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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.…

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…

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…

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…

International - Waiting time policies in the health sector

Examining wait time policies in the 34 OECD countries, this study compares policies in the UK with those in Scandinavia, Portugal, the Netherlands and New Zealand. It discusses the prioritization policies of the UK National Health Service (NHS) and assesses inequalities in waiting times by socioeconomic status across the OECD.

International - A roadmap for comparing readmission policies with application to Denmark, England and the United States

Reducing unnecessary hospital readmissions can improve quality and save costs. This paper by a group of European researchers reviews readmission policies in Denmark, England, Germany and the US Medicare system. It finds that readmission policies vary widely and develops a comparative roadmap to evaluate ways for countries to adopt each other’s policies.

Help Wanted? Providing and paying for long-term care

Brief analytical summaries or syntheses #23 Help Wanted? Providing and paying for long-term care Summary Spending on long-term care in OECD countries is set to double, even triple, by 2050, driven by aging populations. Governments need to make their long-term care policies more affordable and provide better support for family carers and professionals, according to a new OECD report. “Help Wanted? Providing and paying for long-term care” reveals that half of all people who need long-term care are over 80 years old. And the share of the population in this age group in OECD countries will reach nearly one in 10 by 2050, up sharply from one in 25 in 2010. This percentage will reach 17% in Japan and 15% in Germany by 2050. Background With population aging, no clear signs of a reduction in disability among older people, family ties becoming looser and growing female labour-market participation, it is…

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.

Improving and measuring quality of care

Brief analytical summaries or syntheses #8 Improving and measuring quality of care Summary This publication presents new data on patient safety in OECD countries and shows that significant variations in quality of care persist in cancer, acute myocardial infarction and stroke, as well as in services provided by family physicians. The report looks at how countries can improve the measurement of quality, the balance between privacy and transparency in matters of quality and safety, and links between quality indicators and policies to improve the performance of physicians, hospitals and the health system as a whole. Background Health systems face important challenges today an increasingly complex case mix, greater demand for health care services (especially for chronic diseases) and an economic context in which improvements in care must come at the lowest possible cost. Measuring the quality of care becomes increasingly important in this context. Poor quality care undermines the goals…

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 –…

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 - Investment for health and well-being: a review of the social return on investment from public health policies to support implementing the Sustainable Development Goals by building on Health 2020

Based on a scoping review, this WHO report concludes that Europe's current public health investment policies and practices are unsustainable and carry high social, economic, and environmental costs. Instead, it advocates investment in policies based on values and evidence that contribute to social, economic and environmental sustainability. Investing for health and wellbeing is a driver and enabler of sustainable development.

Canada - Improving Access to Canadian Health Care: The Role of Tax Policies

Produced by the Conference Board of Canada, this paper assesses Canadian fiscal and tax policies related to health care. It examines their role in providing access to uninsured or underinsured health care services, and their costs in terms of foregone federal revenues. The research concludes it is unclear whether health-related fiscal policies can be leveraged to improve access to health care.

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…

Lunch hour conferences 2013

22_mai_2013.pdf Towards greater equity and better results in mental health in Québec perspective of the Commissaire à la santé et au bien-être regarding improvements in the performance of the health and social services system. March 13, 2013 By Jacques E. Girard, Deputy Commissioner for Assessment and Analysis The CSBE’s 2012 Report on the Performance Appraisal of the Health and Social Services System includes 5 major recommendations and 15 specific actions to improve the performance of the health and social services system in this sector, with the aim of consolidating knowledge gained in recent years and better responding to the needs of persons with mental disorders, in particular, with regard to front-line services. Following an outline of the key findings, the presentation will highlight the need to re-examine the allocation of mental health resources for an optimal supply of services, with an emphasis on continuity, collaborative health care and the provision…

International - Which Policies Increase Value For Money in Health Care?

Published by the OECD, this working paper investigates how policies and institutions helped achieve better healthcare value for money across 26 OECD countries from 2000-2015. Findings showed that policies that increase the scope of goods and services covered by basic health care coverage helped achieve better value for money by moderating health spending growth and increasing life expectancy.

Canada - Exploring alternative level of care (ALC) and the role of funding policies: An evolving evidence base for Canada

This report commissioned by the Canadian Health Services Research Foundation (CHSRF) synthesizes the evidence regarding funding policies designed to improve patient care in the transition period between acute and post-acute settings. Those in this transition period are referred to as alternate level of care (ALC) patients. Provinces and regions are adopting a number of strategies to prevent the use of expensive hospital beds for ALC patients. This report provides a number of recommendations for improving policies and practices in this area.

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…

UK - Towards a new age: The future of the UK welfare state

Published by the International Longevity Centre (ILC) and available online, this 170-page book collects essays by multiple authors on the effects of population aging on Britain’s welfare state. The book considers the societal challenges posed by demographic change and proposes health, pension, housing, and labour market reforms to preserve welfare state policies and encourage social participation by older Britons.

