions, product markets and labour markets. This paper is a contribution to the wider OECD project. It is based on evidence from the countries which have seen their health systems reviewed by the OECD in recent years, and on a selected review of the literature.

Nordic health care systems. Recent reforms and current policy challenges

The Nordic model of health care systems is assumed to contain consistent features across all five Nordic countries, Finland, Sweden, Denmark, Norway and Iceland: tax-based funding, publicly owned and operated hospitals, universal access based on residency, and comprehensive coverage. The reality is considerably more complex, with great variation at the structural level in the way that institutions are designed and at the policy level in the way strategies are conceived and implemented. This new comparative study highlights how the Nordic countries have retained the principles of universalism and equity while promoting the benefits of patient choice.

Australia - Initial impression and response to the recently announced national health reform plan

Given the announcement of the recently proposed health reforms in Australia, the Asia Pacific Journal of Health Management has taken the opportunity to ask key health policy leaders and commentators on their views of the benefits and challenges that such sweeping reforms will bring.

USA - Financial Incentives for Health Care Providers and Consumers

Health reform will emphasize financial incentives for providers and consumers to promote the use of effective health services and discourage the use of marginally effective or inappropriate services. This brief looks at evidence on the impact of financial incentives and draws lessons for policymakers.

Australia - Building a 21st Century Primary Health Care System. Australia's First National Primary Health Care Strategy

This strategy represents the first comprehensive national policy statement for primary health care in Australia. It provides a road map to guide current and future policy and practice in the Australian primary health care sector. The four priorities are: improving access and reducing inequity, better management of chronic conditions, increasing the focus on prevention, improving quality, safety, performance and accountability.

Italy - EU integration and health systems: challenges and opportunities for patients, professionals and policy-makers

The Observatory Venice Summer School brings together high-level policy-makers in a stimulating environment. Organized by the European Observatory on Health Systems and Policies and one of its partners, the Veneto Region of Italy. it draws on their experiences of promoting evidence-based policy-making and of providing a unique platform for European health policy debate in action. The Summer School will take place in Venice on July 25-31, 2010.

Nordic health care systems. Recent reforms and current policy challenges

The Nordic model of health care systems is assumed to contain consistent features across all five Nordic countries, Finland, Sweden, Denmark, Norway and Iceland: tax-based funding, publicly owned and operated hospitals, universal access based on residency, and comprehensive coverage. The reality is considerably more complex, with great variation at the structural level in the way that institutions are designed and at the policy level in the way strategies are conceived and implemented. This new comparative study highlights how the Nordic countries have retained the principles of universalism and equity while promoting the benefits of patient choice.

UK - Health and wellbeing – Three new reports by UK experts

A group of independent experts have published their reports on health and well-being, specifically focusing on the prevention of ill health: A liberal dose? Health and wellbeing: the role of the state, Influencing public behaviour to improve health and wellbeing, and Enabling effective delivery of health and wellbeing.

Europe - Health in the European Union: trends and analysis

Prepared for DG Employment, Social Affairs and Equal Opportunities of the European Commission, this reportinvestigates differences in health status within and between European countries. The relationship between living conditions, socio-economic factors and health is discussed and analyzed with the objective of stimulating a debate and policy action for creating a healthier and more equitable society.

Canada - A Foundation for Alberta’s Health System. Report of the Minister’s Advisory Committee on Health. A New Legislative Framework For Health

This report by the Minister’s Advisory Committee on Health presents a new focus and architecture for health care legislation in Alberta that will reframe the way Albertans, health policy makers and the health system view health and health care in the years ahead. The report defines a new context for Alberta’s health system. It will shape the system in ways that ensure the health needs of Albertans are served by using best available evidence and removing barriers to putting people and families at the centre of their health care.

UK- Making policy count: developing performance indicators for health and social care partnerships in the UK

This paper updates on work underway to develop new performance indicators for adult social care, and health and care partnerships. It sets out its context, recent progress, and asks for stakeholder support through comments and offers to pilot work.

USA - Launch of First County-By-County Health Rankings

The County Health Rankings—the first set of reports to rank the overall health of every county in all 50 states—are now available on The 50-state report, released by the University of Wisconsin’s Population Health Institute and the Robert Wood Johnson Foundation, help public health and community leaders, policy-makers, consumers and others to see how healthy their county is, compare it with others within their state and find ways to improve the health of their community.

Ireland - Value for Money and Policy Review of the Economic Cost and Charges Associated with Private and Semi-Private Treatment Services in Public Hospitals

The Department of Health and Children is currently undertaking a Value for Money and Policy Review of the Economic Cost and Charges Associated with Private and Semi-Private Treatment Services in Public Hospitals. This interim report sets out a revised costing methodology and an estimate of the gap which currently exists between private and semi-private bed charges and the average economic cost.

OCDE - Achieving Efficiency Improvements in the Health Sector through ICTs - Final report

This report presents an analysis of OECD countries’ efforts to implement information and communication technologies (ICTs) in health care systems. It provides advice on the range of policy options, conditions and practices that policy makers can adapt to their own national circumstances to accelerate adoption and effective use of these technologies.

Canada - Effective Governance for Quality and Safety

Commissioned by the Canadian Health Services Research Foundation in partnership with the Canadian Patient Safety Institute, this report, prepared by a team of researchers led by Ross Baker, explores the structures, processes and tools used by effective governing boards of healthcare organizations, and the strategies and tactics that can be employed by boards in their efforts to improve governance for quality and patient safety. The report also offers recommendations for board members and executives of healthcare organizations and for policy makers.

Canada - Health Care Reform: Lessons from the Edge

Most Canadians would acknowledge that health care in Canada requires reform. But substantive changes will likely be difficult to effect, given current demand and expectations around health care. This commentary argues that solid policy options are an essential first step. Equally important, given the political challenges associated with health care, is the process for reform. There are instructive lessons from the recent New Brunswick strategy on poverty reduction and income security renewal that successfully involved government, business and voluntary organizations in a comprehensive, collaborative initiative.

USA - State Policymakers’ Priorities for Successful Implementation of Health Reform

This State Health Policy Briefing identifies and describes ten aspects of federal health reform that states must get right if they are to be successful in implementation. States that pursue the ten critical elements identified in this brief will have the greatest chance of achieving the goals embodied in the federal health reform law.

