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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…

Opportunities and challenges in measuring the quality of care in England

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

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

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

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

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

Do quality improvements in primary care reduce secondary care costs ?

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

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…

United Kingdom: Management of NHS hospital productivity

Brief analytical summaries or syntheses #13 United Kingdom Management of NHS hospital productivity Summary Hospital productivity has fallen over the last ten years. There have been significant increases in funding and hospitals have used this to deliver against national priorities. But, according to this report from the National Audit Office, hospitals need to provide more leadership, management and clinical engagement to optimise the use of additional resources. Background In 2000, the Department of Health published the NHS Plan, a ten-year vision for reforming the NHS. The Plan argued that the NHS was failing to deliver because it had been under-funded, and set out to substantially increase funding in order to meet public expectations for more and better paid staff using new ways of working; reduced waiting times; high quality patient-centred care; and improvements in local healthcare buildings. The Plan set out the systemic problems of the NHS, such as a…

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

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

A CEO Checklist for High-Value Health Care

Brief analytical summaries or syntheses #45 A CEO Checklist for High-Value Health Care Summary This discussion paper reflects an Institute of Medicine Roundtable Discussion among the CEOs of major American health systems. It provides a checklist of 10 strategies that, in their experience, have proven effective and essential to improving quality and reducing costs. Background Leaders of health care organizations are acutely aware of the pressures that rising health care costs place on individuals, employers, and the government, and of unacceptable shortfalls in the quality and efficiency of care. They have also learned, through experiences in their own institutions and through communication and collaboration with colleagues in other institutions, that better outcomes at lower costs can be achieved through care transformation initiatives that yield improved results, more satisfied patients, and cultures of continuous learning. These transformation efforts have generated certain foundational lessons relevant to every CEO and Board member, and…

Managed competition in the Netherlands: an example for others?

Brief analytical summaries or syntheses #21 Managed competition in the Netherlands an example for others ? Summary The introduction of managed competition in the Netherlands in 2006 fundamentally changed the roles of patients, insurers, providers and the government. This article, included in the last issue of Eurohealth, discusses the challenges presented by the introduction of managed competition in the Netherlands. Background After almost two decades of preparation, major health system reforms were introduced in the Netherlands in 2006. These brought important new structures and regulatory mechanisms to the Dutch health system, including managed competition among actors in health care. The basic aims of the reform were to contain rising health expenditures by increasing health system efficiency (i.e. higher quality at lower costs) through the introduction of managed competition; reduce system inequities related to age, income and health status (under the new system everybody is insured under the same conditions and…

Canada - Quality Matters: Realizing Excellent Care for All

The Quality Matters initiative is part of Health Quality Ontario’s ongoing effort to unite everyone in the health system through a common language of quality and to reach a shared commitment to take action on common goals. This report articulates the vision guiding the initiative. It offers six domains of quality, a set of principles to guide us, and key factors we need to consider in order to instill quality at the core of our health system. A one-page visual and a patient video accompany the report.

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.

International - Can competition reduce quality?

This paper from Portugal’s University of Minho studies competition’s effects on quality in markets such as health care when competition among provider is based on both price and quality. The paper argues that because providers are motivated and risk-averse and because, for given quality levels, fiercer competition results in lower profits due to lower prices, providers will respond by lowering their quality in order to recover some of the lost profits.

UK — Maintaining and Improving Quality during the Transition: safety, effectiveness,

This report is the first in a two-phase review about maintaining and improving quality during the transition and beyond. Focusing on 2011/12, it describes the key roles and responsibilities for maintaining and improving quality; suggests practical steps to safeguard quality during the transition; and emphasises the importance of the effective handover of knowledge and intelligence on quality between old and new organisations.

UK - OECD reviews of health care quality: United Kingdom 2016

This report by the OECD looks at healthcare quality in the UK’s four regions: England, Scotland, Wales and Northern Ireland. It says the four health systems need to publish more disaggregated quality and outcomes data, and balance top-down approaches to quality management with bottom-up approaches to quality improvement.

The Netherlands - Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands

In this study, researchers interviewed 72 health professionals and quality managers in 14 acute care hospitals to explore the use of performance indicators for internal quality management activities. Differences in hospital data collection made comparisons of outcomes difficult, but the study suggests that robust data collection software, proactive quality managers and engaged medical specialists are positive factors for performance indicator use in hospital quality management.

Canada — Ontario is consolidating the former Ontario Health Quality Council and five other health care organizations into Health Quality Ontario

Under the Excellent Care for All Act, the Ontario Health Quality Council is now Health Quality Ontario which has an expanded mandate to: recommend and help health care providers adopt evidence-based standards of care and best practices; and monitor and report on quality improvement efforts across health care sectors.

UK - Improving quality in general practice

Developed for the benefit of attendees attending a UK National Summit on Quality in General Practice in July 2014, this evidence scan investigates definitions of quality, tenets of quality care important to the public, and past interventions to improve the quality of general practice care. The scan concludes that patients want easy access to care, clinicians with good interpersonal skills, and shared decision-making processes.

UK - Quality 2020 - A 10-year Quality Strategy for health and social care in Northern Ireland

A 10 year Quality Strategy for Health and Social Care has been developed for Northern Ireland. It is intended that the Strategy will protect and improve quality and aim to achieve excellence, in terms of safety, effectiveness and patient/client experience in the period up to 2020. A consultation document is available online.

USA - Study Finds Consumers Choose High-Value Health Care Providers When Given Good Cost and Quality Information

According to this study from the Agency for Healthcare Research and Quality (AHRQ), U.S. consumers consistently associate more expensive healthcare options with higher quality care. However, when shown detailed cost and quality information, consumers instead choose providers who deliver high-quality care at a lower cost. The study's findings have many implications for the design of provider report cards for the public.

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

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

UK - Paying for quality: an analysis of the impact of the 2010/11 Commissioning for Quality and Innovation Scheme (CQUINs) in London

Published by consultancy MHP Health Mandate, this report examines Commissioning for Quality and Innovation (CQUIN) schemes, an internal U.K. National Health Service (NHS) program that rewards the delivery of quality improvements with financial payments. The report finds that while CQUIN schemes focus on improvements in clinical effectiveness, some merely reward achieving a minimum standard of care.

Nurses in advanced roles: a description and evaluation of experiences in 12 developed countries

Brief analytical summaries or syntheses #1 Nurses in advanced roles a description and evaluation of experiences in 12 developed countries Summary This health working paper from the OECD Directorate for Employment, Labour and Social Affairs looks at the development of advanced practice nurses in 12 countries Australia, Belgium, Canada, Cyprus, Czech Republic, Finland, France, Ireland, Japan, Poland, United Kingdom and United States. Many countries are seeking to improve healthcare delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in situations of limited or diminishing supply of doctors. The redefinition of roles might also contain costs by delegating some of the tasks currently accomplished by expensive doctors to nurses, especially in primary care. The paper also assesses how the reorganization of work impacts the quality of patient care. Background Advanced nursing roles vary significantly between countries. The…

USA - Bundled Payment: Effects on Health Care Spending and Quality: Evidence Report

This evidence report from the Agency for Healthcare Research and Quality (AHRQ) evaluates the effects of bundled payment systems on health care and quality of care. The report is part of Closing the Quality Gap, a series updating a 2004 collection of quality improvement strategies.

USA - Measuring the quality of healthcare in the U.S.

The American healthcare system is vast, and has no easy way to determine the quality of its products and services. This brief describes various approaches to measuring the quality of US health care and provides trend and comparative statistics on key measures. Available data suggests the quality of US health care is improving, but is falling short of other developed countries.

Canada - Health Quality Ontario Publishes New Report on Cross-Sectoral Quality Improvement

A Quality Improvement Plan (QIP) is a formal commitment to quality improvement, aligned with system and provincial priorities. This most recent analysis of the QIPs submitted by Ontario’s healthcare organizations explores how organizations across the province are partnering with their peers in other sectors in order to deliver more collaborative care for their patients and ensure appropriate transitions between care providers.

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.

China - Types of health care facilities and the quality of primary care: a study of characteristics and experiences of Chinese patients in Guangdong Province, China

This study assesses potential differences in the quality of primary care provided in Chinese county hospitals, rural community health centres (CHCs), urban CHCs, and tertiary and secondary hospitals. Based on a survey of a total 8,640 patients in Guangdong province, the authors used a Primary Care Assessment Tool (PCAT) to compare quality domains. Results showed that urban CHCs provided the best quality primary care by far.

Canada - Quality Reporting in German Hospitals: A Model for Quebec

Québec’s government is planning to fund hospitals using an activity-based formula rather than historically defined global budgets. This article says this measure should be paired with the kind of mandatory quality reporting that exists in Germany in order to harmonize and publicize Québec’s hospital quality data. Published regularly on the Internet, German quality reports provide comprehensive information on the treatments provided in hospitals.

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

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

Canada - 2013/14 Hospital Quality Improvement Plans: An Analysis for Improvement

This report from Health Quality Ontario analyses quality improvement plans for 2013/14 submitted by all Ontario hospitals. It assesses progress on the delivery of patient-centred, evidence-informed, continuously improving care that makes efficient use of health system resources. Findings indicate that more hospitals are soliciting the opinions of patients and involving patients in the design of care. Coordination of care remains a challenge. The report further analyses quality improvement by indicator.

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…

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 - Which way to quality? Key perspectives on quality improvement in Canadian health care systems

To learn what is happening across Canada, the Health Council interviewed senior health system leaders to hear more about their experiences with system-wide approaches to quality improvement. This report highlights the range of approaches to measuring and improving quality being used across Canada.

UK - QualityWatch Annual Statement 2013

In this annual report, the UK organization QualityWatch assesses the quality of Britain’s health and social care services. The assessment draws on 150 indicators spanning primary care, community services, hospital stays, mental health services and social care. The indicators are evaluated in relation to six domains of care quality: access, safety, effectiveness, capacity, equity, and person-centred care.

Canada - Quality of care: How the provinces fare internationally

For the first time, provincial and international health care systems can be compared in terms of quality of care. The Canadian Institute for Health Information(CIHI) found that the results of these comparisons are mixed, with no province being consistently the best or worst performer across the Organisation for Economic Co-operation and Development (OECD) quality of care indicators. CIHI provides snapshots of international comparisons for each province through a new interactive tool. A companion report, International Comparisons: A Focus on Quality of Care, contains essential information and context for interpreting Canada’s performance on various indicators and identifies potential quality improvement strategies.

Health care for 1.3 billion. An overview of China’s health system

Brief analytical summaries or syntheses #41 Health care for 1.3 billion. An overview of China’s health system Summary This Stanford University paper provides a brief overview of how China’s health system has transformed alongside society and economy since the 1960s. The paper describes how the Chinese system is financed, organized and regulated, and why it is currently being reformed. Background A half century ago, in the early Mao era, China’s population of half a billion people was young (36% aged less than 15), 80 percent rural, one-third illiterate, and living in absolute poverty. By 2010, China’s 6th population census — the largest social survey ever conducted — revealed a population of 1.3397 billion that was fundamentally different ageing (13.3% over age 60 and only 16.6% below age 15); half (49.7%) urban; 96% literate, with 23% attaining a high school or college education; and the second largest economy in the world,…

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.