International - WHO urges global action to curtail consumption and health impacts of sugary drinks

Taxing sugary drinks can lower consumption and reduce obesity, type 2 diabetes and tooth decay, says a new WHO report. Fiscal policies that lead to at least a 20% increase in the retail price of sugary drinks would result in proportional reductions in consumption of such products, according to the report titled “Fiscal policies for Diet and Prevention of Noncommunicable Diseases (NCDs)”.

International - Strategizing national health in the 21st century: a handbook

Released by the WHO, this handbook is designed as a resource providing up-to-date and practical guidance on national health planning. It establishes a set of best practices to support strategic plans for health and represents the wealth of experience accumulated by the WHO on national health policies, strategies and plans.

Norway - Impact of changed management policies on operating room efficiency

This study, published in Biomed Central, investigates the impact on operating room (OR) efficiency in Norway of new policies for resource allocation and patient urgency classification and a new system for OR booking. The authors found that each intervention facilitated the implementation of others, leading to a 48% increase in daytime surgery, a 26% drop in use of overtime, and shorter median wait times even for the lowest urgency patients.

International - Reform, Competition, and Policy in Hospital Markets

This OECD report examines competitive policies, cost controls, and efficiency reforms in hospital markets in the U.S., the Netherlands, and the U.K. since the 1980s. The report concludes that the evidence supports the idea that competition improves quality in hospital markets when policies are set and/or overseen by administrative and regulatory bodies.

International - Why human resources policies and practices are critical to improving the patient experience

This US paper argues that human resources (HR) policies, procedures and programs are key to improving patient experience by supporting an organization’s vision and culture. As the organization achieves a better understanding of how to best serve patients, HR can build patient care improvement into every aspect of the organization. The author also describes how competency-based performance reviews, compensation and retention strategies should reflect patient-centred values.

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.

Italy - Cost-containment policies and hospital efficiency: evidence from a panel of Italian hospitals

This paper from Italy’s Centre for Economic and International Studies evaluates how cost-control policies like hospital mergers and regional bailouts have affected Italian hospital efficiencies. The longitudinal study samples hospitals over the period from 1999 to 2007.

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.

UK - Moving care to the community: an international perspective

The Royal College of Nursing prepared this policy briefing to set out the international thinking behind the acute to community shift and the types of policies and programmes implemented in various countries. The aim is to inform policies in the UK that might support the shift to community care. It highlights international trends and makes recommendations for commissioners, providers, governments, policy experts and clinicians.

Canada - Changes to Long-Term Care Policies will Improve Access to Care in Nova Scotia

Nova Scotia has introduced changes to its long-term care policies to ensure more timely access for those with the greatest needs. Starting March 2, 2015, new criteria will ensure that efforts have been made to support people in their homes or communities before seeking long-term care placement.

Canada - Mental Health Commission of Canada Releases Summary of Report on Support to Emerging Adults

On February 23, 2015, the Mental Health Commission of Canada released the executive summary of its forthcoming report on how to promote a more seamless continuum of services for emerging adults. Developed in partnership with a research team from the Children’s Hospital of Eastern Ontario (CHEO), the report will detail the current state of policies and practices in the area of youth transitioning from child and youth to adult mental health and addiction services. It will also present best practices and policies from the Canadian and international experience.

UK - Public health responses to an ageing society: opportunities and challenges

This British article outlines the opportunities and challenges faced by England’s aging society and public health structures. It provides examples of both good practice and potential pitfalls, and stresses eight local public health policies to reduce costs and improve older peoples’ health. The policies concern smoking, exercise, nutrition, road safety, housing, loneliness, immunization and falls.

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.

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.

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.

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 - 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.

UK - NHS maximum waiting times and patient choice policies

Developed by British parliamentary researchers, this briefing describes National Health Service (NHS) waiting time standards and patient choice policies in England. As set out in the NHS Constitution, patients have a right to a maximum 18 week waiting time from referral to consultant-led treatment, and to be seen by a cancer specialist within a maximum of two weeks from GP referral for urgent referrals where cancer is suspected.

International - Health workers with right skills in right places needed

The number of doctors and nurses has reached record levels in the OECD. Countries should now reform their training and employment strategies to better respond to people’s changing health needs and also reduce their reliance on foreign-trained health workers from developing countries, according to a new OECD report. “Health Workforce Policies in OECD countries: Right Jobs, Right Skills, Right Places” says that in 2013, a total of 3.6 million doctors and 10.8 million nurses were employed in OECD countries, up from 2.9 million doctors and 8.3 million nurses in 2000.

Sweden - Sweden: Health system review. Health Systems in Transition, 2012

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.

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.

Canada — Government policies restricting medical training mean Canada's physician shortage will worsen; recruiting foreign doctors a necessary short-term solution

Canada’s physician shortage will grow worse in coming years because of ill-conceived policies on physician supply, says a new article published by the Fraser Institute. In the article, Nadeem Esmail examines the evolution of Canada’s physician supply over time and projects what could happen in the coming years, taking into account factors such as population growth and Canada’s aging workforce.

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.

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…

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…

UK - The impact of the NHS market: an overview of the literature

NHS ‘internal’ or ‘quasi’ market policies in England have aimed to promote competition among providers in the hope of replicating the benefits markets have been known to bring about in the private sector: decreases in cost, and increases in efficiency, quality, innovation, and provider responsiveness. This briefing presents the results of a large-scale literature search on the effectiveness of these policies over the past 20 years.