USA - Determinants of preventable readmissions in the United States: a systematic review

Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. The authors of this paper undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.

International - Health: Improving health care efficiency is key to curbing spiraling costs

Governments must make their health care systems more efficient if they are to maintain quality of care without putting further stress on public finances, according to a new OECD report. In Health Care Systems: Efficiency and Policy Settings, the OECD warns that cash-strapped governments no longer have the option of boosting spending to improve health outcomes, as they have done over the past several decades.

International - Sharing the Burden. Could risk-sharing change the way we pay for healthcare?

Risk-sharing is a relatively new concept in the field of healthcare policy. As such, it is subject to confusion and misunderstanding, not only in terms of terminology but also in terms of substance. This paper will examine and compare risk-sharing schemes in the following five countries: Australia, Germany, Italy, the United Kingdom, and the United States.

Sweden - Health Promoting Settings in Primary Health Care - "Hälsotorg": an implementation analysis

Sweden, like many other western countries, faces increasing rates of lifestyle related diseases and corresponding rise in costs for health care. To meet these challenges, a number of efforts have been introduced at different societal levels. One such effort is “Hälsotorg” (HS). HS is a new health promotion setting that emerged in collaboration between the Swedish County Councils and Apoteket AB, a state-owned pharmacy company. The aim of this study was to explore the HS policy implementation on local level and to analyse HS´s activities, in order to provide a more in depth understanding of the HS´s potential as a health promoting setting.

Australia - Widespread Support for Health Reform

Over three-quarters of all Australians support the Australian Government’s historic health reform agenda according to new statistics released on November 24. The Menzies-Nous Australian Health Survey reports that Australians have a very positive view of their own health and are confident they will receive the best quality care.

Europe - Measuring and managing performance

This issue of Eurohealth focuses on performance monitoring to maintain high quality health services. Also covered are the topics of user fees in the Czech Republic; private sector providers in England; barriers to physician workforce development in Uzbekistan; and providing a solid evidence base for policy makers through the ECHI initiative.

International - Report of the International Bioethics Committee of UNESCO (IBC) on social responsibility and health

After a descriptive part on the social determinants of health and constraints on health access, and a specific section devoted to the elaboration of the ethical and legal dimensions of the principle of social responsibility and health, the report presents a sample of possible concrete strategies and courses of action in order to translate the principle of social responsibility and health into specific policy applications, with a view to promote the highest attainable standard of health for all.

Europe - European Observatory on Health Systems and Policies. New template for writing HiTs

The Observatory announces the launch of a new and improved template for the Health system profile (HiT) series. HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. They are produced by country experts in collaboration with the Observatory staff. The HiT template is designed to guide the writing of HiTs by setting out key questions, definitions and examples needed to compile a country profile of the health system.

Australia - Implementing Health in All Policies: Adelaide 2010

The concepts, examples and practical experiences documented in this volume provide essential learning for moving towards a clearer conceptual framework for Health in All Policies. National and sub-national country case studies shed light on how nations as diverse as Australia, Canada, Finland, France, Norway and Thailand are incrementally working towards better policy integration and governance for social wellbeing and equity.

Europe — The impact of global processes on health systems in Europe

The relationship between globalization and health systems is a complex one, where both positive and negative influences are reported. This paper explores the impact of globalization on European health systems and emphasizes the need for national policy-makers and leaders to consider global processes when designing national health systems.

Europe - Projecting future health care expenditure at European level: drivers, methodology and main result

To assess correctly the demography-related risks facing public finances in the EU over the next couple of decades and establish adequate policy responses to the demographic, social and economic developments, it is essential to devise a reliable method to estimate future health care expenditure. To tackle this issue, the European Commission and the Economic Policy Committee projected future public health care expenditure in all EU Member States over the period 2007-2060. A unique internationally comparable database has been established and a model built allowing to project health care spending in a common, coherent framework of macroeconomic variables.

Canada - Physician Payment System – policy brief

Système de paiement des médecins : bref de politique The use of more efficient payment systems for physicians would reduce the cost of health care and encourage efficient provision according to this report. Several mechanisms of payment could help achieve these goals. This report presents an overview of those mechanisms.

Belgium: Health system review. Health Systems in Transition, 2010

The Belgian HiT profile (2010) presents the evolution of the health system since, including detailed information on new policies. While no drastic reforms were undertaken, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility include measures to reduce the out-of-pocket payments of more vulnerable populations; quality of care reforms included incentives to better integrate different levels of care and the establishment of information systems; several measures on pharmaceutical products have aimed to reduce costs for insurers and patients, while maintaining the quality of care.

Europe - Health Systems Perspectives – A new European Observatory on Health Systems and Policies/BMJ collaboration

Health Systems Perspectives is a new occasional series published in the BMJ based on Observatory work. The series focuses specifically on developments in the European Union and the EU health policy agenda.

Germany - The organizational‐institutional transformation of the German Healthcare System: mixing rescaling, privatization, and managerialism

Since the early 1990s, European public health care systems experience dynamic transformation processes. Health care systems have come under the pressure of strong financial constraints, indicating the end of the “golden age” of welfare state policy. Thus, the most important issue at hand is cost control. Various tools have been employed in order to contain rising costs. The broad range of different reform measures can be categorized into three major reform types, namely privatization, managerialization and rescaling, e.g. the reshaping of the distribution of decision‐making authority. In all European health care systems – albeit in different forms and with differing degrees – market mechanisms have been implemented in health care financing as well as in health care provision. The following case study assesses the impact of the regulatory changes on the German health care system.

Europe - New policy briefs published for the Belgian European Union Presidency Ministerial Conference on the European Health Workforce

Two joint Health Evidence Network - European Observatory on Health Systems and Policies policy briefs and two policy summaries were prepared for the Belgian EU Presidency Ministerial Conference on ‘Investing in Europe’s health workforce of tomorrow: scope for innovation and collaboration’ (La Hulpe, September 9–10 2010): How to create conditions for adapting physicians’ skills to new needs and lifelong learning, how to create an attractive and supportive working environment for health professionals, assessing future health workforce needs, and using audit and feedback to health professionals to improve the quality and safety of health care.

Brazil - Is Universal Health Care in Brazil Really Universal?