Canada - Alberta: Quality and Patient Safety Dashboard Indicators

Alberta Health Services announced a new “dashboard” of measurements designed to gauge its performance and drive improvement throughout the health system. The Quality and Patient Safety Dashboard will measure 26 quality- and safety-related indicators and identify potential areas for improvement. The Alberta Health Services Board, through its Quality and Safety Committee, will monitor the dashboard on a regular basis. About half of the dashboard indicators will be reported in 2010, with the remainder reported by 2013, as some indicators require the implementation of a program or data collection processes.

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.

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.

A guide to physician integration models for sustainable success

Brief analytical summaries or syntheses #49 A guide to physician integration models for sustainable success Summary As health care delivery and financing shifts from a volume-based to a value-based business model, improved alignment between hospitals and physicians becomes essential. This guide, published by Health Research & Educational Trust, describes the prerequisites for successful hospital-physician integration and offers an overview of integration models currently used in American hospitals and health systems. Background This guide offers an overview of physician integration models currently deployed at hospitals and health systems. These models include a wide array of programs, covering customer service offerings, contractual ventures, joint venture/shared equity arrangements and employment/practice acquisition models. The legal, taxation and regulatory issues surrounding hospital-physician integration are complex and changing. Analysis and results As health care delivery and financing shifts from a volume-based to a value-based business model, provider success will be achieved through offering services with the…

Primary care for the 21st century

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

UK - More than money: closing the NHS quality gap

Caught between an enlarging mandate and available resources, Britain’s National Health Service (NHS) is currently in financial difficulty. This report discusses the impact on quality of care, arguing that additional resources alone will not be enough to close a growing ‘quality gap’. The report outlines service delivery and care improvements that could make the NHS more quality conscious and cost-effective.

International - Measuring, Reporting, and Rewarding Quality of Care in 5 Nations: 5 Policy Levers to Enhance Hospital Quality Accountability

This study deals with accountability for the quality of hospital care in England, Germany, the Netherlands, Sweden and the US. It identifies five levers to enhance accountability: a central role for standards and incentives; a balance in system centralization to enable national comparisons and promote local innovation; a focus on outcomes transparency; the engagement of providers as proponents; and reporting that focuses on hospitals to ensure comparability and patient choice.

USA — Lessons Learned in Public Reporting: Crossing the Cost and Efficiency Frontier

This brief provides lessons from communities involved in Aligning Forces for Quality, the Robert Wood Johnson Foundation’s signature effort to lift the quality of care in America. Public reporting is a cornerstone of the Aligning Forces for Quality program. This brief focuses on the evolving process of public reporting and the challenges associated with adding cost and efficiency measures to reports of quality performance data.

Canada - Health Quality Ontario Unveils New Data on Existing Health Interventions and Highlights Areas for Change in the Province's Health Care System

Health Quality Ontario (HQO) has released the 4th edition of its Ontario Health Technology Maps Project Report. It looks at the adoption of evidence-based medical and surgical procedures and laboratory tests and provides information to healthcare professionals on variations in care across the province, and on changes needed to improve the quality of health care for Ontarians.

Canada - Variations in Quality Indicators across Ontario Physician Networks

This chartbook from the Institute for Clinical Evaluative Sciences (ICES) in Ontario reports performance levels for a set of quality indicators that reflect health care delivery across settings of primary and specialty care, acute hospital care and long-term care, as well as shared care and transitions from one setting to another. The quality indicators include screening and prevention, evidence-based medications, drug safety, hospital to community transitions, adverse outcomes, imaging and cancer end-of-life care.

France - The relationship between costs and quality of care : a profitable alliance for hospitals?

Investigating the relationship between cost reduction and quality of care, this review considers whether the two objectives are contradictory or can be resolved to the benefit of hospitals and health systems overall. Its findings show that no international consensus has yet developed because the impact of quality of care on costs is still difficult to quantify.

France - What the French think about the quality and accessibility of care

According to public opinion polls conducted by the DREES, 80% of French residents think they receive good quality medical and dental care, a level that falls to 65% for care received in public hospitals. Satisfaction with access to care has fallen 10 points over 10 years to reach 70%, and the majority (60%) believe that care varies according to where you live, an inequality that is of considerable concern.

International Profiles of Health Care Systems

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

New Zealand - Exploring the Links between Quality Improvement Strategies and Organisational Outcomes in Four New Zealand District Health Boards: Final Report

This publication reports on the results of a project initiated by three New Zealand government agencies in 2015 that examined links between quality improvement strategies implemented by New Zealand district health boards (DHBs) and their organizational outcomes. A number of DHBs use quality frameworks and concepts as core elements of their strategies to improve patient outcomes and manage costs.

International - The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries

Drawing on the Health Care Quality Indicator program of the OECD, this study looks at doctors in hospital management in 19 OECD countries and examines the phenomenon in more depth in seven OECD countries. It determines that doctor involvement in hospital management is positively associated with the advanced implementation of quality management systems.

Sweden - Management Practices and the Quality of Primary Care

This study explores the use of management practices in primary care units, based on the World Management Survey method. It relates the scope and quality of management to different types of primary care providers and to the quality of care. Overall, the results suggest a high level of management quality in Swedish primary care.

UK - Focus on: international comparisons of healthcare quality - what can the UK learn?

This study compares British healthcare quality in four sectors (primary care, acute care, cancer care and mental health) with equivalent care in 12 countries: Australia, Belgium, Canada, France, Germany, Ireland, Italy, the Netherlands, New Zealand, Spain, Sweden and the US. Analysis reveals that the UK ranks last or second last on 16 of 27 quality indicators used in the study.

Finland - Dimensions of health care system quality in Finland

This paper from the Government Institute for Economic Research evaluates the determinants of quality-cost relationship in primary health care in Finland. It uses principal component analysis to produce quality of care indicators and evaluates the relationship between these and cost.

UK - International benchmarking of healthcare quality: A review of the literature

The report focuses on the three quality domains identified as important by the NHS Next Stage Review High Quality Care for All, namely effectiveness of care, patient safety and patient experience.

Canada – Quality Monitor. Ontario Health Quality Council. 2010 report on Ontario’s health System

The report shows that although there have been some modest improvements in quality across Ontario’s health system, there is room for more improvement. There are examples of higher performance that could be applied more broadly. The top-line findings underscore areas of concern that are of critical importance: wait times; the accuracy and completeness of medical information; chronic disease management; access to primary care; and patient safety.

Canada - Quality of Healthcare in Canada: A Chartbook

The Canadian Health Services Research Foundation has released Canada’s first-ever chartbook on healthcare quality. Providing both domestic and international data, the chartbook reports on six key domains of quality: the effectiveness of the healthcare sector; access to healthcare services; the capacity of systems to deliver appropriate services; the safety of care delivered; the degree to which healthcare in Canada is patient-centred; and equity in healthcare outcomes and delivery.

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

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

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…

Canada - Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality

Produced by the Ottawa Hospital Research Institute, this article describes a 2010-2015 initiative to achieve a higher quality of patient care in Canada’s university hospitals. The bottom-up initiative was successful in engaging healthcare leaders in developing a framework and set of performance measures for reporting and benchmarking.

Portugal - OECD Reviews of Health Care Quality: Portugal 2015. Raising Standards

Released by the OECD, this report reviews the quality of Portuguese health care, highlights best practices, and provides a series of targeted assessments and recommendations for improvement. The report describes how Portugal has responded well to financial pressure, successfully balancing financial consolidation and continuous quality improvement.

USA - Aligning Forces for Quality Report. Local Efforts to Transform American Health Care

This special report from the Robert Wood Johnson Foundation’s (RWJF) Aligning Forces for Quality (AF4Q) initiative chronicles the program’s ambitious progress. AF4Q is the Foundation’s signature effort to improve the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform. It asks the people who get care, give care and pay for care to work together toward common, fundamental objectives to lead to better care. The program works to improve health care in 15 communities, that together cover 11 percent of the U.S. population. It is the largest effort of its kind ever undertaken by a U.S. philanthropy.

Switzerland - The relationship between costs and quality in nonprofit nursing homes

Using data from 45 Swiss nursing homes, this study investigates the relationship between cost and quality, a key issue in the context of cost containment measures. The study finds clear evidence that poor quality outcomes lead to higher costs.

Practice nurse cost benefit analysis: Report to the Ministry of Health in New Zealand

Brief analytical summaries or syntheses #2 Practice nurse cost benefit analysis Report to the Ministry of Health in New Zealand Summary This study looks at the financial impact of transferring tasks from GPs to nurses and GPs in primary health care in New Zealand (NZ). It describes a model developed to estimate this impact based on 2,000 consultations in nine New Zealand primary care practices and summarizes findings from a literature search. It is clear that practice nurses can, and in some practices in NZ, do provide a broad set of primary care services. The study focuses on the financial contribution practice nurses make to primary care practices and does not address issues of quality of care, utilization of care, workforce availability or the managerial work required to distribute tasks between doctors and nurses. Background The study is part of the ‘New Zealand Primary Health Care Strategy 2001,’ which articulates…

Canada - Canada's Quality Improvement Conundrum

The Health Council has published Proceedings of the National Symposium on Quality Improvement held last October. The symposium provided an opportunity for 200 senior leaders from across Canada to discuss health system performance measurement and reporting, as well as the need to build capacity and capability for quality improvement.

International - The 2015 Quality of Death Index. Ranking palliative care across the world

The 2015 Quality of Death Index, a measure of the quality of palliative care in 80 countries, shows that income levels are a strong indicator of the availability and quality of palliative care, with wealthy countries clustered at the top. The UK, Australia and New Zealand rank first, second and third, while Canada is in 11th place.

UK - A guide to quality improvement methods

Developed by the Healthcare Quality Improvement Partnership (HQIP), this guide introduces 12 quality-improvement methods based on a review of the international literature. It describes when and how the methods should be used and presents case examples and tools to assist implementation. Methods include clinical audits, performance benchmarking, and process mapping.

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

This report reviews information systems that report on the quality or performance of providers of healthcare in seven countries (Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States) to inform the use and further development of quality information systems in the English NHS.

Ireland - Health Care Quality Indicators in the Irish Health System

Utilizing an IT system called HIPE to capture information on all hospital stays in Ireland’s public hospitals, this preliminary government report is an important step in the development of an Irish national reporting system on health quality. The system will report at national and regional levels and will enable international comparison on selected health indicators.

USA — Success Factors in Five High-Quality, Low-Cost Health Plans

In this report, the authors conducted case studies of five health plans that received high scores on quality and resource utilization, using data collected by the National Committee for Quality Assurance. The focus of this study was to understand how health plans with delivery systems that include a significant network of independent, community physicians achieve high performance.

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…

UK - Do quality improvements in primary care reduce secondary care costs? Primary

The introduction in 2004 of the Quality and Outcomes Framework (QOF) in UK general practice represents one of the most ambitious efforts to measure and incentivise quality improvements in primary care. This report takes advantage of a large database of over 50 million English citizens to determine whether the levels of QOF attainment in general practices have led to improvements in two major outcomes: mortality and the costs of hospital inpatient and outpatient use. The findings are that primary care performance improvements are associated with some modest but measurable improvements in subsequent outcomes and costs.

Australia - OECD Reviews of Health Care Quality: Australia 2015. Raising Standards

Published by the OECD, this review provides an overview of Australia’s mixed public and private health sector and the quality of its health services and institutions. It calls for a national approach to raise quality and performance, but says Australia’s health system functions well despite many overlapping jurisdictions that disrupt care funding and continuity.