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.

International — A New Look at OECD Health Care Systems: Typology, Efficiency and Policies

This year’s issue of Going for Growth features a chapter on health care (Chapter 6), a key contributor to individual well-being and an important driver of long-term economic growth. The OECD has assembled new cross-country comparative data on health policies and health care system efficiency, which show that there is room in all countries surveyed to improve the effectiveness of their public health care spending.

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.

UK — Assessing Welfare Effects of the European Choice Agenda: The case of health care in the United Kingdom

Choice and competition policies in public services are popular reform strategies in the member states of the European Union (EU). This paper discusses choice policies in European countries and uses the case of choice in health care in the UK to assess the welfare effects of choice and competition. The results indicate positive effects of choice, particularly for middle class individuals.

International - Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review

Shared decision-making (SDM) is poorly implemented in routine care, despite being promoted by health policies. Conducted by German and American researchers, this scoping review of 48 publications on 32 distinct implementation projects compiles a comprehensive overview of organizational and system-level characteristics that are likely to influence the implementation of SDM, and describes strategies to address those characteristics found in the literature.

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.

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 of the French population — 2015 edition

Presenting more than 200 indicators, this detailed overview from the DREES combines population, health determinant and pathological approaches to illustrate the health of the French population. It also highlights the major health problems public policies must confront, including social inequalities in health.

International - Noncommunicable diseases prematurely take 16 million lives annually, WHO urges more action

Premature noncommmunicable disease (NCD) deaths can be significantly reduced through government policies reducing tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity, and delivering universal health care. In the report entitled "Global status report on noncommunicable diseases 2014," WHO Director-General Dr Margaret Chan, states that an investment of just US$ 1-3 dollars per person per year would dramatically reduce illness and death from NCDs.

Europe - Crises and reforms from a health perspective

This special issue of the IRES journal illustrates the importance of taking health seriously as a criterion for evaluating societies. The articles explore the effects of austerity policies on health services in Europe, the methodical dismantling of Greek healthcare institutions, the effects of unemployment, managerial reforms in healthcare institutions, and much more.

International - Inclusive growth and health

In 2012, the OECD began studying how to help governments improve living standard for marginalized social groups. This paper links health to this inclusive growth agenda and assesses the relationship between health and socioeconomic factors. It includes a review of policies across the OECD.

Europe - Building primary care in a changing Europe: case studies

In this report, the European Observatory on Health Systems and Policies presents structured case studies of primary care in 31 European countries. They establish the context of primary care, key governance and economic conditions, look at the workforce and at how primary care services are delivered, and assess the quality and efficiency of the different systems.

Europe - Assessing chronic disease management in European health systems: country reports

This book published by the European Observatory on Health Systems and Policies systematically examines efforts in 12 countries in Europe to redesign delivery systems to provide appropriate support to people with long-standing health problems. It compares approaches to chronic care and evaluates the outcomes of these initiatives.

Australia - Options for Finance in Primary Care in Australia

Austerity policies in Australia are encouraging new finance policy options for primary health care. This article says stakeholders should look beyond payment schemes to financing models focused on outcomes. The article calls for introducing social impact bonds for private investors and says primary networks should adopt financial models based on shared services.

Europe - Assessing chronic disease management in European health systems: concepts and approaches

This report from the European Observatory of Health Systems and Policies explores approaches to chronic disease management across Europe. Drawing on 12 detailed country reports the study provides insights into the range of care models and the people involved in delivering these; payment mechanisms and service user access; and challenges faced by countries in the implementation and evaluation of these novel approaches.

Europe - Building primary care in a changing Europe

In this report, the European Observatory on Health Systems and Policies analyses how primary care is organised and delivered across European countries, looking at governance, financing and workforce aspects and the breadth of the service profiles. It describes wide national variations in terms of accessibility, continuity and coordination, and financial, workforce and technological challenges.

International - Pathways to progress: a multi-level approach to strengthening health systems

Produced by the UK Overseas Development Institute (ODI), this report draws lessons from five countries that are developing effective institutions and policies to promote health and social development. The report synthesizes findings from country case studies that focus on maternal and child health (Mozambique, Nepal and Rwanda), and neglected tropical diseases (Cambodia and Sierra Leone).

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.

France - Marisol Touraine and Laurence Rossignol present the principles behind a new law geared to help society adapt to an aging population

The Minister of Social Affairs, Health and Women's Rights, and the Secretary for Family Affairs, Senior Citizens and Autonomy in France presented the principles and components of a bill aimed at strengthening protection for vulnerable citizens. It provides for the introduction of an additional solidarity contribution for the maintenance of autonomy. The three main aims of the law are anticipation to prevent the loss of autonomy; adaptation of public policies on housing, urban planning and transport; and support to improve home care for people with reduced autonomy.