Since Brazil’s adoption of a universal health care policy in 1988, the country’s health care has been delivered by a mix of private and free public providers. The authors of this paper examine whether income-based disparities in medical care usage still exist after the development of the public network using a nationally representative sample of over 44,000 Brazilians from 2003.

Europe - How can telehealth help in the provision of integrated care?

This policy brief is divided in four parts: 1. Health policy context and current use of telehealth, 2. What do we know about the benefits and effectiveness of telehealth? 3. Policy options to help foster use of telehealth as a support to integrated care systems, 4. Identifying alternative ways of bringing about change.

Canada – Fatal Flaws: Assessing Quebec’s Failed Health Deductible Proposal

Quebec’s government recently withdrew its proposal to impose a form of user fees for health care. In a new C.D. Howe Institute Working Paper, “Fatal Flaws: Assessing Quebec’s Failed Health Deductible Proposal,” health policy experts Mark Stabile, C.D. Howe Fellow-in-Residence and Associate Professor at the Rotman School of Management, and Sevil N-Marandi, a graduate of the School of Public Policy at the University of Toronto, assess Quebec’s failed proposal. Their recommendations lay out how future reforms in other provinces or in Quebec might be made more likely to succeed.

USA - Hospitals and Care Systems of the Future

U.S. industry experts have projected that multiple pressures will drive the transformation of health care delivery and financing from volume- to value-based payments over the next decade. This inaugural report of the American Hospital Association (AHA) Performance Improvement Committee is based on interviews with policymaker to identify the strategies and competencies organizations should establish.

Governance for health in the 21st century : a study conducted for the WHO Regional Office for Europe

Brief analytical summaries or syntheses #27 Governance for health in the 21st century a study conducted for the WHO Regional Office for Europe Summary The WHO Regional Office for Europe recently presented conclusions from an in-depth study of current thinking and innovative practices in governance for health in the 21st century. The study recommends different ways that public authorities can strengthen health governance through collaboration. Background In this study, ‘governance for health’ is defined as the attempts of governments or other actors to steer communities, countries or groups of countries in the pursuit of health as integral to well-being through both a ‘whole-of-government’ and a ‘whole-of-society’ approach. It positions health and well-being as key features of what constitutes a successful society and a vibrant economy in the 21st century and grounds policies and approaches in values such as human rights and equity. Governance for health promotes joint action of health…

Shared-savings payment arrangements in health care. Six case studies

Brief analytical summaries or syntheses #48 Shared-savings payment arrangements in health care. Six case studies Summary American shared-savings programs are an alternative approach to paying health care providers. Providers receive a share of savings achieved by reducing costs for care. This Commonwealth Fund paper presents six case studies of pilot shared-savings programs. Background One of the most talked-about new ideas in health care is rewarding providers for reducing medical spending by giving them a share of the net cost savings. Driven by an interest in seeing medical homes and other providers shift to some form of performance-based payment, as well as by the Affordable Care Act’s push for "accountable care," shared-savings approaches are currently being tested by numerous payer and provider organizations across the United States. A previous Commonwealth Fund policy brief summarized 27 examples of shared-savings initiatives and found wide variation in how participants implemented such initiatives. These variations…

Ireland - Health system responses to financial pressures in Ireland: policy options in an international context

This report from the WHO reviews policy options open to Ireland’s government as it responds to the financial crisis’ impact on the health system. The report analyzes the system’s major pressures and reviews policy levers, focusing on changes to health coverage and more efficient health services.

Health policy responses to the financial crisis in Europe

Brief analytical summaries or syntheses #47 Health policy responses to the financial crisis in Europe Summary This August 2012 report by the Health Evidence Network (HEN) identifies key challenges for European health policy makers in the wake of the ongoing financial crisis. The report focuses on responses to essential service cuts and interruptions in revenue streams, as well as on inefficiencies and exacerbations of adverse effects evident in national health systems. Background The global financial crisis that began in 2007 can be classified as a health system shock – that is, an unexpected occurrence originating outside the health system that has a large negative effect on the availability of health system resources or a large positive effect on the demand for health services. Economic shocks present policy-makers with three main challenges Health systems require predictable sources of revenue with which to plan investment, determine budgets and purchase goods and services.…

Financial sustainability and affordability of health care systems. Lessons from OECD countries

Brief analytical summaries or syntheses #46 Financial sustainability and affordability of health care systems. Lessons from OECD countries Summary This presentation by Mark Pearson, head of the Health Division at the OECD, reviews how health spending has been affected during the economic crisis in various countries. the author makes some recommendations on how policy should react. The presentation was delivered at the International Conference of Social Security Actuaries and Statisticians that took place in Berlin from May 30 to June 1, 2012. Background The problem facing many European health systems is one of fiscal unsustainability. Claims that health spending is good value for money compared to many other things that people purchase are beside the point. Fiscal sustainability needs to be restored in the short term and once this is done, there will still remain the longer-term challenge of ensuring economic sustainability, which requires a different agenda of policies –…

Health system performance comparison: an agenda for policy, information and research

Brief analytical summaries or syntheses #44 Health system performance comparison an agenda for policy, information and research Summary This WHO policy brief calls for more international comparisons of health system performance. It describes the methodology of international comparative studies, key domain comparators, and cites the benefits of international comparison in policy influence and as a source of evidence. Background This policy brief seeks to summarize the current “state of the art” of health system comparison, identifying data and methodological issues and exploring the current interface between evidence and practice. It also draws out the priorities for future work on performance comparison, in the development of measurement instruments, analytic methodology, and assessment of evidence on performance. It concludes by presenting key lessons and future priorities policy-makers should take into account. Analysis and results Comparing key domains of performance Population health measures often take a broad perspective, which captures the effect of…

UK - New HiTs (Health Systems in Transition) health system reviews for the United Kingdom (Northern Ireland, Scotland, and Wales) have just been released

In November 2012, the European Observatory on Health Systems and Policies released Health Systems in Transition (HiT) reviews for British health systems in Northern Ireland, Scotland and Wales. HiT health system reviews are country or region-based reports providing a detailed description of local health system reforms and policy initiatives.