UK — Impact of Quality and Outcomes Framework on health inequalities

This research study sets out to evaluate the impact of the Quality and Outcomes Framework (QOF) on the public health activities of general practices in deprived areas, and whether the QOF has contributed to reducing the gap in life expectancy as defined in national targets.

Portugal - Evaluating Hospital Efficiency Adjusting for Quality Indicators: an Application to Portuguese NHS Hospitals

This working paper by economics researchers at the University of Porto develops methodologies to assess whether there is a trade-off between efficiency and quality in Portugal’s National Health Service. The paper compares two methodologies to compute technical efficiency scores adjusted for quality.

USA – The State of Quality Improvement Science in Health. What Do We Know About How to Provide Better Care?

Quality improvement (QI) is considered a promising tool for transforming the health system. This paper looks at the evidence that supports QI’s ability to produce the intended effects. It looks at four fundamental questions about QI in health care, including how it has evolved over time, current evidence about its strengths and limits, what still needs to be learned, and what stakeholders can do to build capacity for QI research and practice.

UK - Developing People - Improving Care

Created by NHS Improvement, this evidence-based national framework guides action on skills building and leadership development in quality improvement. It focuses on helping NHS and social care staff develop four critical capabilities: systems leadership, compassion and inclusivity, talent management and knowledge of established quality improvement methods.

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

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

UK - Can pay for performance improve the quality of primary care?

In 2004, the UK National Health Service (NHS) introduced the world’s largest healthcare related pay-for-performance scheme in primary care: the Quality and Outcomes Framework (QOF). Primary care doctors were paid up to 25% more if they met a complex set of clinical and organizational indicators. This article explores what other countries can learn today from the UK’s experience with the QOF.

Denmark - Good hospitals but primary health care must improve

The Danish central government and regions are leading international efforts to reform hospital systems, improving quality and safety by gathering specialists into major hospitals and closing smaller ones. The country should now focus on modernising its primary care sector to deal with the rising demands of chronic disease and a leaner hospital sector, according to the OECD’s Health Care Quality Review of Denmark.

Lunch hour conferences 2012

Why a good idea as the integration of services is taking so long to implement ? May 25, 2012 By Yves Couturier, holder of Canada Research Chair in Professional Integration Practices of Gerontology Services, Université de Sherbrooke Louis Demers, professor, École nationale de santé publique Francis Etheridge, doctoral student and organizational change specialist This conference will address the results of a study on the implementation status of Quebec’s project to integrate services in three health and social services centres and will allow to reflect on the conditions that affect the ability of institutions to fully achieve the outcomes of the reform. It will also present the opportunity to discuss a new research project aimed at better understanding the role of health and social services agencies in Quebec and health agencies in France in the context of services integration. [b][i]Strategies for implementing quality indicators for primary care health service professionals and…

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.

Sweden — Quality and Efficiency in Swedish Health Care – Regional comparisons 2010

This is the fifth report in a series of indicator-based comparisons of healthcare quality and efficiency among the various regions and counties in Sweden. One purpose of the report is to make the publicly financed healthcare system more transparent. Another purpose is to promote healthcare management and control.

Canada – Ontario : 2011 Quality Monitor Released

Health Quality Ontario’s sixth annual report on Ontario’s health system, and first as HQO, identifies significant achievements and challenges in areas such as access to healthcare, chronic disease management and keeping the population healthy. Overall, despite progress across a wide range of indicators, there is room for further improvement.

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…

USA - The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance

The authors of this working paper, published by the Harvard Business School, examine the relationships between conformance and experiential quality and two important dimensions of hospital performance: cost efficiency and clinical outcomes. They find that hospitals with high levels of both conformance and experiential quality demonstrate better clinical outcomes as measured by length of stay and readmissions, but have worse performance with regard to cost efficiency.

UK - New programme to ensure greater local choice of care services

In September 2012, Britain’s Department of Health launched a program to provide more choice and quality in local care and support services. The new program, Developing Care Markets for Quality and Choice, will help local authorities shape regional markets for care services that drive up quality and provide greater choice.

The Netherlands - Dutch healthcare reform: did it result in better patient experiences in hospitals? A comparison of the consumer quality index over time

In 2006, the Dutch hospital market was reformed to create a more efficient delivery system through managed competition. To allow competition on quality, patient experiences were measured using the Consumer Quality index (CQI). This study in BMC Health Services Research examines whether public reporting and competition had an effect on the CQI between 2006 and 2009.

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

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

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

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

International - Contribution of quality management systems for patient safety: international panorama

This systematic review, published in Pratiques et Organisation des Soins, aimed to identify the contribution of international quality management systems in patient safety.

Canada - Effective Governance for Quality and Safety

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

USA - Public Reporting on Quality and Costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers?

This paper asks if public reporting of health provider performance leads to better consumer choices and improvements in care. Published in Health Affairs, the paper describes the theory behind public reporting, its evolution over time, and evidence as to whether it improves healthcare quality and lowers costs.

Australia - Quality improvement financial incentives for general practitioners

This policy issue review from the Australian Primary Health Care Research and Information Service (PHCRIS) examines financial incentive programs instituted in Australia, the UK, the US and Canada to improve the quality of primary care. In all cases, indicators are employed, though they are accompanied by different obligations and benefits. The authors also find that the literature lacks explicit acknowledgement of whether the outcomes measured were absolute or relative improvements.

UK - Changing care, improving quality: reframing the debate on reconfiguration

This report from the Academy of Medical Royal Colleges, the NHS Confederation and National Voices aims to highlight the value of collaboration and use the stakeholder conversations between the groups to support those engaged locally in making a decision on whether and how to redesign services. It provides an authoritative, expert view on a case for change that focuses on how to meet the needs of patients, improve the quality of care and achieve better value for society. The concern behind the report is that change itself has developed a negative image.

USA - Health Care Quality Continues to Improve, But Disparities Persist

According to a new report, the quality of American health care has improved steadily since 2000, with notable gains occurring in patient safety. However, disparities in care have not improved. Hospital visits for mental health care, for example, have increased among the poor — from 1,400 per 100,000 in 2007 to 2,000 per 100,000 in 2014.

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.

UK - Clinical-financial partnerships in the NHS: why we need them to deliver the cost and quality challenge

This study explores the importance of partnerships between financial and clinical leaders in Britain’s National Health Service (NHS) as it faces cost and quality-improvement challenges. The authors interviewed 20 senior healthcare leaders (including CEOs, CFOs, and hospital chiefs of medicine) to discuss efficiency savings and quality improvement.

Canada - Improvements in patient and public safety highlighted in 2014 Quality Index on Ontario's Cancer System

The Cancer Quality Council of Ontario (CQCO) released its 10th annual Cancer System Quality Index on June 24, 2014. It shows that the Ontario cancer system is successful in ensuring Ontarians are receiving care based on the best available evidence. Notable improvements were made in automated drug ordering systems in hospitals. Areas for improvement include reducing unplanned hospital visits during chemotherapy and radiation.

Canada - Toward Performance and Quality

This special edition of Healthcare Quarterly highlights the transformation that is under way in Ontario’s healthcare system. Many topics are discussed such as patient-centred care, successful Quality Councils, leadership, links between evidence and quality of care, and The Excellent Care for All Act.

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…

US - Centers for Medicare & Medicaid Services created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. The Nursing Home Compare Web site now features a quality rating system that gives each nursing home a rating of between one and five stars.

Australia - OECD health-care quality indicators for Australia 2011-12

This Australian government report summarizes information supplied to the Health Care Quality Indicators 2012–13 data collection of the OECD. The report compares Australian data with previous years and with other OECD countries. Indicators cover primary care, hospital acute care, mental health care, cancer survival, hospital patient safety and patient experience. Compared to OECD averages, Australia has a higher burden of asthma and chronic obstructive pulmonary disease, and higher readmission rates for schizophrenia and bipolar disorders, but also better survival rates for certain cancers and acute myocardial infarction.

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

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

Norway - Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality?

This study published in BMC Health Services Research aims to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement efforts. It also analyzes how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide.

France - Care Quality and Activity-Based Funding: for Better or Worst?

This article by researchers at the Institut de recherche et documentation en économie de la santé (IRDES) explores the possible impacts of diagnostic-related groups (DRG)-based funding in terms of treatment policy and medical outcomes and discusses how these payment models could be adjusted to improve care quality.

Europe - Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

Using institutional theory and an analysis of healthcare quality practices in 10 hospitals in five European countries, this British paper explores pressures to improve quality and constrain spending. How hospitals responded to these challenges was dependent on managerial competence and stability, and the coherence of demands from external institutions.

UK - How is success achieved by individuals innovating for patient safety and quality in the NHS?

In this study, researchers interviewed 15 National Health Service (NHS) professionals who had received a national award for developing healthcare innovations improving patient safety or quality. Four themes emerged from the data: personal determination, an ability to broker relationships and navigate organizational culture, and the effective use of evidence to influence others. Focus and persistence were important personal characteristics.

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…

Canada - 2010 Canadian Health Accreditation Report: Through the Lens of Qmentum - Exploring the Connection between Patient Safety and Quality of Worklife

Accreditation Canada's 2010 national report on health care in Canada explores the connection between quality of work life and patient safety in health organizations. The report also examines the relationship between health care staff perceptions of work climate and patient safety culture in their own organizations, and how those perceptions are useful in identifying patient safety issues.

Reducing waste in health care

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

Canada - Implementing Choosing Wisely Canada Recommendations in Ontario to Improve Quality of Care

Choosing Wisely Canada is clinician-led campaign to help patients and healthcare providers engage in conversations about unnecessary care. This report from Ontario highlights provincial and local initiatives across three sectors (hospital, long-term and primary care) to improve quality of care by implementing Choosing Wisely Canada recommendations. The report provides an overview of resources and support tools available in Ontario.

The evolution of healthcare managers’ role: a comparison France/United Kingdom

Brief analytical summaries or syntheses #54 The evolution of healthcare managers’ role a comparison France/United Kingdom Summary This study on nurses’ job satisfaction from the University of Lyon compares the expanding role of healthcare managers in France and the UK. It concludes that the evolution of the healthcare manager role has negative consequences for workplace relations and staff retention in both countries, and suggests research into new modes of leadership. Background Nursing shortages are a problem in all countries (Hayes et al., 2010; Lu et al., 2005). More than 70% of expenses at the UK National Health Service (NHS) go to human resources. Optimal use of the workforce is therefore a key issue. Job satisfaction is recognized in the international nursing literature as being related to turnover rate, staff retention and intention to leave (Hayes et. al., 2010; Lu et. al., 2005; Caers et al., 2008 ; Van Saane, 2003…

Canada - Lean in British Columbia’s Health Sector.
Annual Report 2010–11

Brief analytical summaries or syntheses #38 Canada - Lean in British Columbia’s Health Sector. Annual Report 2010–11 Summary Published in September 2011 by the British Columbia Ministry of Health, this annual report presents seven case studies of Lean process redesign work carried out by B.C. health authorities in 2010-11. In the health sector, Lean is a patient-focused approach that systematically eliminates waste in health care organizational processes in order to improve quality, productivity, and efficiency. Background Lean is an approach to systematically eliminate waste in organizational processes in order to improve quality and productivity, and reduce costs. At the heart of Lean in health care is the mapping of a patient’s journey through the system in order to identify steps that are of value to the patient, and those that add no value (i.e., are waste). Lean may be used to redesign a discrete process, as a strategy for improving…

Australia - Expanding healthcare quality and patient safety reporting across Queensland’s health system

Prepared for the government of the Australian state of Queensland, this paper discusses the benefits of increasing healthcare quality and safety reporting across the state’s health system. Using Australian and international comparators, it provides evidence that expanded reporting will positively affect health outcomes, professional practice, system administration and cost-effectiveness. The paper proposes extending common reporting measures to Queensland's network of private hospitals.