Canada - The governance of the health system in Quebec should be based on ten user-focused Service Regions responsible for coordinating and supervising the health-care establishments within their region

The reforms carried out in recent years failed to yield the expected results. The coordination and availability of services to patients will be achieved through a decentralized system made up of autonomous organizations operating with a tight and effective governance. The overall supervision of the network remains the responsibility of the Ministère de la Santé et des services sociaux (MSSS), which sets policies, budgets and structures of the system. However, the Ministère must not manage the network; it must govern it effectively. This proposal comes from a Working Group set up by the Institute for Governance (IGOPP), which publishes recently a report proposing a simplified, more effective governance for the health network in Quebec.

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 - 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.

Europe - WHO European Region advances health on political and social agendas: Health 2020 progress report

In the two years since its launch, Health 2020 has become a vital resource for Member States, helping to bolster their health policies and decrease inequities. This first progress report reveals the accomplishments of Europe's governments and defines the WHO Europe vision for the future. Emphasis on reducing health inequalities, a focus on healthy cities, and measures to improve governance are among the advances described.

International - Measuring and comparing health care waiting times in OECD countries

Waiting times for elective treatments are an international concern. This study describes common measures of wait times from 12 OECD countries. It focuses on procedures, such as hip replacements, where lengthy waits are the norm, and analyzes different country policies to reduce waiting times. Solutions include increased spending and the introduction of targets and incentives.

UK - The Promise of Healthtech

This report examines how digital innovators are transforming the National Health Service (NHS) via the development and adoption of cloud computing, 3-D printing and genomics. The authors surveyed hundreds of private health technology start-up companies to determine key barriers to new technology acquisition by the NHS. Slow procurement policies, undefined safety standards, limited digital skills, poor interoperability and lack of clarity about evidence were all factors.

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.

International - Trends in health systems in the former Soviet countries

Based on health system reviews from the European Observatory on Health Systems and Policies, this 217-page book analyzes health system reform in 12 countries that were previously part of the Soviet Union. The book reviews the reorganization, financing, and provision of health services in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. A large section is devoted to Russia.

Europe - Self-assessment tool for the evaluation of essential public health operations in the WHO European Region

Through a process of extensive consultation, the WHO Regional Office for Europe devised 10 essential public health operations (EPHOs) that define the field of modern public health for the Member States in the WHO European Region. This report provides a series of criteria that national public health officials can use to evaluate the delivery of the EPHOs in their particular settings and can contribute to the development of public health policies.

Europe - Public health in Europe during the austerity years

Released by the UK International Longevity Centre (ILC-UK), this report explores the relationship between European governments’ economic austerity policies and public health across Europe. Using cross-national data and evidence from individual countries, the report charts the evolution of austerity across the continent since the financial crisis of 2008, describes subsequent changes to health systems and health outcomes, and identifies channels through which austerity impacts on health.

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.

Europe - Priorities for health systems strengthening in the WHO European Region

In this issue, the European Observatory on Health Systems and Policies explores how Member States are strengthening their health systems. Articles look at priorities for strengthening people-centred health systems; moving towards universal health coverage; enhancing the health workforce; ensuring equitable access to cost-effective medicines and technology; and improving health information systems.

Europe - The changing role of nursing

Four articles in this issue of the journal EuroHealth assess nursing in the 28 European Union (EU) countries, where regulations on the free movement and qualifications of nurses within the European Union affect clinical and managerial practices at the national level. The articles consider EU policies on nursing education, certification and migration.

International - Pharmaceutical Expenditure and Policies. Past Trends and Future Challenges

Across the 34 member countries of the OECD, pharmaceutical spending reached just over $1 trillion Cdn in 2013, accounting for about 20% of total health spending. This paper looks at recent trends in pharmaceutical spending across the OECD and examines drivers of recent spending trends, highlighting differences across therapeutic classes.

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 - What is the evidence on the economic impacts of integrated care?

This policy summary from the European Observatory of Health Systems and Policies reviews the existing evidence on the economic impact of integrated care approaches. The authors find weak evidence on cost-effectiveness and suggest that the concept itself is ill-defined, making assessment difficult.

Canada - Economic arguments for shifting health dollars upstream

Researchers have offered evidence that Canada’s health sector could serve citizens better at less cost if more attention was paid to improving living and working conditions across society. This paper analyzes drivers of Canadian health funding and spending while making an economic argument explicitly linking healthcare outcomes and costs with social determinants, structural social power relations, and current government socioeconomic policies.

Europe - Europe paying a heavy price for chronic diseases, finds new OECD-EC report

Better public health and prevention policies as well as more effective health care could save hundreds of thousands of lives and billions of euros each year in Europe, according to a new joint OECD/European Commission report. Besides the loss of lives and the human tragedy that this always entails, Health at a Glance: Europe 2016 estimates that the premature deaths of 550,000 working age people across European Union countries from chronic diseases, including heart attacks, strokes, diabetes and cancer, cost EU economies EUR 115 billion or 0.8% of GDP annually.

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.

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.

International - The Organisation of Out-Of-Hours Primary Care in OECD Countries

Out-of-hours (OoH) services provide urgent primary care when primary care physician offices are closed. Based on a policy survey covering 27 OECD countries, this working paper reviews existing OoH service models and the challenges of delivering OoH primary care. The paper pays particular attention to policies that improve OoH access and quality.

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.