Europe - Re-orienting health systems: towards modern, responsive and sustainable health promoting systems

This position paper from EuroHealthNet is the culmination of a policy dialogue process with stakeholders, experts and European Union (EU) institutions to identify key contributions to sustainable health systems across Europe. The paper frames its findings in the context of the EU 2020 Europe strategy for continental growth.

Reducing waste in health care

Brief analytical summaries or syntheses #56 Reducing waste in health care Summary A key target in slowing healthcare spending in the US is the elimination of waste, which is thought to constitute over one third of all American health spending. This policy brief published in Health Affairs focuses on the types of waste in health care and ways to eliminate it. Background Health care spending in the United States is widely deemed to be growing at an unsustainable rate, and policy makers increasingly seek ways to slow that growth or reduce spending overall. A key target is eliminating waste — spending that could be eliminated without harming consumers or reducing the quality of care that people receive and that, according to some estimates, may constitute one-third to nearly one-half of all US health spending. Waste can include spending on services that lack evidence of producing better health outcomes compared to…

Primary care for the 21st century

Brief analytical summaries or syntheses #50 Primary care for the 21st century Summary Many GPs in New Zealand work collaboratively in independent practitioner associations (IPAs). These are networks whose functions include quality control and the delivery of complementary primary health services. This report, published by the U.K.’s Nuffield Trust looks at the evolution of IPA’s role within the health system. Background As the National Health Service (NHS) in England prepares to give general practitioners (GPs) a leading role in commissioning local health services, it is clear that general practice itself needs to be strengthened and made into an effective foundation for transformed, integrated care. This report offers insights from the experience of organized general practice in New Zealand. Over the past two decades, many GPs and other primary care clinicians in New Zealand have worked collaboratively in independent practitioner associations (IPAs). These networks of primary care providers developed in the…

USA - Reducing Waste in Health Care

A key target in slowing healthcare spending in the US is the elimination of waste, which is thought to constitute over one third of all American health spending. This policy brief published in Health Affairs focuses on the types of waste in health care and ways to eliminate it.

China - A case study of the counterpart technical support policy to improve rural health services in Beijing

Published in BMC Health Services Research, this study looks at China’s attempts to improve rural healthcare by requiring urban doctors to spend time in rural hospitals. Drawing upon 1.6 million cases from 22 hospitals (11 rural) in the Beijing Municipality, the study shows that Beijing’s strategy for reducing urban-rural gaps in health services is slowly gaining ground.

Sweden – Health System Review

Brief analytical summaries or syntheses #43 Sweden – Health System Review Summary Published by the European Observatory on Health Systems and Policies, this report regards Sweden’s health system in detail. It describes the institutional framework, process, content, and implementation of Swedish health policies, highlighting challenges and areas that require further analysis. Background Sweden is a monarchy with a parliamentary form of government. The size of the population is about 9.4 million inhabitants and more than 80% of the population lives in urban areas. The GDP per capita, measured as purchasing power parity (PPP, current international US$), amounted to Swedish krona (SEK) 37 775 (€4200) in 2010. Life expectancy in Sweden is among the highest in the world. Diseases of the circulatory system are the leading cause of mortality, accounting for about 40% of all deaths in 2009. The second largest cause of death is cancer. There are three independent government…

USA - Curbing Costs Improving Care. The Path to an Affordable Health Care Future

Over the past year, the U.S. National Coalition on Health Care (NCHC) conducted an intensive dialogue with health care experts and organizations that represent businesses, consumers, health plans, providers, and disability advocates. This report is the product of those discussions. It offers federal policymakers a path forward to address the unnecessary growth in health care costs and to improve quality of care by transforming incentives for all actors in the health system.

Norway - Hospital Capacity, Waiting Times and Sick Leave Duration - An Empirical Analysis of a Norwegian Health Policy Reform

This paper from the University of Bergen evaluates Norway’s Faster Return to Work (FRW) scheme to reduce hospital wait times and sickness absences. Sixty FRW facilities were established as part of health reforms in 2007-2009. The study finds that wait times for FRW patients are 12 to15 days shorter than those of other patients.

International - Systems thinking for health systems strengthening in LMICs: seizing the opportunity

This supplement from Health Policy and Planning provides an overview of the fundamental concepts of “systems thinking” within the context of global health care. Articles make a case for its relevance in strengthening health systems internationally, especially in lower middle-income countries.

New Zealand - Primary care for the 21st century

Many of New Zealand’s general practitioners (GPs) work collaboratively in Independent Practitioner Associations (IPAs). These are networks whose functions include quality control and the delivery of extended primary care services. This report into IPAs by the Nuffield Trust is based on interviews with IPA leaders, health policymakers, and officials.

France - Marisol Touraine proposes a "pact of confidence for hospitals"

On September 7, 2012, the Minister of Social Affairs and Health of France presented the broad lines of new hospital policy. It will see an end to public-private convergence in rates, improve pay for performance and enhance access to emergency care.

USA - Aligning Health Information Technology and Delivery System Transformation Efforts: Themes from a Discussion among State and National Leaders

This State Health Policy Briefing describes an April 2012 meeting between US state and national leaders to consider ways in which delivery system transformations can capitalize on information technology and improve health care. Provider and plan measurement, payment reform, care delivery innovation, and consumer engagement are discussed.

UK - All together now: competitive integration in the NHS

Britain’s National Health Service (NHS) is comprised of many autonomous organizations. This report from Policy Exchange proposes reintegrating the NHS, beginning with a program of integrated care organisations (ICOs) to drive system-wide efficiency and exert competitive pressure. ICOs would bring together primary, community and acute services with a single budget for purchase and provision.

International - A Comparative Analysis of Health Forecasting Methods

Concerns about health expenditure growth and its long-term sustainability have stimulated the development of health expenditure forecasting models in many OECD countries. This comparative analysis reviewed 25 models that were developed by, or used for, policy analysis by OECD member countries and other international organisations.

USA - NGA Launches Virtual Health Resource Center

The National Governors Association (NGA) unveiled a resource website that explores solutions to health policy problems at the state level in the U.S. The site, State Health Policy Options, provides policymakers with expert analysis and data from other states on health care access, affordability and quality.