Canada - Safer cancer care for Ontarians

The 2017 Cancer System Quality Index (CSQI), released May 17, 2017 by the Cancer Quality Council of Ontario, identifies several improvements to safety this year within the cancer system. There were fewer perforations during colonoscopies, better drug ordering for chemotherapy, and increasing use of peer review among radiation oncologists across Ontario, increasing quality assurance and safety within the system.

Canada - Measuring Up. A yearly report on how Ontario’s health system is performing

This report marks the first time Health Quality Ontario (HQO) has used the Common Quality Agenda – a set of about 40 indicators created by HQO in consultation with health partners and system leaders — to monitor the quality of health care. Comparisons with other provinces and countries are included for some indicators.

Canada - Patient partnership in quality improvement of healthcare services: Patients’ inputs and challenges faced

Researchers at the Université de Montréal’s teaching hospitals co-authored this patient engagement study looking at patient participation as members of clinical teams in hospital Continuous Quality Improvement Committees (CICs). The study highlights the contribution of patient CIC members to quality of care improvement and includes interviews with patient participants.

UK - Top industry influencers reveal what healthcare excellence means to them

Interviewing public healthcare administrators and charity and industry executives, the Picker Institute Europe recently asked prominent UK health sector leaders what care excellence means to them. Healthcare quality, patient-centred decision-making, increased community care and better funding top the responses from the nine interviewees.

A review of telehealth in Scotland

Brief analytical summaries or syntheses #30 A review of telehealth in Scotland Summary This government review, prepared for Scotland’s Auditor General, focuses on National Health Service (NHS) telehealth initiatives that deliver care to patients. It determines that, targeted appropriately, telehealth has the potential to help NHS boards deliver clinical services more efficiently and effectively. Background The use of technology in the NHS has the potential to improve the quality, delivery and efficiency of healthcare services. Telehealth is the provision of healthcare to patients at a distance using a range of technologies, such as mobile phones, internet services, digital televisions, video-conferencing and self-monitoring equipment. Telehealth can offer a number of potential benefits to patients and NHS boards, such as reducing the need to travel to outpatient clinics, providing a quicker diagnosis, and avoiding referrals to hospital for diagnosis or treatment. It also has the potential to help NHS boards deliver clinical…

Canada - Performance of an integrated network model. Evaluation of the first 4 years

Conducted by Université de Montréal researchers, this study evaluated changes in accessibility, care experiences, and quality-of-care indicators after a Québec clinic moved to a fully integrated network model. Increases in accessibility were seen after the transition, while improvements in biologic data suggested better quality of care. Patient satisfaction remained high throughout the four-year study.

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

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

International - Strengthening primary care: recent reforms and achievements in Australia, England and the Netherlands

This paper published by the Commonwealth Fund examines recent primary care reforms in Australia, England and the Netherlands. It details quality improvement strategies, strategies for improving access, mid-level primary care organizations and payment reforms that have contributed to enhancing the quality and accessibility of primary care.

International - WHO releases country estimates on air pollution exposure and health impact

A new WHO air quality model confirms that 92% of the world’s population lives in places where air quality levels exceed WHO limits. Information is presented via interactive maps, highlighting areas within countries that exceed WHO limits.

UK - Launch of a new series of reports to improve the healthcare experience in Scotland

Health and Social Care Alliance Scotland has published a series of documents to help physicians talk to people with long term conditions about what matters to them. The series focuses on how dialogue about outcomes can change practice and provides information on person-centred care. The publications are part of Scotland’s Personal Outcomes and Quality Measures Project.

Russia - The impact of private health insurers on the quality of regional health care systems in Russia

In Russia, health insurance is organized regionally and offered by private companies. This paper from Moscow’s Centre for Economic and Financial Research measures the effect of private insurers on quality-related outcomes of regional health insurance systems. Overall, the study shows a positive effect.

International - Overview of a formal scoping review on health system report cards

There is an extensive body of literature on health system quality reporting that has yet to be characterized. Scoping is a novel methodology for systematically assessing the breadth of a body of literature in a particular research area. The objectives of this study were to showcase the scoping review methodology in the review of health system quality reporting, and to report on the extent of the literature in this area.

Canada - Ontario ranks among the best in Canada and internationally when it comes to certain measures of the coordination of care and communication between older patients and their health care providers

Ontario patients aged 55 and older often experience top-rated coordination of their health care, as well as communication with their health care providers, compared to people in other provinces and in other countries, according to Experiencing Integrated Care, the latest report from Health Quality Ontario (HQO), the provincial advisor on health care quality.

The Netherlands - Stuck in the middle?: A perspective on ongoing pro-competitive reforms in Dutch mental health care

Dutch mental health care has been under reform since competition was introduced in 2008. As the sector has no accepted quality indicators, insurers and municipalities now contract providers in negotiations based on price, which may negatively affect quality. This article criticizes the current reliance on what it calls the worst aspects of both pre- and post-reform systems.

Sweden - Quality and Efficiency in Swedish Health Care. Regional Comparisons 2012

This is the seventh report comparing healthcare quality and efficiency that the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions have published jointly. The report provides information and data for use in the public debate about the healthcare system and supports efforts by the county councils to analyse, improve and manage the healthcare services they provide. Results on 169 indicators are presented.

Denmark - Explaining the Sources of Income Related Inequality in Health Care Utilization in Denmark

This paper from the University of Southern Denmark explores the sources of income-related inequality in the utilization of healthcare services by linking survey data to register based data. Results suggest that health care is distributed equally in Denmark when needs based variables are controlled for.

Canada - Moving To Patient-Based Funding Will Improve Care in Ontario

On March 19, 2012, the Ontario government announced a new funding model that will see hospitals funded based on how many patients they see, the services they deliver and the quality of those services. Anticipated results include shorter wait times and better access, more services and better quality care with less variation between hospitals.

Time for Transformative Change: A review of 2004 Health Accord

Brief analytical summaries or syntheses #40 Time for Transformative Change A review of 2004 Health Accord Summary Canada is no longer seen as a model of innovation in health care delivery and financing, says this report from the Standing Senate Committee on Social Affairs, Science and Technology. The committee’s review revealed that real systematic transformation of health care systems across the country had not yet occurred, despite more than a decade of government commitments and increasing investments. The committee made 46 recommendations it believes will truly transform the way health care professionals do business and will achieve lasting reform. Background On January 31, 2011, the Minister of Health requested that the Standing Senate Committee on Social Affairs, Science and Technology initiate the second parliamentary review of the 10-Year Plan to Strengthen Health Care (10-Year Plan), an agreement reached by First Ministers on September 16, 2004 that focuses on federal/provincial/territorial (F/P/T)…

UK – Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review

Since 2004, British primary care practices have received financial rewards for achieving standards set out by the National Health Service (NHS) Quality and Outcomes Framework. This systematic review from the Annals of Family Medicine examines evidence on the impact the framework has had on primary health care.

France - Production, Productivity and Care Quality in French Hospitals Before and After the Introduction of Activity Based Payment

This study from IRDES provides new data and quantitative analysis to assess the effects of P4P reforms on the productivity and quality of hospital care in France. Results show that in public hospitals, activity and production increased steadily between 2002 and 2009 regardless of the type of activity, with a more marked increase in surgical activity. However, the readmission rate at 30 days for cardiovascular and cancer indications increased since the introduction of P4P.

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…

Canada - Greater efficiencies realized in Ontario's cancer system

The Cancer Quality Council of Ontario has released findings from the 2016 Cancer System Quality Index (CSQI) that measures the performance of the province’s cancer system. The findings indicate that efficiencies, such as new cancer treatment centres, have begun improving patient outcomes and safety by enabling greater capacity in the system.

New Zealand - New health data will help drive improvements in patient safety

This report from the Health Quality and Safety Commission of New Zealand provides data on the quality and safety of care in each District Health Board (DHB). Measures include falls, healthcare-associated infections, hand hygiene and perioperative harm and enable comparison between different DHBs and a view of progress made in each against baseline measures.

USA - Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality

This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country.

Australia - OECD health-care quality indicators for Australia 2015

This report summarizes information Australia provided to the OECD's Health at a Glance 2015 Report. It compares data supplied by Australia in 2015 with data from previous years and data from the other 33 countries of the OECD. The OECD healthcare quality indicators provide a common set of measures for member states.

UK - Is bigger better? Lessons for large-scale general practice

In Britain, three-quarters of general practices are now working collaboratively within larger-scale organizations. Drawn from a study of 22 large-scale practices, this report examines factors affecting the evolution of general practice and its impact on quality, staff, and patient experience. It finds that larger scale practices encourage efficiency, standardized processes, use of technology and employee security, but has mixed effects on quality improvement and patient satisfaction.

USA - Working Under a Clinic-Level Quality Incentive: Primary Care Clinicians’ Perceptions

Some designers of clinician pay-for-performance programs argue that team-level incentives (where members receive identical incentives based on overall performance) are most effective. This study surveyed 198 primary care clinicians to obtain opinions on a team-based quality incentive awarded at the clinical level. Most of the clinicians (73%) favoured a mix of clinic-level and personal incentives to maintain collaboration while also recognizing individual performance.

Canada - Health Quality Council of Alberta Releases Follow up Report to 2013 Continuity of Patient Care Study

Released in July 2016, this follow-up report to a 2013 study on continuity of care finds that considerable effort has been made by Alberta stakeholders towards implementing the study's recommendations. The newly released report identifies measures that stand to have the greatest impact on continuity of care for the greatest number of patients.

UK - New single oversight framework launched to help NHS providers improve services

The UK National Health Service (NHS) has launched a new single oversight and improvement framework to improve services by NHS providers. The framework identifies where providers may benefit from improvement support across 5 areas: quality of care, finance and resource use, operational performance, strategic change and leadership capability.

USA - AHRQ Report Shows Disparities Persist, Despite Improvements in Quality and Access

Released in April 2015, this report by the US Agency for Healthcare Research and Quality (AHRQ) provides a snapshot of healthcare disparities across the US. While insurance coverage for Black and Hispanic Americans has grown, disparities persist and are worsening for households below the poverty line.

UK - Equality for all: delivering safe care - seven days a week

Published by NHS Improvement, the quality arm of the U.K. National Health Service (NHS), this guide presents case studies of service delivery models used by the NHS to deliver clinical services outside standard hours seven days a week. Admission prevention, early supported discharge, and early diagnosis and intervention are three of the main service delivery models.

Canada - Ontario primary care reform and quality improvement activities: an environmental scan

The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector in Ontario. This is intended as a first step to developing a coordinated and sustainable framework of primary healthcare that will enable an evaluation of these initiatives.