International - Together on the road to universal health coverage. A call to action

Universal health coverage (UHC) is central to achieving better health and wellbeing for people at all ages. It delivers health promotion, disease prevention and treatment, and ensures that patients are not driven into poverty because of high costs. This WHO publication provides a comprehensive overview of UHC and discusses policies, priorities, financing, health inequities, and human rights.

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.

Europe – Cost-Containment Policies in Hospital Expenditure in the European Union

This European Union study suggests that the reorganization and rationalization of care is a major factor in hospital cost containment, especially in institutions with high bed densities. It notes the difficulty of gauging the impact of tools to improve performance via structural changes.

UK - Waiting time prioritisation: evidence from England

Numerous countries have introduced wait time policies prioritizing severely ill patients. This study investigates how patients in England are prioritized using a national dataset of 200,000 people waiting for hip and knee replacement between 2009 and 2012. It finds that patients with the worst pain and immobility have the shortest waits, particularly in hospitals with longer average waiting times.

Switzerland – Switzerland: Health system review. Health Systems in Transition, 2015

The European Observatory on Health Systems and Policies presents a look at the health system in Switzerland, where life expectancy is the second highest in Europe. It examines efforts since 2000 to improve the country's mandatory health insurance program, and discusses challenges in lowering healthcare spending as a percentage of GDP and reducing the burden of out-of-pocket costs on lower income households.

International - Caring For Quality in Health. Lessons Learnt from 15 Reviews of Health Care Quality

Between 2012 and 2016, the OECD conducted a series of reviews looking at policies and institutions design to measure and improve healthcare quality in 15 OECD countries, primarily in Europe. The findings presented in this final synthesis report identify common challenges, responses, and leading edge practices to delivering value for money in health care.

International - WHO launches new NCDs Progress Monitor

The WHO has released a progress monitor for noncommunicable diseases (NCDs) that charts actions by countries to set targets; implements policies to address four NCD risk factors (tobacco, poor diet, inactivity and alcohol abuse); and builds capacities to reduce and treat NCDs. The progress monitor provides data on 19 indicators.

Sweden - Effects of Increased Competition on Quality of Primary Care in Sweden

Many health systems have implemented policies to make care providers engage in competition based on quality. This paper examines the impact of recent reforms in primary care in Sweden that affected competition in municipalities. The paper shows that, overall, the reforms have increased the number of municipal private care providers, with modest effects on primary care quality. There was no indication that quality had decreased.

UK - Improving quality in the English NHS. A strategy for action

This report argues that England’s branch of the UK National Health Service (NHS) cannot hope to meet health needs without a coherent, comprehensive and sustained commitment to quality improvement as its principal strategy. The report reviews the recent history of policies to improve the quality of care in the English NHS, outlines the key features of a quality improvement strategy, and describes the role of NHS organizations at different levels.

Canada - Levels of care, quality norms and standards

Les niveaux de soins. Normes et standards de qualité The guide is now available on the Web site of the Institut national d’excellence en santé et en services sociaux (INESSS). This guide aims at supporting establishments and healthcare professionals in the adoption and the application of policies concerning levels of care which answer the proposed norms and standards. It is designed to promote the good use of the levels of care so that they always remain a shared clinical decision-making tool in varied contexts.

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

Quebec Health System

This section presents key websites providing information on the Quebec health and social services system Ministère de la Santé et des Services sociaux (MSSS) The ministry mission is to maintain, improve, and restore the health and well-being of Quebecers by providing access to a set of integrated and high-quality health and social services, thereby contributing to the social and economic development of Québec. Its website presents the administrative organization, press releases, publications, information for health professionals, a directory of resources in the areas of health and social services, and more. « Health and Social Services System in Brief » This section of the MSSS website gives an overview of the Quebec health and social services system. It presents its structure, the ministry's roles and responsibilities and those of the different institutions within its network, the health status of the Quebec population as well as governmental and ministerial policies and action…

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.

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.

Spain - Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

This study published in BMC Health Services Research empirically measures how sensitive prescribing doctors are to the price patients pay for drugs. The study analyses population data on primary care prescriptions for cardiovascular disease and mental illness in the Spanish National Health System. Implications for drug policies are discussed.

Australia - A New Ten Year Plan for Mental Health

On January 16, 2012, the Australian Ministry of Mental Health and Ministry of Disability Reform released a Ten-Year Roadmap for National Mental Health Reform. The Roadmap will provide state governments, workplaces, communities and the health sector with a measurable long-term national reform plan to determine mental health policies and funding over the coming decade.

UK - RCGP consultation on developing integrated care

This information brief from the Royal College of General Practitioners (RCGP) consults general practitioners about the development of integrated care in order to form policies guiding future service design. The RCGP will relay consultation feedback to the U.K. Department of Health.

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

Published in August 2011, this study of contemporary European health governance conducted for the WHO defines a ‘whole of society approach’ to health governance that requires synergistic policies supported by many mechanisms enabling collaboration across the health sector and beyond. The study states that public health agencies are ideally placed for partnerships and joint actions.