Re-orienting health systems : Towards modern, responsive and sustainable health promoting systems

Brief analytical summaries or syntheses #55 Re-orienting health systems Towards modern, responsive and sustainable health promoting systems Summary This position paper from EuroHealthNet is the culmination of a policy dialogue process with stakeholders, experts and European Union (EU) institutions to identify key contributions to sustainable health systems across Europe. The paper frames its findings in the context of the EU 2020 Europe strategy for continental growth. Background The sustainability of national health systems is a core concern of the European Member States, the European Commission, and the World Health Organisation. As early as 2001, the European Commission identified ‘financial viability’ as one of three long-term objectives for national health systems, along with accessibility and quality. Since then, the development of high-quality, accessible and sustainable services has been in the spotlight of different EU policy agendas social protection, public health, and economic and financial affairs. Initially, the issue was incorporated in…

Health in the Americas. 2012 edition

Brief analytical summaries or syntheses #53 Health in the Americas. 2012 edition Summary In Health in the Americas 2012, the Pan American Sanitary Bureau presents and analyzes health data and information from every country in the Region of the Americas. In drafting the publication, it has used data from many domestic and international, as well as unofficial, sources, trying as much as possible to identify and eliminate any discrepancies. Background Chapter 1 A Century of Public Health in the Americas In the last 110 years, Latin America and the Caribbean have experienced great transformations, from the independence of the Caribbean countries to the construction of modern states, from authoritarian regimes and dictatorships to democracy and the rule of law, and from cycles of economic growth and high productivity to financial crises, economic slow-downs, and massive foreign debt. The Region also has achieved a notable increase in life expectancy and a…

Canada - Understanding the Health System Use of Ambulatory Care Patients

Produced by the Manitoba Health Policy Centre, this report describes Manitoba’s provision of ambulatory care services from 2007 to 2010 and analyzes 7,662,411 ambulatory care visits during that period. The report focuses on users previously diagnosed with at least one of six chronic conditions: hypertension, total respiratory morbidity, diabetes, ischemic heart disease, congestive heart failure, and mood and anxiety disorders.

UK - Tough times, tough choices. Being open and honest about NHS finance

In the UK, demand for health care continues to grow at a rate that funding cannot match. This report examines the problem and proposes financial and policy solutions. This report sets out options, not solutions. These choices are not pain-free and the authors warn that some may prove too difficult to swallow, but feel that an informed public will be better placed to make difficult choices.

Europe - A comparative analysis of health policy performance in 43 European countries

This article from European Public Health assesses national variations in health policy and investigates the influence of local political, economic and social determinants. The article reviews the policies of 43 European countries on nutrition, child health, infectious diseases, hypertension, cancer screening, road safety, air pollution, and tobacco and alcohol use.

USA - A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment

This report from the Bipartisan Policy Center (BPC) Health Care Cost Containment Initiative provides recommendations for containing rising US healthcare spending while improving the quality and affordability of care. The report’s recommendations are aimed at improving the delivery and financing of healthcare in both the public and private sectors. They span four broad categories: Medicare, tax policy, quality, and payment reform.

Canada - Medical devices and healthcare costs in Canada and 65 other countries, 2006 to 2011

This study from Canadian Health Policy examines the impact of medical device expenditures on total healthcare costs in Canada and 65 other countries, and compares the affordability of medical device expenditures relative to GDP per capita. Canada ranks 9th in total health spending per capita, but only 56th in spending on medical devices as a percentage of total health expenditures.

Vietnam - Public Health Insurance in Vietnam towards Universal Coverage: Identifying the challenges, issues, and problems in its design and organizational practices

Vietnam is attempting to achieve universal health insurance coverage by 2014. This study from Japan’s Osaka School of International Public Policy provides an overview of Vietnam’s push towards universal coverage based on official documents, research reports, and high-level policy access. The study says distorted incentives and a lack of financial stability are hindering progress.

Europe - The changing national role in health system governance: a case-based study of 11 European countries and Australia

Conducted by the European Observatory on Health Systems and Policies, this study was undertaken to compile background material for the 2012 Swedish Governmental Inquiry on Health Care. Assessments of 11 European countries and Australia focus on changing national roles in health systems, and government efforts to reconfigure responsibilities for health policy, regulation and management.

Europe - The European health report 2012

As part of its mandate to monitor the health of 900 million Europeans, the WHO issues this comprehensive continent-wide health report every three years. The 2012 report focuses on providing an evidence base for Health 2020, the European Union (EU) policy framework to improve health and wellbeing.

Canada - How do Canadian primary care physicians rate the health system? Survey results from the 2012 Commonwealth Fund International Health Policy Survey of Primary Care Doctors

In this issue of Canadian Health Care Matters, the Health Council of Canada examines survey results that shed light on the potential for improvement in several key areas: access to primary health care, coordination among health care providers, the uptake of information technology in primary care, and initiatives to drive practice improvement.

Canada – Canada: Health system review. Health Systems in Transition, 2013

The new HiT (Health Systems in Transition) health system review for Canada has just been released by the European Observatory on Health Systems and Policies. HiT health system reviews are country or region-based reports providing a detailed description of local health system reforms and policy initiatives.

Australia - New website showcases innovation in Australia’s health workforce

Health Workforce Innovation in Australia is a new website that showcases organisations that are driving workforce reform across the Australian health sector. The site contains hundreds of examples of innovation in five categories: workforce reform, capacity and skills, leadership, workforce planning and policy, funding and regulation. The website is part of the Innovation and Reform Strategic Framework for Action 2011-2015.

Preventive care and healthy ageing: a global perspective

Brief analytical summaries or syntheses #51 Preventive care and healthy ageing a global perspective Summary Published by the Economist Intelligence Unit, this report investigates the challenges and pressures that ageing populations put on healthcare systems and economies worldwide. It includes case studies of eight countries Brazil, China, India, Japan, Russia, South Africa, the UK and the US. Background The world is ageing rapidly, and this is good news. It means that people are living longer and recovering more frequently from acute diseases. But it also poses a grave challenge a world that is barely able to meet the healthcare needs of its existing population is having to take on the costlier healthcare needs of hundreds of millions of older people. Government policymakers will have to find new ways to promote healthy ageing—and will have to find them soon. Analysis and results Preventive care measures are often focused on particular diseases…

The Netherlands - Health Care Reform and Long-Term Care in the Netherlands

This OECD report provides an overview of healthcare reform and long-term care policy in the Netherlands. In health care, reforms expanded the market’s role in the hospital sector but reinforced budget controls. The cost of long-term care is set to double over the coming decade.