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…

International - Urgent action needed to tackle rising inequality and social divisions, says OECD

Society at a Glance 2014, published by the OECD, examines social spending since the economic crisis began in 2008 and finds that Income inequality and social divisions could worsen and become entrenched unless governments act quickly to boost support for the most vulnerable in society. It warns against further across-the-board cuts in social transfers. The number of people living in households without any income from work has doubled in Greece, Ireland and Spain, and risen by 20% or more in Estonia, Italy, Latvia, Portugal, Slovenia and the United States.

Canada - Health Equity in Northern Ontario

The life expectancy rates for those living in northern Ontario continue to be lower and mortality rates higher than the rates in the province overall, according to a new report by Health Quality Ontario, the provincial advisor on the quality of health care.

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

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

Canada – Exploring Accountable Care in Canada: Integrating Financial and Quality Incentives for Physicians and Hospitals

This report, commissioned by the Canadian Foundation for Healthcare Improvement and the Ontario Ministry of Health and Long-Term Care explores the relevance and feasibility of establishing Accountable Care Organizations (ACOs) in Canada using Ontario as a case study. In ACOs, physicians, hospitals and other provider organizations assume accountability for the cost and quality of care for a defined population.

Canada - Quality in Primary Care Setting a Foundation for Monitoring and Reporting in Ontario

Ontarians are less likely to receive optimal primary care if they are immigrants, live in a low-income neighbourhood, or live in a rural, remote or northern area of the province, according to this new report published by Health Quality Ontario.

International - What shapes patient's satisfaction in countries' health care systems?

Patient satisfaction is an important measure of healthcare quality. This study by Greek researchers developed a set of socio-economic and health provision indicators to study patient satisfaction and healthcare organization in 32 countries over a five-year period. Findings showed a positive association between patient satisfaction, public health expenditures, and the number of physicians and nurses.

International - Regulating quality and safety of health and social care. International experiences

This report provides an overview of regulatory strategies and actors that different systems employ to govern safety and quality in health and social care. The countries reviewed provide examples of systems that vary in the way that health and social care services are organised and financed.

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

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

UK - Understanding NHS financial pressures: how are they affecting patient care?

This report examines what current National Health Service (NHS) financial constraints mean for patient care in four areas: genito-urinary medicine (GUM), district nursing, elective hip replacement, and neonatal services. Strong evidence was found that quality of care has suffered in GUM and district nursing services. Waiting times for hip replacements are also rising, although neonatal services appear to have maintained quality.

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

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

USA - Do Integrated Health Care Systems Provide Lower-Cost, Higher-Quality Care?

Obamacare has introduced accountable care organizations (ACOs) based on integrated delivery system (IDS) models as a way to reduce costs and improve care through better service integration. This article analyzes the costs and quality of care provided by 52 Midwestern ACOs using IDS practices. Results show important variations in the costs of care provided by different medical groups serving local communities.

Australia - Pay-for-performance programs. Do they improve the quality of primary care?

This article published in Australia Family Physician updates recent evidence about the impact of physician pay-for-performance programs (P4P) on the quality of primary care. After reviewing the evidence, the authors conclude that P4P does not improve health outcomes or health system efficiency.

Canada - Health Quality Council launches first Saskatchewan Change Day

People working in Saskatchewan’s healthcare system, and those who access care, are being encouraged to pledge to do one small thing to improve the lives of patients, family members and healthcare workers as part of a new campaign called Saskatchewan Change Day. The day will be held on November 6, 2014. The belief that underlies the initiative is that small actions, when combined together, can make a big difference.

US - Regional and Racial Variation in Primary Care and the Quality of Care among Medicare Beneficiaries

This Dartmouth Atlas Project report updates and extends previous reports on geographic variation in health care quality and health outcomes, this time with a focus on access to and use of primary care.

US - The Effect of Financial Incentives on Hospitals That Serve Poor Patients

Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown. The aim of this study is to determine how financial incentives for quality performance affect hospitals with more poor patients compared with those with fewer poor patients.

Australia - Patient Safety in Primary Health Care. Discussion Paper and Consultation

The Australian Commission on Safety and Quality in Health Care is seeking to clarify its understanding of patient safety issues in primary health care, including identifying key priorities and solutions both nationally and internationally that could be applied to the Australian primary health care context. A draft discussion paper on Patient Safety in Primary Health Care has been developed for public consultation. The findings of this consultation process will be used to inform the Commission's consideration of activities it could undertake or support to strengthen patient safety in primary health care in Australia.

Italy - Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial

Studies show that 20% of hospital bed use is inappropriate. Published in BMC Health Services Research, this trial evaluated a physician accountability strategy to reduce unnecessary hospital days. Physicians were given a list of patients whose hospital stay was compatible with discharge according to a validated Delay Tool and provided physicians with an audit tool. Results indicate that a strategy involving physician direct accountability can reduce unnecessary hospital days.

The Netherlands - The effect of competition on process and outcome quality of hospital care: An empirical analysis for the Netherlands

The paper focuses on the relationship between competition and quality in the Dutch hospital sector. The authors of the paper analyse the period of 2004-2008, in which a healthcare reform took place in the Netherlands, introducing competition in the healthcare sector.

France - Is quality of care soluble in quantities? A critique of pay for performance

This working document published by Economix presents a critique of pay for performance in medicine. The payment mechanisms seek to encourage doctors to meet quantified standards of quality that are derived from the results of evidence-based medicine (EBM). The author considers that the statistical objects used by this method are problematic and finds it questionable to consider care service as a product that can be reproduced an infinitum.

USA - New HHS data show quality improvements saved 15,000 lives and $4 billion in health spending

The Department of Health and Human Services (HHS) has announced a 9% decrease in US hospital-acquired conditions during 2012. Reductions in adverse drug events, infections, falls, and other forms of harm are estimated to have prevented 15,000 hospital deaths, and saved $4 billion in health spending.

UK - Changes in Patient Experiences of Primary Care during Health Service Reforms in England between 2003 and 2007

Major primary care reforms have been introduced in recent years in the United Kingdom, including financial incentives to improve clinical quality and provide more rapid access to care. Little is known about the impact of these changes on patient experience. The authors of this paper examine patient reports of quality of care between 2003 and 2007.

USA - Patient-Centered Medical Homes. A new way to deliver primary care may be more affordable and improve quality. But how widely adopted will the model be?

Patient-centered medical homes are considered by many to be among the most promising approaches to delivering higher-quality, cost-effective primary care, especially for people with chronic health conditions. Although there is no single standard definition of a medical home, there is an agreed upon set of principles behind the concept, and most medical homes share common elements. This brief describes recent projects that have applied patient-centered medical home concepts, as well as concerns about widespread adoption of the model before results are definitive.

USA - The ABCs of Measurement

This report from the National Quality Forum explains how the science of measuring health care performance is making enormous progress, and continues to evolve. Measures represent a critical component in the national endeavor to assure that all patients receive appropriate and high quality care.

Canada - Ontario: Wait times down in emergency, but still long for some patients

A new report by Health Quality Ontario (HQO), the provincial advisor on health care quality, shows a 10% drop in the maximum amount of time patients spent waiting in Ontario’s emergency departments (EDs). Urban residents wait longest, especially ED patients requiring hospital admission.

Canada - Improvements in health system quality still in the future says New Brunswick Health Council

The New Brunswick Health Council (NBHC) has released its 2016 report card for the province’s health system, giving it a C grade that signifies adherence to national standards but no improvements in system performance and quality of care. Primary care and long-term care continue to push New Brunswick’s grade downwards.

The Netherlands — Regulated competition in health care: Switching and barriers to switching in the Dutch health insurance system

In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers will in theory strive for a better balance between price and quality. The authors of the study examined switching behaviour over three years (2007-2009). Conclusion: the percentages of switchers are comparable to the old system.

USA - Physician-Leaders and Hospital Performance: Is There an Association?

This discussion paper from the Institute for the Study of Labour (IZA) in Germany seeks to fill the evidence gap around the assumption that physicians make better hospital leaders than non-physicians. The authors looked at quality data from the top 100 U.S. hospitals and researched the personal histories of the 300 CEOs of these hospitals to classify them into physician and non-physician managers. They found a strong positive association between the ranked quality of a hospital and whether the CEO is a physician.

Sweden - A Star Performer in the Eyes of an Emerging Health Leader. Lessons in Quality and Patient Safety

Every year, the Canadian College of Health Leaders (CCHL) takes Canadian health sector leaders on study tours of Sweden’s healthcare system. This report on the 2012 tour provides an overview of Swedish health care, compares health indicators, and discusses lessons learned from Sweden’s performance in the areas of quality and patient safety.

USA - HHS announces $685 million to support clinicians delivering high quality, patient-centered care

On September 29, 2015, the US Department of Health and Human Services (HHS) announced $685 million in awards to equip over 140,000 clinicians with the tools and support to improve quality of care. The new initiative is one of the largest federal investments supporting clinicians and patient-centred care through peer-based, collaborative learning networks.

Canada - Performance-Based Healthcare: How Hospitals Can Leverage Business Intelligence and Information Management to Meet Ontario's Healthcare Reforms

This paper by three consultants with IBM Global Business Services in Volume 10, Number 2 of Electronic Healthcare recognizes that hospitals are at different stages of readiness in information management to align their practice with Excellent Care for All Act quality legislation. It identifies eight key business intelligence dimensions that can help hospitals advance their information management and quality improvement agendas.

USA - Health Reform 2.0: A Call to Action

Committed to ensuring that all Americans have high-quality affordable health care, Families USA presents this report on ways to achieve that aim by enhancing the quality of care and reducing care costs. The report calls for expanding state Medicaid and strengthening children’s coverage, reducing prescription drug costs, and halting the uncompetitive consolidation of providers.

Sweden - OECD’s Health Care Quality Review of Sweden

Sweden’s health and elderly care systems deserve their reputation as being among the best in the world. Yet an ageing population with growing chronic conditions and requiring more complex health services are testing Sweden’s ability to continue delivering high-quality care, according to a new OECD report.

UK - Learning from the best: What the NHS needs to do to implement high quality care for all

This paper summarizes discussions that took place at a seminar on lessons for the NHS from high performing health care organizations held on March 12-13,, 2009. The seminar, sponsored by the NHS Institute for Innovation and Improvement, brought together NHS leaders and researchers to explore evidence from studies into high performing organizations, and how this evidence can be applied in the NHS.

Canada - Measuring Up. A yearly report on how Ontario’s health system is performing

Measuring Up uses the Common Quality Agenda, a set of indicators developed with experts across the province, to see how the quality of care is changing in Ontario — how each local health integration network (LHIN) region is performing, and how the province compares with the rest of Canada and other countries. The report shows that over the past four to 10 years, 13 key performance indicators demonstrate improvement, 20 indicators show no change and two have deteriorated.

Belgium - Incorporating Societal Preferences in Reimbursement Decisions. Relative Importance of Decision Criteria According to Belgian Citizens

This study, published by the Belgian Health Care Knowledge Centre (KCE) is meant to help decisionmakers establish a more transparent procedure to guide them in their future coverage decisions. A large survey was undertaken in the general public to identify priorities. Disease severity in terms of quality of life under current treatment, and opportunities for improving quality of life through health care interventions are considered to be the most important criteria for resource allocation decisions in health care by the Belgian general population, with relatively less importance attached to changes in life expectancy.