International — Spending for seniors to double or more by 2050, says OECD

Spending on long-term care in OECD countries is set to double, even triple, by 2050, driven by ageing populations. Governments need to make their long-term care policies more affordable and provide better support for family careers and professionals, according to a new OECD report. “Help Wanted? Providing and paying for long-term care” says that half of all people who need long-term care are over 80 years old. And the share of the population in this age group in OECD countries will reach nearly one in ten by 2050, up sharply from one in 25 in 2010. This percentage will reach 17% in Japan and 15% in Germany by 2050.

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.

Australia - Strategic approaches to the development of Australia’s future primary care workforce

Shortages in, and misdistribution of, the primary health care workforce will continue to limit access to health care. The current health reform proposals and policies recognise workforce development as a priority, but only partially address the barriers to improvement. In particular, there will need to be more systematic development of interdisciplinary education within primary health care services, and funding to support this according to the authors of this article.

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.

Europe - Health Systems, Health, Wealth and Societal Well-being

This book by the European Observatory on Health Systems and Policies is a compilation of studies arguing that health systems are not a drag on resources but a means to improve societal health to achieve economic growth. The book’s 18 authors take a multidisciplinary look at interdependencies between health and wealth.

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…

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.

Italy - Veneto Region, Italy: Health system review. Health Systems in Transition. 2012

This health system profile from the European Observatory on Health Systems and Policies examines different approaches to the organization, financing and delivery of health services and the role of the main actors in the health system of this region of Italy.

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.

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…

Telehealth : what can the NHS learn from experience at the U.S. Veterans Health Administration?

Brief analytical summaries or syntheses #35 Telehealth what can the NHS learn from experience at the U.S. Veterans Health Administration? Summary Published on the website, this comparative study examines the largest implementation of telehealth anywhere, the Veterans Health Administration in the U.S. With the British government's announcement of the positive results of the Whole System Demonstrators and the launch of the 3 Million Lives Programme, this report is timely as U.K. stakeholders plan how to implement telehealth widely and deliver significant benefits. Background As a large publicly funded system delivering comprehensive services to a veteran population of 23m and with an annual budget of over £30bn, the VHA has many parallels with the NHS. Extensive studies show that the VHA consistently provides a better quality of care than other health systems in the U.S., and at a lower cost. Central to its strategy of ‘keeping patients healthy’, the VHA…

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 — Health Care in a Renewed Federalism

In this paper, Tom Kent argues that confusion and conflict in the Canadian fiscal federalism are inhibiting nation-wide economic, social and environmental policies of which Canada has urgent need. The impending negotiation of new financing arrangements for Medicare can be the occasion for a wide reshaping of federal-provincial relations.

International - Health Care Systems: Efficiency and Institutions

This paper presents a set of indicators to assess health care system performance. It also presents new comparative data on health care policies and institutions for OECD countries. This set of indicators allows the empirical characterisation of health care systems and the identification of groups of countries sharing similar health institutions. It also helps to uncover strengths and weaknesses of each country’s health care system and assessing the scope for improving value-for-money.

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.

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.

Canada - National pharmacare plan could save up to $10.7 billion a year: study

A universal public pharmacare plan could generate savings of up to $10.7 billion on prescription drugs, says a new study released recently by the Canadian Centre for Policy Alternatives (CCPA) and Institut de recherche et d’informations socio-economiques (IRIS). The study finds Canadians could save between 10% and 42%—up to $10.7 billion—of total drug expenditures, depending on the choice of industrial policies related to drug costs.

Netherlands - The Netherlands: Health system review. Health Systems in Transition

The Health System in Transition’s (HiT) profile on the Netherlands was co-produced by the European Observatory on Health Systems and Policies and NIVEL, Netherlands Institute for Health Services Research. The report examines the organisation’s financing and delivery of health services and the role of the main actors in the health system.

Europe - Global Health: European Commission calls on European Union to gear up on health actions

The European Commission has recently adopted proposals to enhance the EU's role in global health. The objective is to make Europe's contribution more effective so as to better accompany developing countries towards achieving health-related Millennium Development Goals (MDGs). The Commission presents four approaches to improving global health: establish a more democratic and coordinated global governance; push for a collective effort to promote universal coverage and access to health services to all; ensure better coherence between EU policies relating to health; improve coordination of EU research on global health and boost access in developing countries to new knowledge and treatments.

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.

Republic of Korea: Health system review. Health Systems in Transition, 2009

This paper produced by the European Observatory on Health Systems and Policies focuses on major health care reforms carried out in the last (ten)10 years. These include the integration of existing health insurance funds into a single insurer system in 2000 and the incremental expansion of the benefit package.

International - Economic Transition and Health Care Reform: The Experience of Europe and Central Asia

This paper exploits the staggered adoption of major concurrent health reforms in countries in Europe and Central Asia after 1990 to estimate their impact on public health expenditure, utilization, and avoidable deaths. While the health systems all derived from the same paradigm under central planning, they have since introduced changes to policies regarding cost-sharing, provider payment, financing, and the rationalization of hospital infrastructure.