Canada - Health cooperatives: a policy brief

In this brief, the Association québécoise d’établissements de santé et de services sociaux (AQESSS) presents comments from the working group on health cooperatives and their recommendations around the establishment of these cooperatives within the health system.

International - Waiting Time Policies in the Health Sector. What Works?

This book describes healthcare system wait-list policies in 14 OECD countries. It looks at discrepancies between countries in wait times for medical specialties, reviews best practices and different policy approaches, and discusses government use of sanctions against providers with long wait times.

Ireland - Minister Publishes Key Health Reform Policy Paper on ‘Money Follows the Patient’

In early February 2013, Ireland’s Health Minister released a policy paper about the upcoming introduction of the country’s new universal health insurance scheme. The document describes mechanisms for hospital funding that will drive efficiency and support the equitable provision of quality care.

International - Sustainable Health Systems. Visions, Strategies, Critical Uncertainties and Scenarios

In 2012, the World Economic Forum worked with the McKinsey consultancy group to engage over 200 international health system leaders, policy-makers and experts in a global effort to provide a holistic long-term analysis of sustainable health systems. This report examines what health systems could look like in 2040.

Korea - Institutionalizing the Healthcare Service Systems in Korea

In 2012, South Korea’s government proposed legislation enabling private hospitals and service providers to provide healthcare services. This study from the Korea Institute for Health and Social Affairs contrasts the pending Healthcare Service Bill with policy alternatives and advocates a different approach to the reform of Korea’s healthcare system.

Europe - Health ministers adopt European policy for health and well-being

In September 2012, the WHO announced the adoption of Health 2020, a comprehensive policy designed to protect and promote the health of Europe’s 900 million inhabitants. The policy targets regional health inequities, shrinking public service expenditures, and the growing burden of non-communicable disease.

Europe - Reforming payment for health care in Europe to achieve better value

In Europe, funding cutbacks have prompted healthcare policies focusing on better value for money. This report from the Nuffield Trust examines European trends in payment reform in health care and their effect on payers, providers and policy-makers.

Canada - The Fiscal Sustainability of Canadian Publicly Funded Healthcare Systems and the Policy Response to the Fiscal Gap

This fifth paper in the Canadian Health Services Research Foundation (CHSRF) series on health care financing models presents five expenditure scenarios for Canada as a whole, each of the 10 provinces and the territories for the period 2010 to 2035. It finds that real per capita public health care spending can be expected to grow anywhere from 78% to 115% and reach dollar levels of between $6,552 and $8,798 per capita by 2035. Potential policy solutions to make health care more sustainable are presented.

International - Paying for “End-of-Life” Drugs in Australia, Germany, and the United Kingdom: Balancing Policy, Pragmatism, and Societal Values

This edition of Issues in International Health Policy analyses British, German, Australian and American policies on the coverage of costly life-extending medicines. For Europe and Australia, the challenge is to pay for medicines through publicly-funded systems without undermining core principles. In the U.S., the goal is to ensure the sustainability of Medicare and the private insurance market without restricting choice.

UK - Can NHS hospitals do more with less?

This report by the Nuffield Trust looks at hospital efficiency in the U.K.’s National Health Service (NHS) and proposes sustainable improvements to support ongoing health care reform. An accompanying policy analysis reviews the evidence on methods used internationally by hospitals to increase efficiency.

UK - What was the programme theory of New Labour’s Health System Reforms?

This study from the Kings Fund examines whether health system reforms enacted in the U.K. under the Labour Party Government between 1997 and 2010 were a coherent program reinforced by underlying theory. The authors argue that the reforms assumed a one-size-fits-all approach to policy implementation and did not constitute a mutually supportive set of levers and incentives.

USA - Primary Care 2025: A Scenario Exploration

The Institute for Alternative Futures (IAF) provides, in this report, scenarios describing alternative futures for U.S. primary care in the year 2025. The scenarios consider economic challenges, political polarization, disruptive technological advances, and new health delivery systems. The report includes implications and recommendations for policy-makers envisioning the alternative paths 21st century primary care could take.

International Profiles of Health Care Systems

Brief analytical summaries or syntheses #32 International Profiles of Health Care Systems Summary This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.S. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views. Background The Commonwealth Fund is a private foundation that promotes a high performance health care system providing better access, improved quality, and greater efficiency. The Fund carries out…

Russia - Russian Federation: Health system review. Health Systems in Transition, 2011

The WHO produces health system profiles (HiTs), which are country-based reports providing a detailed description of health systems and policy initiatives. This HiT on the delivery of health care in Russia examines different approaches to the organization, financing and delivery of health services in that country, along with the roles of main local actors.

Norway - Health care priority setting in Norway a multicriteria decision analysis

This study published in BMC Health Services Research compares the values of Norwegian health policymakers with the official principles guiding Norway’s public health system: guaranteed care in case of severe illness, proven health benefit, and proportionality between need and treatment.

Canada - Canadian Primary Healthcare Policy: The Evolving Status of Reform

This report from the Canadian Health Services Research Foundation (CHSRF) provides an update on the current status of primary health care policy and reform across Canada. Much work has been undertaken since the late 1990s in the context of service integration and health system reform, but there is some impatience with the slow pace of change. This study was undertaken to allow decision-makers to better understand the current picture, consider the legitimacy of significant recent primary health care investments and showcase and promote positive change and progress. It also enables scrutiny of what might not be working in Canadian primary health care today.

Canada - Primary Care Reform: Can Quebec’s Family Medicine Group Model Benefit from the Experience of Ontario’s Family Health Teams?

This paper published in Healthcare Policy analyzes the family medicine group (FMG) model's potential as a lever for improving health care system performance and discusses how it could be improved. It reviews the history of primary care in Quebec, presents the FMG model and discusses ways of advancing primary care services in Quebec using the family health team (FHT) model developed in Ontario.

Austria - Public Health in Austria. An analysis of the status of public health

Published by the European Observatory on Health Systems and Policies and carried out by the London School of Economics on behalf of the Austrian government, this report argues that orienting health policy solely towards the health care sector is too limiting. It highlights areas of public health in which Austria is lagging and offers recommendations for improvement.