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

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

International - How to do better health reform: a snapshot of change and improvement initiatives in the health systems of 30 countries

This article discusses a book entitled "Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries" that analyses the impact of reform initiatives on the quality and safety of care in low, middle, and high-income countries. Reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality. Richer countries largely focus on developing new information technology systems and innovative funding models.

UK – New study to drive further improvements in health care for the most vulnerable

A new short study, Inclusion Health: Improving the way we meet the primary healthcare needs of the socially excluded,outlines how improvements in healthcare for the most excluded groups in society can be accelerated to ensure that high quality services are available to all. The study recognises the great progress that has been made in healthcare provision whilst setting out the need for more sophisticated and flexible responses to improve access and quality of services for socially excluded groups.

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.…

Germany - Informing the development of a resource allocation framework in the German healthcare system

This report provides the National Association of Statutory Health Insurance Physicians in Germany with an overview of quality indicators and approaches that are currently used for ‘high stakes’ assessment in a range of countries in Europe and elsewhere and so inform the development of the quality component of a proposed national resource allocation framework in the German statutory healthcare system.

France - Competition and Hospital Quality: Evidence from a French Natural Experiment

This study evaluates the effect of a pro-competition reform introduced in France between 2004 and 2008 on hospital quality measured by mortality in heart-attack patients. The study finds that non-profit hospitals, which had managerial autonomy and no incentive for competition before the reforms, saw larger declines in mortality in places with greater competition than in less competitive markets.

Predicting social care costs. A feasibility study

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

USA — Medicare Launches Quality-Based Payment System for Hospitals

After a decade or so of collecting information from hospitals on the quality of their care, the Medicare program announced recently that it will finally start using what the data actually reveals about a hospital's performance to set the level of payments it receives.

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…

Brazil - Interregional Performance of the Public Health System of a High-Inequality Country

In the decentralized Brazilian health system, the country’s 27 federal units (FUs) are responsible for health care in their jurisdictions. This study examines the efficiency of individual FUs and explores the overall performance of the health system in a country with high rates of social and health inequality.

Italy - Still too much variation in health care quality across Italian regions, says new OECD report

The OECD report on health care in Italy finds that health outcomes are among the best in the OECD, with comparatively long life expectancy and low rates of asthma, COPD and mortality after stroke and heart attack. The report points to significant regional differences and encourages a national emphasis on quality and on reducing disparities.

Norway - Lost in translation: a case-study of the travel of lean thinking in a hospital

Lean thinking is a systematic quality improvement approach to identify and eliminate non-value-adding activities in work processes. This study of Lean techniques in a Norwegian hospital finds that Lean concepts are so culturally complex, site-specific and context-dependent that local translations (even within different hospital departments) affect the analysis of evidence, as well as the success of Lean initiatives within and among hospitals.

UK - The NHS atlas of variation in healthcare: reducing unwarranted variation to increase value and improve quality

The National Health Service (NHS) Atlas of Variation in Healthcare identifies unwarranted geographical, population, institutional and specialist variations in British healthcare services. Utilizing over 100 indicators and performance measures, the atlas is a key resource to help the NHS identify waste and release resources for higher-value interventions.

UK - Measuring employee productivity

Exploring measures of productivity, this Public Health England report focuses on employee health, absenteeism and presenteeism (working while ill). Its key finding is that measures of labour productivity must take into account multiple input and output factors, particularly the quality of completed work and the effects on organizational wellbeing of presenteeism, described as the single greatest cause of decreased output.

New Zealand - New Zealand Health Strategy consultation announced

New Zealand has begun public consultations on updating the country’s overall health strategy. A draft update available for review emphasizes improved local health care, integrated care, value and quality, and smart systems. The consultation period ends in December 2015 and the final updated strategy will be released in 2016.

UK - Putting integrated care into practice: the North West London experience. Evaluation of the Whole Systems Integrated Care programme

The Whole Systems Integrated Care (WSIC) program in London, England, is an initiative that seeks to improve the quality of integrated care for over two million people in the city's eight North West boroughs. This initial evaluation assesses and provides feedback on the design of the WSIC program, and makes 17 recommendations for future learning.

Canada - Never Events for Hospital Care in Canada

This report published by Health Quality Ontario presents the collective work of the National Patient Safety Consortium to identify, for the first time, a list of 15 never events for hospital care in Canada. Never events are patient safety incidents that result in serious patient harm or death and that are preventable using organizational checks and balances.

Lunch hour conferences

Lunch hour conferences of the Direction générale de la planification, de l'évaluation et de la qualité These lunch hour conferences, organized by the Direction générale de la planification, de l'évaluation et de la qualité, are the result of an initiative by the Direction de la recherche, de l'innovation et du transfert de connaissances and the Direction de l'éthique et de la qualité. They aim to support knowledge transfer through dialogue between researchers and decision-makers regarding research results that have an impact for decision-makers, to discuss possible courses of action, and to reflect on issues and trends in the health and social services sector. They also aim to foster discussions on the quality of our health and social services system and the best means of supporting its continuous improvement.

Europe - Performance of EU health care systems investigated in new study

A new European research project has been launched to evaluate the performance of European health care systems in terms of outcomes, quality, use of resources and costs. Financed by the European Union and coordinated at the National Institute for Health and Welfare (THL) in Finland, the EuroHOPE project (European Health Care Outcomes, Performance and Efficiency) will focus the evaluation on five key public health problems or diseases: acute myocardial infarction, stroke, hip fracture, breast cancer and low-birth-weight infants.

Europe - Hospitals 2020. Hospitals of the future, healthcare of the future

Drawing on the June 2015 conference of the European Hospital and Healthcare Federation held in Warsaw, this report on hospital management in 15 European Union (EU) countries discusses innovations in patient care, clinical work, nursing, human resources, information systems, drug management, laboratory operations, finances, quality control and patient involvement. Information on each of the 15 countries is included.

UK - Personalised health and care 2020

The UK Health Department has developed an action plan to reduce the cost of British health care and improve care quality by using data and technology to give patients more control over their health. Based on evidence from patient organizations and other stakeholders, the action plan focuses on immediate priorities for the delivery of personalized digital health care services by 2020.

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

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

International - International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care

The journal Health Affairs conducted a survey of the healthcare experiences of 15,617 older adults in 11 Western countries, including Canada. This report presents the survey findings, which show that the US lags behind in care access, quality, and affordability. Accessing primary care and avoiding the emergency department was more difficult in Canada than in other countries.

UK - Formal launch of MyNHS

Launched in November 2014, MyNHS is a website where people in the UK can compare their local National Health Service (NHS) hospital, health authority, and health services on a number of performance indicators. MyNHS includes searchable data on hospital food quality, staffing, patient safety and mental health, along with many other areas of care.

Europe - Health at a Glance: Europe 2014

Published by the OECD, this book presents indicators related to health status, access to care, quality of care, and health financing, expenditure and resources in 35 European countries. Key indicators reflect the new availability of comparable data in the areas of non-medical determinants of health and access to care.

International - Health at a Glance: Asia/Pacific 2014. Measuring Progress towards Universal Health Coverage

Published by the OECD, this book presents indicators related to health status, access to care, quality of care and health financing, expenditure, and resources in 27 Asian and Pacific countries. Indicators are presented with charts, brief descriptive analyses and methodological context. An annex provides information on country health systems and local demography.

USA - Beacon Communities Share Strategies for Using Health Information Technology in New eGEMs Special Issue

The online journal, eGEMS, has published a special issue on lessons learned from eight ‘Beacon Communities’ that are using information technology (IT) to achieve better health care at lower costs. Beacon Communities are part of a program by the Office of the US National Coordinator for Health IT to strengthen health IT infrastructure, reduce costs and improve care quality.

Japan - Redesigning how health services are delivered in Japan would better meet the needs of a super-ageing population, says OECD

This health care quality review by the OECD says Japan must improve the way it delivers health services for older citizens by strengthening primary care and making mental health services more widely available. The review also recommends expanding nursing home spaces and reducing hospital bed capacity.

UK - Open consultation: Transparency in care: visible ratings for health and care providers

Britain’s proposed 2014 Care Act will give the UK Care Quality Commission (CQC) the power to assess healthcare provider performance and assign ratings. This consultation document seeks views on requiring providers to display performance ratings and includes draft regulations on how the new legislation will work in practice.

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

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

Canada - Government of Alberta to create rural health care action plan

Alberta has created a panel of experts and stakeholders to develop a healthcare action plan for the province’s rural communities. The panel will review access to healthcare services’, quality, organization and coordination. The final report is expected in January 2015.

Canada - Your Health System website reveals Canadian health care statistics by hospital, region, province and territory

The Canadian Institute for Health Information (CIHI) has launched a website that allows the Canadian public to find accessible and easy-to-understand information about Canada's healthcare system. Information is available on access to care, quality of care, spending, health outcomes and much more. Interactive graphics enable comparison between Canada and other countries, between provinces, regions and even individual hospitals on the different measures.

International - International responses to austerity

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

International - How Was Life? shows long-term progress in key areas of well-being

Research published by a consortium of economic historians (CLIO-INFRA) in collaboration with the OECD finds that people’s well-being has generally progressed across a large part of the world. The study presents systematic evidence of trends in areas such as health, education, inequality, the environment and personal security over the past 200 years. With the exception of sub-Saharan Africa, countries have generally become more equal to each other in terms of well-being than in terms of per capita GDP.

Europe - Mental Health and Integration. Provision for Supporting People With Mental Illness: A Comparison Of 30 European Countries

Intelligence Unit (EIU) created this Mental Health Integration Index comparing mental health services and treatment in 30 European countries. It considers medical service provision, human rights, stigma, quality of life, housing and employment, along with other factors. The index is accompanied by interviews with experts and a literature review.

International - Money talks - Paying physicians for performance

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

Canada - Patient experience survey

The Primary Care Patient Experience Survey is an evidence-based tool that will help providers develop an understanding of their patients’ experiences of care, identify what is working well and where there may be room for improvement. The survey is the result of a collaboration between Health Quality Ontario, the Association of Ontario Health Centres, the Ontario College of Family Physicians, the Ontario Medical Association, and the Association of Family Health Teams of Ontario. It is currently being field tested in primary care practices across the province. A draft version is available to download.

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.

Canada - Home Care in Canada: Advancing Quality Improvement and Integrated Care

This report from Accreditation Canada and the Canadian Home Care Association tracks the evolution of home care in Canada and highlights results achieved in the context of Accreditation Canada's QMENTUM program. It features tools to assess governance and safety culture, presents best practices and looks at future directions.

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

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

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

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

The Netherlands - Dutch Health Care Performance Report 2014

The 2014 edition of this annual report on Dutch health care gives high overall marks for access and quality. However, variations in elder and nursing home care due to insufficient staffing are evident. The Netherlands continues to be Europe’s fourth highest spender on health care, largely because of long-term care costs.

China - Reform and Innovation for Better Rural Health Services in China

Launched in 2008 in eight provinces, China’s Rural Health Project focuses on the rural health insurance system and on improving rural health delivery, public hospitals, and core public health services. This article published by the World Bank describes lessons to be learned from China's success in ensuring affordable, equal access to high quality rural health services.

USA - Reducing Health and Health Care Disparities: Implementation Lessons and Best Practices for Health Care Organizations

Undertaken to address health disparities more effectively, this paper shares lessons from nine US healthcare organizations on programs designed to address disparities between patient populations. The paper offers concrete recommendations to improve the quality of healthcare delivery systems and implement interventions to tackle inequities in patient care and outcomes.