Vietnam - Dynamics of health insurance ownership in Vietnam, 2004 – 06

Vietnam is undertaking health financing reform in an attempt to achieve universal health insurance coverage by 2014. Changes in health insurance policies have doubled the overall coverage between 2004 and 2006. However, close examination of Vietnam Living Standard Surveys during this period reveals that about one fifth of the insured in 2004 dropped out of the health insurance system by 2006. This paper uses longitudinal data from VHLSS 2004 and 2006 to investigate the characteristics of those who joined and those who left the health insurance system.

International - Improving Value in Health Care. Measuring Quality

This report gives new evidence on patient safety across OECD countries, and shows that large variations in quality of care remain for cancer, stroke, heart attacks, and services provided by family doctors. It addresses the various ways countries can improve measuring quality; the need for a balance between privacy concerns and transparency on quality and safety and how links can be made between quality indicators and policies to improve the performance of physicians, hospitals and the health care system as a whole.

Italy - Does Fiscal Discipline towards Sub-National Governments Affect Citizens’ Well-Being? Evidence on Health

This paper aims at assessing the impact on citizens’ well-being of fiscal discipline imposed by Central Government to sub-national governments. Since health care policies involve strategic interactions between different layers of governments in many different countries, the authors of this paper focus on a particular dimension of well-being, namely citizens’ health. In other words, does fiscal discipline towards sub-national governments has any real effects on citizens’ well-being, by influencing their health, e.g., via a reduction of the quantity or the quality of relevant health care services? Or it simply reduces the waste of public resources, e.g., by rationalizing the existing hospital network or improving service appropriateness?

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…

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.

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.

World Health Report 2010
Health systems financing: The path to universal coverage

Brief analytical summaries or syntheses #10 World Health Report 2010 Health systems financing The path to universal coverage Summary The 2010 World Health Report presents practical guidance on ways to finance health care. It describes different options for changing healthcare financing systems in order to move towards universal coverage and maintain gains that have been achieved to date. The report draws on evidence and lessons from a number of different countries. Background Promoting and protecting health is essential to human welfare and sustained economic and social development. This was recognized more than 30 years ago by the Alma-Ata Declaration signatories, who noted that Health for All would contribute both to a better quality of life and also to global peace and security. In this context, timely access to health services is critical. This cannot be achieved, except for a small minority of the population, without a well-functioning health financing system.…

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.

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.

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.

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.

The Netherlands - OECD Economic Surveys: Netherlands 2012. Health care reform and long-term care in the Netherlands

This survey examines recent economic developments, policies and prospects and takes a special look at harvesting the benefits of globalisation, the labour market, and health care reform. This last chapter looks at reforms brought in over the past decade and at the next wave of reforms.

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.

Europe - Report on health inequalities in the European Union

In 2009, the European Commission adopted a communication on ‘Solidarity in health: reducing health inequalities in the EU" and introduced measures to support action by Member States and stakeholders, along with EU policies. The report describes the main actions the Commission has taken and examines trends in health inequalities since 2000 with a focus on recent years.

International - Series of five papers on integrated primary health care

In this this policy issue review, the Primary Health Care Research and Information Service examine policies that have an impact on the integration of care at the macro, meso and micro levels.

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 - Implementing a Health 2020 vision: governance for health in the 21st century. Making it happen

This report from the WHO Regional Office for Europe outlines how whole-of-government and whole-of-society approaches can achieve real health outcomes. The report reviews a range of specific policies and programmes from the European Region and elsewhere, highlights the lessons learned, and provides valuable guidance in pursuing this agenda of good governance for health.

Australia - The Australian Government releases the National Aboriginal and Torres Strait Islander Health Plan

On July 23, 2013, the Australian Government released an evidence-based policy framework to guide policies and programs to improve Aboriginal and Torres Strait Islander health over the next decade. It continues efforts begun in 2008 to close the gap in life expectancy and child mortality between these two groups and the broader population. The framework involves additional spending of $12 billion over the next 10 years.

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.

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.

Austria - Austria: Health system review. Health Systems in Transition, 2013

Produced by the WHO, this publication examines the organization, financing and delivery of healthcare in Austria. It describes the framework, process and implementation of healthcare policies and makes an assessment of the health system based on measures of equity, quality, efficiency and accountability.

France – Launch of a consultation on a bill to help adapt French society to population aging

On November 29, 2013, the French Prime Minister launched a consultation on a bill to establish direction for adaptation of an aging society. The bill aims to establish individual and collective mechanisms to prevent loss of autonomy, and re-examine all policies relating to longer lifespans: transport policy, housing, of planning, among others. The ambition is to pass the law before the end of 2014.

UK - UK needs to tackle high cost of mental-ill health, says OECD

According to this report by the OECD, mental health issues cost Britain an annual £70 billion ($126.8 billion), or 4.5% of GDP, in benefit payments, healthcare expenditures, and lost productivity at work. Better policies and practices by employers and the UK health system are needed to help people with mental health issues get back to work.

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.

Australia - Medical graduates becoming rural doctors: rural background versus extended rural placement

Australia promotes rural physician employment by funding extended placements at rural clinical schools and providing incentives to medical schools to recruit rural students. This study assesses whether these policies are associated with the acceptance of rural internships. The authors found that rural clinical training is more influential than background in the decision to practice in a rural area.