Australia - 35-Year High in the Number of Australians Covered by Private Hospital Insurance

New figures issued in November 2011 by Australia’s Private Health Insurance Administration Council (PHIAC) show that more Australians are now covered by private hospital insurance than at any other time in the past 35 years. The Australian government is considering changing its reimbursement policy for private insurance to exclude high earners from rebates.

Medical Tourism: Treatments, Markets and Health System Implications: A scoping review

Brief analytical summaries or syntheses #28 Medical Tourism Treatments, Markets and Health System Implications A scoping review Summary This broad OECD review examines what is currently known about the flow of medical tourists between countries and discusses the interaction of the demand for, and supply of, medical tourism services. It highlights the different organisations and groups involved in the industry. It highlights treatment processes (quality, safety and risks) and system-level implications for countries of origin and destination (financial issues, equity and the impact on providers and professionals of medical tourism). Background The global growth in the flow of patients and health professionals as well as medical technology, capital funding and regulatory regimes across national borders has given rise to new patterns of consumption and production of healthcare services over recent decades. A significant new element of a growing trade in healthcare has involved the movement of patients across borders in…

Europe - Governing public hospitals. Reform strategies and the movement towards institutional autonomy

This study by researchers at the WHO explores major developments in the governance of public hospitals in Europe and looks at their implications for national and European health policy. Individual hospitals have been given varying degrees of semi-autonomy within the public sector and empowered to make key strategic, financial and clinical decisions themselves. The study includes an in-depth assessment of eight different country models of semi-autonomy.

Responding to the challenge of financial sustainability in Estonia’s health system : one year on

Brief analytical summaries or syntheses #29 Responding to the challenge of financial sustainability in Estonia’s health system one year on Summary This WHO follow-up report looks at changes in Estonian health care financing one year after a comprehensive WHO analysis. It reviews developments in four areas where policy recommendations had been made. Background Health system financial sustainability has always been a central health policy issue, but the recent financial crisis has forced it to the top of the policy agenda the world over. With the aim of supporting a financially sustainable, high-performing health system, this report assesses health financing policy in Estonia. It looks at how well placed current financing policy is to enable goal attainment in the medium-to-long term (to 2030) and identifies ways to strengthen financing policy. The report is the result of a year-long process of stakeholder consultations and expert analysis initiated by the Ministry of Social…

Governing public hospitals. Reform strategies and the movement towards institutional autonomy

Brief analytical summaries or syntheses #33 Governing public hospitals. Reform strategies and the movement towards institutional autonomy Summary This study by researchers at the World Health Organization (WHO) explores major developments in the governance of public hospitals in Europe and looks at their implications for national and European health policy. Individual hospitals have been given varying degrees of semi-autonomy within the public sector and have been empowered to make key strategic, financial and clinical decisions themselves. The study includes an in-depth assessment of eight different country models of semi-autonomy. Background For hospital governance to be effective, it must incorporate two powerful and well-developed lines of health sector logic on the one hand, national health policy and objectives; on the other, operational hospital management. One sphere is political, the other technical. One is subjective and value-based, the other is objective, with performance that can be measured both clinically and financially. The…

Canada - Provincial and Territorial Health System Priorities: An Environmental Scan

With the approaching expiry of the 10-Year Plan to Strengthen Health Care (2004), the Canadian Health Services Research Foundation (CHSRF) undertook an environmental scan to explore the shared values and principles, goals and key health policy issues across provinces and territories. The authors examined strategic planning documents and consulted with senior policy-makers across provinces and territories in ministries of health, intergovernmental affairs and finance. This summary presents key findings from the framework analysis and face-to-face meetings.

UK - New approach to education and training published

On January 10, 2012, Britain’s Department of Health unveiled a new policy framework for health workforce planning, education, and training. The new policy gives health employers national support to identify and anticipate key workforce challenges, allowing them more autonomy in planning and management. Local Education and Training Boards (LETBs) are to be developed.

Canada - Roadblocks to Reform: Beyond the Usual Suspects

This paper from the Centre for Health Economics and Policy Analysis (CHEPA) looks at the failure of healthcare system reform in 20 countries. Three main explanations have been offered for why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. This paper focuses on the role of societal preferences as a plausible cause for opposition to reform.

Canada – CHSRF: Three new reports on healthcare improvement commissioned with the Canadian Nurses Association

The three reports released by the CHSRF in June 2012 are 1) Better Health: An analysis of public policy and programming focusing on the determinants of health and health outcomes that are effective in achieving the healthiest populations, 2) Better Value: An analysis of the impact of current healthcare system funding and financing models and the value of health and healthcare in Canada and 3) Better Care: An Analysis of Nursing and Healthcare System Outcomes.

USA - U.S. Health-Care System Faces Obstacles to Improving Health Care Value

The Boston Consulting Group assessed international progress in adopting value-based health care, and found the US trailing other countries. The assessment evaluates national health systems according to support at a national level for things like common national standards and IT infrastructure and the engagement of clinicians and policymakers. It also considers the quality of a country’s disease registries.

Canada - Canada's Doctors Urge Health Impact Assessment for all Federal Policies

The Canadian Medical Association (CMA) is calling on the federal government to conduct a health impact assessment as part of its policy development process to ensure that the health of Canadians is a key factor in every policy decision it makes.

International - Health system performance comparison: an agenda for policy, information and research

This WHO policy brief calls for more international comparisons of health system performance. It describes the methodology of international comparative studies, key domain comparators, and cites the benefits of international comparison in policy influence and as a source of evidence.

New Zealand - The State of the Art? An Analysis of New Zealand’s Population-¬Based Funding Formula (PBFF) for Health Services

This technical report from the University of Otago examines how the PBFF is used to distribute two-thirds of public health spending between New Zealand’s 20 health boards. It does so according to the demographic characteristics of their populations and certain unavoidable costs in providing services to rural populations, but these factors are poorly understood by the policy community and the public. The report is the first-ever independent guide to the methodology supporting the PBFF.

International - Financial sustainability and affordability of health care systems. Lessons from OECD countries

This presentation by Mark Pearson, head of the Health Division at the OECD, reviews how health spending has been affected during the economic crisis in various countries. It also makes some recommendations on how policy should react. The presentation was delivered at the International Conference of Social Security Actuaries and Statisticians that took place in Berlin from May 30 to June 1, 2012.