UK - Health Secretary Jeremy Hunt sets out the direction of reform for the future NHS

Published by the UK government, this transcript of a July 16, 2015 speech by Health Secretary Jeremy Hunt sets out a five-year reform plan for Britain’s National Health Service (NHS). The plan emphasizes integrated seven-day-a-week patient-centred care, service devolution, organizational transparency, quality improvement and digital health technologies.

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

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

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.

UK - What are we afraid of? Universal healthcare in market-oriented health systems

This paper argues that Britain’s universal health coverage and National Health Service (NHS) should be abandoned and replaced by the social health insurance (SHI) systems used in the Netherlands, Switzerland, and Germany. The paper says SHI systems are more competitive and patient-driven, show greater plurality in provision and financing, and consistently outperform on measures of health outcomes, quality, and efficiency.

UK - All new healthcare assistants and social care support workers will need to get a Care Certificate in their first 12 weeks of employment

In the wake of recent scandals surrounding poor patient care, the UK government has announced that novice healthcare assistants and social care support workers must qualify for a new Care Certificate. The 15 Care Certificate standards assess the skills needed to give effective and compassionate care, and act as a quality benchmark for provider organizations.

Canada - Accelerating Health System Transformation in Saskatchewan: Lessons Learned from the Saskatchewan Surgical Initiative

In 2010, the Saskatchewan government set out to transform the surgical patient experience through an ambitious multi-year, system-wide strategy. While the Saskatchewan Surgical Initiative (SkSI) placed strong emphasis on wait time reduction for elective surgery, the breadth of the initiative also gave priority to quality, safety, patient experience, and sustainability. Through the systematic exploration of a single policy case study—the SkSI—this research published by the Foundation for Healthcare Improvement identifies the critical factors that facilitate and inhibit major health system change.

International - International Profiles of Health Care Systems, 2014

This publication presents overviews of the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the US. Each overview covers insurance, financing, organization, care quality, cost containment, efficiency and integration, and use of information technology and evidence-based practice. Data is provided on key health system characteristics and performance indicators.

Lunch hour conferences 2015

By Michel Perreault, psychologist-researcher, Douglas Mental Health University Institute, associate professor, Psychiatry Department, Université McGill Hélène Provencher, professor, Nursing Faculty, Université Laval, researcher, Groupe de recherche sur l'Inclusion sociale, l'Organisation des services et l'Évaluation en santé mentale (GRIOSE-SM), CSSS de la Vieille-Capitale This conference will address the added value question of the intervention focusing on the contribution of peer helpers in care and services network, particularly in the area of mental health. The major findings from two research projects supported by the MSSS will be presented, one about the peer helpers intervention to facilitate access to clinical treatment for people with anxiety disorders with the support group Phobies-Zéro and the other one addressing the peer helpers integration in teams of support in the community for people with severe mental disorders proposed by the “Peer Helpers Network Program” associated with the Association québécoise pour la réadaptation psychosociale. Peer helpers accompany researchers…

Brazil - Considerations on the Brazilian national health system (SUS) performance index

One of the quality measures used by Brazil’s National Health System (SUS) is the Brazilian National Health System Performance Index (IDSUS), which assesses the effectiveness of health care in municipalities and regions. This study looks at the potential of IDSUS to improve Brazilian public health management, but finds that its application and usage remains patchy across the country.

Canada - Delivering a Patient-Centred, High Performing and Sustainable Health System in B.C.: A Call to Build Consensus and Take Action

British Columbia’s Ministry of Health produced this report calling for provincial action in three areas: the delivery of patient-centred services and care; the enhancement of outcomes and services; and the prioritization of cross-sector actions to improve quality and sustainability. The report includes over 50 recommendations.

France - Should France take part in medical tourism?

The global market for medical tourism is estimated at around $60 billion. Many countries have chosen to invest in medical tourism, with some highlighting their low-cost care and others their care quality. This analysis published by France Stratégie asserts that France should develop a framework to welcome foreign patients for treatment, and promote the expansion of its system and the marketing of its capabilities to foreign countries.

Switzerland - Health2020: Ten priorities for 2015

Switzerland’s Health2020 strategy calls for the implementation of 36 health measures by 2020. The 10 measures to be developed in 2015 have now been announced by the Swiss government and include legislation on tobacco products and patients’ rights, and the promotion of cost-effective quality care.

UK - The habits of an improver. Thinking about learning for improvement in health care

This UK paper examines the importance of education to healthcare improvement capability, looks at improvement from the perspective of frontline healthcare staff and describes five habits individuals can deploy for successful professional development. These include learning, influencing, resilience, creativity and systems thinking. The paper suggests there is a particular pedagogy for improving quality that best develops capability.

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…

Canada - Increasing accessibility and quality of primary care through family medicine groups

Despite the support of stakeholders, the implementation of family medicine groups (FMGs) in Quebec has been slow. The number of registered patients has barely increased, and patients who are registered report better continuity of care, but not access to care. This report finds that the rushed nature of reform and slow computerization to enable electronic medical records that facilitate multidisciplinary care are, in part, responsible for poor implementation.

Finland - National action plan to prevent chronic pain

An expert group appointed by the Finnish Ministry of Social Affairs and Health has drawn up a three-year action plan for Finland’s treatment of chronic pain and cancer pain. It includes measures for establishing patient-centred, high quality services, based on a multidisciplinary approach.

UK - Improving Patient Access to Care: Performance Incentives and Competition in Healthcare Markets

This working paper published by the Cambridge Judge Business School looks at performance-based compensation used to induce competition on quality and efficiency among healthcare providers contracted by government. The authors show that the joint effect of incentives and competition depends on two factors: 1) the aggressiveness of patient access targets that the payer imposes on providers, and 2) patient sensitivity to the level of access to care.

Canada - International Comparisons at CIHI

This report from the Canadian Institute for Health Information (CIHI) presents various measures of how health care in Canada compares to that in other countries, and discusses CIHI's contribution to international data and knowledge production. The report highlights some key comparisons in clear graphic form: Canada spends 10% of its GDP on health, compared to the OECD average of 9%; Canada is above average in reducing premature mortality, especially among men; Canada is in the middle of the pack on combined measures of health status, determinants of health, quality of care, patient safety and access to care.

Canada - The Rural Road Map for Action: Directions

The Canadian Collaborative Taskforce was formed by the College of Family Physicians of Canada and the Society of Rural Physicians of Canada in 2014, with the aim of producing and sustaining an increased number of family physicians practising comprehensive rural generalist medicine. This Roadmap for Action recommends 20 actions in four directions: increasing the social accountability of medical schools to address the needs of rural and Indigenous communities; policy interventions that align medical education with workforce planning; practice models that ensure timely access to quality care; and a rural research agenda.

Canada - Building on Canada's Strengths in Regenerative Medicine

This report summarizes a workshop convened by the Council of Canadian Academies in Toronto on October 13 and 14, 2016 to review current strengths and weaknesses in regenerative medicine in Canada. Overall, the workshop report confirms that Canadian regenerative medical research is both of high quality and highly cited. National networks are recognized as enabling Canada to maintain its status as an international leader in the field.

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

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

France - The evolution of hospital funding models. A new measure of value

This report, prepared at the request of the Ministry of Social Affairs and Health, proposes an evolution of the financing models used in healthcare institutions in order to respond to the criticisms of a P4P model that unduly prioritizes the financial dimension over the fundamental mission of healthcare facilities, which is the delivery of high-quality care. The redesign of P4P would aim to make this funding correspond more closely to the activities of health professionals, be better adapted to the care of patients with chronic diseases, and less centered on existing structures.

Europe - Delivering hospital services: A greater role for the private sector?

Produced by the EU, this report examines the provision of private hospital services in Europe. It maps the extent of private provision, examines the drivers for increased private provision, and presents the views of different stakeholders. The report also analyses the implications of private provision for the public sector, and for the efficiency, accessibility and quality of services.

Australia - Corporatisation of general practice - impact and implications

In Australia, general practice is largely private, provided by physicians working individually or in groups. Since 2001, a number of corporate practices have emerged that vary in size, location (urban, rural), and type of services. This review examines the impact of the corporatization of general practice, and its implications for market competition, quality of care, patient outcomes, cost of care, and the healthcare workforce.

Norway - The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway

Instituted in 2012, health care reform in Norway has devolved administrative responsibility for primary care to municipalities while promoting a more collaborative and multidisciplinary approach for health care professionals. Based on interviews with nurse leaders in 10 municipalities, this article draws attention to their professional concerns about the quality of collaborative nursing care under hierarchical municipal structures and leadership.

International - Health at a Glance: Asia/Pacific 2016. Measuring Progress towards Universal Health Coverage

Published by the OECD, this book presents key indicators of health status and healthcare resources, financing, and quality across 27 Asia-Pacific countries. Each indicator is presented with charts illustrating variations across countries and over time, brief analyses highlighting major findings, and methodological information concerning limitations in data comparability.

Canada - Gainsharing and shared savings strategies in the healthcare setting: Evidence for effectiveness

Alberta Health Services (AHS) is exploring ways to leverage resources with the aim of improving outcomes and value for money. One way to achieve this is to incentivize and reward innovation and quality improvement using gainsharing or shared savings strategies. This internal report investigates evidence for the effectiveness of these strategies. It summarizes 25 facilitators of gainsharing within the AHS, along with 12 barriers to its implementation.

Europe - Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability

Prepared by the European Union (EU) Directorate for Economic and Financial Affairs, this report investigates policy challenges for the healthcare and long-term care sectors within the 28 member countries of the EU. It examines options on how to contain spending pressures through efficiency gains to ensure fiscally sustainable access to quality services.

Denmark - Primary Care Review of Denmark

Produced by the OECD, this review of Denmark’s primary care system says high-quality care is not always delivered. Rates of avoidable hospitalization are higher than in the rest of Scandinavia, and Denmark is one of the few European countries with no means of monitoring primary care performance. Patients also have no access to their health records.

UK - The challenge and potential of whole system flow

Improving the flow of patients, information and resources between health and social care organizations is crucial to service quality. This report provides improvement teams in local health and social care with a guide to approaches and skills to improve flow across systems. The report focuses on care journeys, organizational capability, local enablers and system change levers, and contains case studies of effective practices.

USA - HHS selects eight states for new demonstration program to improve access to high quality behavioral health services

The Department of Health and Human Services (HHS) has selected eight US states for a Certified Community Behavioural Health Clinic (CCBHC) demonstration program aimed at improving community health services. The project is part of an effort to integrate behavioural and physical health care and improve access to care for people with mental and substance use disorders.

International - Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries

Pay-for-performance (P4P) programs have been implemented in the hospital sector to improve quality of care. This paper provides an overview of 34 P4P programs in 14 member countries of the OECD. It notes that the impact of P4P remains unclear, as the programs analyzed are extremely heterogeneous in their aims, selection of indicators, and financial rewards.

Canada - Healthcare Organizations Across Canada Launch Improvement Projects

In April 2017, the Canadian Foundation for Healthcare Improvement (CFHI) announced nine healthcare improvement projects it will support through its flagship fellowship program. Selected healthcare organizations in Quebec, Ontario, British Columbia and Nova Scotia will implement and evaluate projects focusing on innovative ways of providing patient care in the home and communities.