UK - Wellbeing and Policy

In 2011, Britain’s Legatum Institute established a Commission on Wellbeing and Policy to advance the national policy debate. This initial report by the Commission is intended to give UK policymakers a greater understanding of how wellbeing data can be used to improve public policy through the use of metrics not wholly based on economics, such as GDP.

Norway - Norway: Health system review. Health Systems in Transition, 2013

Published by WHO, this review examines the organization, financing and delivery of Norway's healthcare system. Actors, institutional frameworks, and the implementation of public health and healthcare policies are described in detail, as are current efforts at reform.

International - The Role of Fiscal Policies in Health Promotion

This paper provides a review of the theoretical arguments and empirical evidence on the key factors that governments must address when considering the adoption of fiscal measures for health promotion. The main focus is on taxes on health-related commodities.

Europe - Governance for health equity in the WHO European Region

This report from the WHO analyzes why policies and interventions to address social health determinants and health inequities succeed or fail. It discusses features of governance and systems for service delivery that increase success in reducing inequities, and presents a checklist for health equity governance.

Europe - Promoting health, preventing disease: is there an economic case?

This report from the European Observatory of Health Systems and Policies presents the evidence for interventions that address risk factors to health. Many such actions are delivered outside the health sector. Most interventions bring long-term cost benefits, making efforts aimed at children more cost-effective than others.

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.

Canada - Spending on drugs continues to rise but at a much slower annual growth rate—3.3%, the lowest in 16 years—reveals the Canadian Institute for Health Information (CIHI)

According to CIHI’s Drug Expenditure in Canada, 1985 to 2012, drugs continued to account for the second-highest share (15.9%) of health spending, behind hospitals and ahead of physicians. However, drug spending has grown more slowly than those two categories over the past decade. The slowed growth in prescribed drug spending is due to patent expirations of several blockbuster pharmaceuticals and generic pricing policies.

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.

Italy - Italian mutual benefit societies: an organizational social innovation in health and healthcare system

This paper from AICCON Cooperazione looks at the role played in Italian healthcare by mutual benefit societies (MBSs), traditional local insurance cooperatives that offer healthcare and welfare benefits to members. The paper says MBSs are an important supplement to Italian government policies for integrating health and welfare costs.

Brazil - Horizontal equity in health care utilization in Brazil, 1998–2008

This study published in the International Journal for Equity in Health assesses Brazilian trends in achieving equity in the utilization of healthcare services from 1998 to 2008, a period of major economic and social change in Brazil. The study finds that government policies have made healthcare utilization increasingly equitable.

Israel - Excellent primary health care, but hospitals must improve

Israel has world class-primary care services and should now focus efforts on bringing its hospitals up to the same high international standards, according to the OECD Reviews of Health Care Quality: Israel. While most OECD countries grapple with rising healthcare costs, Israel has maintained tight control – limiting health spending to about 8% of GDP, the eighth lowest across OECD countries – and still offers universal coverage and high-quality primary health care services.

UK - Quality in the new health system — Maintaining and improving quality from April 2013

This report sets out future policies for quality improvement in Britain’s National Health Service (NHS). The NHS is organising itself around a single definition of quality — care that is effective, safe, and provides as positive an experience as possible.

Canada - Harper Government Responds to the Senate Review of the 2004 Health Accord

On September 25, 2012, the Government of Canada tabled its response to the Senate Review report “Time for Transformative Change.” The Government's response is grounded in the following core values: a steadfast commitment to Canada's universal, publicly funded health care system; the recognition that provincial and territorial governments hold primary responsibility for the delivery of care; and the firm belief that Canadians can and should play an active role in their own health.

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.

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…

Ireland - Launch of Healthy Ireland - A Framework for Improved Health and Wellbeing 2013 – 2025

A new framework for improved health and wellbeing was launched in March 2013 by Ireland’s government. It lists 64 broad intersectoral actions, with partners including government, the health sector, civil society organizations, the voluntary sector, the private sector, unions and universities.

Europe - Governing Public hospitals

This special issue of EuroHealth, the quarterly of the European Observatory on Health Systems and Policies, focuses on public hospital governance across Europe. It features such topics as hospital autonomy in Spain, pay-for-performance in Macedonia, and innovative governance in Norway.

UK - Social care reform: funding care for the future

Britain’s increasing numbers of older people are straining social care services and causing a pent-up demand for residential care places. This British Parliamentary document discusses these issues and the funding of the UK government’s new social care reform program. The document reviews social care policies over the past 10 years.

USA - Health Care Costs: Solutions from HCFO Research

A research program of the Robert Wood Johnson Foundation (RWJF), Health Care Financing and Organization (HCFO) examines the cost impacts of existing healthcare policies, devises strategies to reduce costs, and formulates potential future costing approaches. The 24 previously published studies contained in this new HCFO research report deal with a variety of issues within these three categories.

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…

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.

USA - Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System

This report by the Commonwealth Fund advocates tying future increases in US health spending to long-term GDP growth, while simultaneously moving to a high performance healthcare system. The report lays out a three-pronged strategy relying on provider payment reform, policies to encourage high-value choices by consumers, and system-wide action to improve healthcare markets.

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.