Canada - The Visible Politics of the Privatization Debate in Quebec

The objective of this paper, published in Healthcare Policy, is to clarify policy-making processes with regard to the privatization of healthcare services. The authors analyze a large sample of mass media and National Assembly debates on the question during the four-and-a-half years following the Chaoulli ruling.

International - Physicians in private practice: reasons for being a social franchise member

This paper from Health Research Policy and Systems examines what motivates physicians in private practice to join a social franchise network. The study finds that franchise membership has a positive effect on client volumes, earnings, and access to cheaper, higher quality medications for patients.

Russian Federation - OECD Reviews of Health Systems: Russian Federation 2012

Published in June 2012 by the OECD, this report analyzes reasons for poor population health in Russia and examines impediments to future improvement. Russia’s current health system is viewed against the background of 1990s reforms and recent corrective policy efforts are explored in depth.

Europe - Health policy responses to the financial crisis in Europe

This August 2012 report by the Health Evidence Network (HEN) identifies key challenges for European health policy makers in the wake of the ongoing financial crisis. The report focuses on responses to essential service cuts and interruptions in revenue streams, as well as on inefficiencies and exacerbations of adverse effects evident in national health systems.

Canada - How Many Patients Should a Family Physician Have? Factors to Consider in Answering a Deceptively Simple Question

The authors of this study, published in Healthcare Policy, argue that before practice size can be used as an accountability measure for individual physicians in primary care, its relationship to quality and outcomes at individual and population levels, as well as the contextual factors that affect it, must be better understood.

USA - HHS launches new web-based tool to track performance of nation’s health care system

On May 15, 2012, the US Health and Human Services Secretary announced the launch of a new web-based tool, known as the Health System Measurement Project. It will allow policymakers, providers, and the public to develop consistent data-driven views of changes in critical US health system indicators.

UK - Health Secretary explains new Health and Social Care Act

On April 4, 2012, U.K. Health Secretary Andrew Lansley outlined Britain’s new Health and Social Care Act and explained its effect on healthcare organizations such as clinical commissioning groups, local authorities, and trusts. Two principles anchor the legislation: patients should share in care decisions, and care should be continually improved.

Russian Federation – Health System Review.
Health systems in transition, 2011

Brief analytical summaries or syntheses #37 Russian Federation – Health System Review. Health systems in transition, 2011 Summary The WHO produces health system profiles (HiTs), which are country-based reports providing a detailed description of health systems and policy initiatives. This HiT on the delivery of health care in Russia examines different approaches to the organization, financing and delivery of health services in that country, along with the roles of main local actors. Background At independence from the Soviet Union in 1991, the Russian health system inherited an extensive, centralized Semashko system, but was quick to reform health financing by adopting a mandatory health insurance (MHI) model in 1993. While the health system has evolved and changed significantly since the early 1990s, the legacy of having been a highly centralized system focused on universal access to basic care remains. High energy prices on world markets have ensured greater macroeconomic stability, a…

International – Real Reform in Health Systems. Special Issue. Journal of Health Politics, Policy and Law

Health care reform seems to be fundamental to the coherence and the future of the welfare state. This volume’s collection of essays and research papers looks at some options that may strengthen our ability to bring about important and necessary transformations.

Denmark – Denmark: Health system review. Health Systems in Transition, 2012

Published by the European Observatory on Health Systems and Policies, this country profile provides a detailed description of Denmark’s health system and policy initiatives. The report describes the institutional framework, process, content, and implementation of Danish healthcare policy reform.

Canada - The Scope of Medicare: What makes sense today? Report from the MUHC-ISAI’s fourth annual conference

The McGill University Health Centre’s Institute for Strategic Analysis and Innovation (MUHC-ISAI) enables the MUHC to contribute to the ongoing development of health care policy. This report presents highlights from the conference it held on October 26 and 27, 2011 to evaluate Canada’s performance against increasing costs and expectations and explore the scope of Medicare with a view to encouraging and supporting an effective framework for change. It includes presentations on health system changes in the U.K. and The Netherlands and talks by Jeffrey Simpson, Pierre-Gerlier Forest, Claude Castonguay, Philippe Couillard, André Picard and others.

Public reporting on quality and costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers?

Brief analytical summaries or syntheses #39 Public reporting on quality and costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers ? Summary This paper examines whether public reporting of health provider performance leads to better consumer choices and improvements in care. Published in Health Affairs, the paper describes the theory behind public reporting, its evolution over time, and evidence of its ability to improve healthcare quality and lower costs. Background Public reporting is a strategy to address quality and cost in the healthcare system by providing consumers, payers, and healthcare providers, such as doctors and hospitals, with information about the performance of these providers and insurance plans. Public reports can allow for the comparison of costs, quality (such as rates of hospital-acquired infections), and how satisfied patients are with service. Advocates of public reporting believe that it helps consumers make…

A working guide to international comparisons of health

Brief analytical summaries or syntheses #41 A working guide to international comparisons of health Summary This guide published by the Australian government highlights the types of questions to ask before comparing health systems in countries or presenting health data in an international context. The guide is intended to encourage users of international health-related data to consider the complexities before comparing countries, and to assist them in interpreting the results of these comparisons. It presents examples to highlight the types of questions to ask when using health data in an international context. Background It is common practice to compare health between countries. Such comparisons provide a broader perspective of health and health care. They enable researchers, policy makers and the general public to see how national experiences of health and health care compare on an international scale. These comparisons often attract much attention from the media, particularly if countries are ranked…

International - Assessing barriers to health insurance and threats to equity in comparative perspective: The Health Insurance Access Database

Methods used for international comparisons of health systems often conflate system characteristics. This paper from BMC Heath Services Research proposes a database containing explicit standardized indicators to capture service policy changes over time in the health system regulation of public and private insurance.

Canada - Patient Centred Community Designed Team Delivered. A framework for achieving a high performing primary health care system in Saskatchewan

This Government of Saskatchewan document synthesizes the healthcare perspectives of over 400 community leaders, patients, providers, policy-makers and managers. It outlines shared visions for a sustainable primary healthcare system providing a superior patient experience and improved outcomes.