Portugal - Health system review

Since the 2008 economic crisis, health sector reform in Portugal has been guided by financing agreements between the Portuguese Government and international lending institutions. While measures mainly focus on containing costs and improving efficiency to ensure financial sustainability, this review says significant health inequalities persist and quality and accessibility of care is likely to be negatively affected by continuing budget cuts.

UK - Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the “NHS Services, Seven Days a Week” project 2013–2016

In 2013, the Seven Days a Week Project was initiated to expand full access to the National Health Service (NHS) on weekends. This study analyzes these changes, finding that the adverse clinical outcomes associated with weekends may not be improved by the reorganization. In fact, unless there is additional financial investment, such changes may negatively impact care quality, as seen by the worsening of some outcomes.

Canada - Canada should not allow two-tiered practicing for medically-necessary services

Comparing Canada with European nations that operate two-tiered health systems with both public and private care, this paper argues that Canada should not allow a two-tiered approach to medically necessary services. It says doing so will weaken healthcare outcomes in the public system as practitioners migrate to the private sector, leaving publicly-funded services with longer wait times and reduced quality.

Australia - Equitable resourcing of primary health care in remote communities in Australia’s Northern Territory: a pilot study

This study in Australia’s remote Northern Territory sought to identify factors that help to ensure equitable access to high quality primary health care (PHC) even in geographically isolated areas. A direct linear relationship was observed between the total cost of PHC services and population, while cost per capita decreased with increasing population. The findings provide evidence based on real costs to guide funding for remote PHC services.

USA - The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization

This evidence report from the Patient-Centered Primary Care Collaborative (PCPCC) highlights findings from 45 newly released peer-reviewed reports and additional government and state evaluations. It finds the patient-centered medical home (PCMH) and other forms of advanced primary care show improved outcomes in many studies.

UK - NHS hospitals to be assessed on how they use their resources from the autumn

Starting in fall 2017, the National Health Service (NHS) will begin reviewing how effectively NHS hospitals are using their resources to provide high quality, efficient and sustainable care. As well as hospital finances, the new measure will look at workforce and facilities. Reports with recommendations for improvement will be produced if required.

Canada - Toward Quality Mental Health Services in Canada: A Comparison of Performance Indicators across 5 Provinces

In 2015, the Centre for Applied Research in Mental Health & Addiction (CARMHA) at Simon Fraser University led an initiative to develop mental health and addictions performance indicators that could be used comparatively across five provinces: British Columbia, Alberta, Manitoba, Ontario and Québec. These two reports present the project: one provides an overall summary and the other details technical information on indicators and results.

USA - A Roadmap for Promoting Health Equity and Eliminating Disparities

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

Europe - 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.

France – Launch of the 2017 national health strategy

On September 18, 2017, the Haut Conseil de la Santé Publique delivered its report on the health status of the French population. Based on the report, the Minister of Health identified four medium and long-term priority themes: prevention and health promotion, addressing social and territorial inequalities in access to health care, increasing the pertinence and quality of care, and innovation.

UK - Learning from Scotland’s NHS

This is the first in a series of reports from the Nuffield Trust that looks at each of the four health services of the UK and asks what lessons they hold for one another. Notable findings include that in improving quality Scotland focuses on engaging the altruistic professional motivations of frontline staff to build their skills to improve, and that a more personalized, less formal approach is used than in England. There is a long history and some good lessons for integrating various parts of the system.

Ireland - National Cancer Strategy 2017 -2026

Following significant progress over the last 10 years, Ireland is determined to make further strides in cancer control such that survival rates reach the top quartile of European countries by 2026. Prevention is a cornerstone, along with integration across primary, acute and social care with enhanced leadership from the National Cancer Control Programme. The strategy describes measures intended to reduce the cancer burden, provide optimal care, and maximize patient involvement and quality of life.

Australia - Second Atlas highlights opportunities for healthcare improvement

This report by the Australian Commission on Safety and Quality in Health Care shows large variations in the provision of common health treatments across Australia. It examines variations in care for hysterectomy, cataract surgery, knee replacement and potentially preventable hospitalizations.

Canada - Alignment of Canadian Primary Care With the Patient Medical Home Model: A QUALICO-PC Study

The patient-centred medical home (PCMH) approach emphasizes integrated care, relationships with a regular physician, holistic self-care and a focus on quality, safety, and access. This paper compares current primary care across Canada with the goals of the PMH model. After surveying 1,172 patients and 772 primary care practices in 10 provinces, the paper found little evidence of consistent implementation of PCMH goals.

UK - Caring to change: how compassionate leadership can stimulate innovation in health care

Produced by a private think-tank for the National Health Service (NHS), this report considers the relationship between innovation, compassionate leadership, and organizational culture in the healthcare sector. The report identifies compassion as the core cultural value of the NHS and analyzes four fundamental elements of a culture for innovative and high-quality care (vision, inclusion, autonomy and support). Case study examples are included.

UK - Improving Outcomes through Transformational Health and Social Care Integration – The Scottish Experience

Scotland's Parliament recently passed legislation to integrate aspects of health and social care in order to improve care quality and outcomes for people with multiple complex needs. Developing a national framework to accelerate progress in care integration, the legislation also provides for tailored local supports and services delivered in partnership with area housing, community, and voluntary sectors.

UK - Driving improvement: case studies from eight NHS trusts

Conducted by the Care Quality Commission (CQC), England's independent regulator of health and social care, these case studies of eight autonomous regional National Health Service (NHS) Trust organizations use quarterly inspection reports to examine drivers of service and care. The case studies take into account leadership capacity, culture, strategy, governance, staff and patient engagement, and the drive for continuous improvement.

Europe - Health and inequality in health in the Nordic countries

Comparing population health, access to health care, and inequalities in the five Nordic countries (Iceland, Norway, Denmark, Sweden and Finland), Germany and the UK, this 2002-2012 study found that Nordic countries lead in access, services, and population health, and have fewer health inequalities. Sweden rated first among the Nordic countries while low-income citizens experienced the best health and care in Iceland.

Canada - Comparing Performance of Universal Health Care Countries, 2016

Canada spends more on health care than almost every other comparable country with universal care finds a new study released by the Fraser Institute. The study compares 28 universal health-care systems in developed countries, spotlighting several key areas including cost, use of resources, access to care and treatment, clinical performance and quality, and the health status of patients.

UK - Review shows how NHS hospitals can save money and improve care

A government-commissioned review of the UK National Health Service (NHS) says NHS hospitals must standardize procedures, be more transparent, and work harder at efficiencies. The Carter Review says implementing the recommendations will help to end variations in quality of care and finances that currently cost the NHS billions.

International - A New Resource for Exploring Health Care around the World

This website presents profiles of healthcare systems in 18 countries in Europe, North America, and Asia, along with Australia. Readers can compare health system organization and insurance, financing, quality, coordination, efficiency, integration, information technology use, evidence-based practice, cost containment and recent reforms and innovations.

International - International profiles of health care systems 2015

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations.

Belgium - Performance of The Belgian Health System - Report 2015

Using 106 indicators, this report on Belgium’s healthcare system from 2008 to 2013 lists the system’s strengths and weaknesses, and recommends future priorities for performance improvement. Overall, Belgians are satisfied with their health care, and 78% consider themselves healthy. In terms of quality of care, the country is slightly above the European average.

International - How High-Need Patients Experience the Health Care System in Nine Countries

Conducted by a US health foundation, this analysis investigates healthcare use, quality, and experience among high-need patients in nine countries (Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the US). It finds that high-need patients use more healthcare than others, and experience more bureaucracy and financial barriers to care. Disparities are particularly pronounced in the US.

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.

USA - The Patient-Centered Medical Home’s Impact on Cost and Quality. Annual Review of Evidence 2014-2015

The Patient-Centred Primary Care Collaborative (PCPCC) is an American primary care delivery initiative that emphasizes a 'medical home' approach to improve patient-centred care while reducing care costs. This 2015 evidence review provides a summary of 'medical home' cost and utilization results from studies, industry reports, and government evaluations.

Belgium - Organisation and Payment of Emergency Care Services in Belgium: Current Situation and Options for Reform

The report explores the strengths, limitations and future challenges and recommends strategies for a more efficient organisation and payment system of emergency departments while access towards high-quality services is maintained.

Canada - New report reveals inequities in people’s health risks, care and outcomes based on their income

Health Quality Ontario has issued a health equity report showing that the province’s poorest people are more likely to have shorter lifespans and suffer from chronic conditions. Ontarians below the poverty line are twice as likely to have multiple chronic conditions and die up to five years earlier than richer residents.

International - Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

Pay-for-performance (P4P) programs have been implemented to improve quality in numerous health systems. This systematic review examined 41 international studies to better understand implementation factors affecting the effectiveness of P4P. It found limited evidence from which to draw firm conclusions, but suggests that P4P programs should align with organizational priorities and undergo regular evaluation.

Canada – The Ontario Government Reports First Year Progress on Patients First Action Plan

On March 23, 2016, the Ontario Minister of Health and Long-Term Care released a report detailing results of efforts to give patients better and faster access to high-quality health services. Measures to improve access have included making hospital parking more affordable, supporting in vitro fertilization, funding nurse practitioners and selecting Ontario's first ever Patient Ombudsman.

USA - Home-Based Primary Care Interventions

Assessing evidence about home-based primary care (HBPC) interventions for adults with serious or disabling chronic conditions, this US comparative effectiveness review examines 19 studies published since 1998. While HBPC was seen to have a positive impact on patient and caregiver experience (including satisfaction, quality of life, and caregiver needs), the strength of evidence for these outcomes was low.

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

International - Health at a glance 2015

This new edition of Health at a Glance presents the most recent comparable data on the performance of health systems in OECD countries and, where possible, partner countries. As always, it presents indicators of health and health system performance and focuses on the pharmaceutical sector, health workforce migration and the quality of health care.

Lunch hour conferences 2016

By Michel Perreault, psychologist-researcher, Douglas Mental Health University Institute, associate professor, Psychiatry Department, Université McGill Hélène Provencher, professor, Nursing Faculty, Université Laval, researcher, Groupe de recherche sur l'Inclusion sociale, l'Organisation des services et l'Évaluation en santé mentale (GRIOSE-SM), CSSS de la Vieille-Capitale This conference will address the added value question of the intervention focusing on the contribution of peer helpers in care and services network, particularly in the area of mental health. The major findings from two research projects supported by the MSSS will be presented, one about the peer helpers intervention to facilitate access to clinical treatment for people with anxiety disorders with the support group Phobies-Zéro and the other one addressing the peer helpers integration in teams of support in the community for people with severe mental disorders proposed by the “Peer Helpers Network Program” associated with the Association québécoise pour la réadaptation psychosociale. Peer helpers accompany researchers…

International - Case-based Payment Systems for Hospital Funding in Asia. An Investigation of Current Status and Future Directions

Published by the OECD, this book presents a study of payment systems based on Diagnosis Related Groups (DRGs) that focuses on hospital funding arrangements in the Asia-Pacific region. The book assembles international evidence regarding the impact on cost, quality and efficiency of introducing of a DRG-based hospital payment system.

Australia - Value co-creation: a methodology to drive primary health care reform

The Medical Journal of Australia (MJA) devotes this issue to a discussion of value co-creation as a methodology to drive Australian primary health care. Nine articles consider the topic from different perspectives, including mental health, the role of consumers, organizational performance, pharmacy structuration, and quality improvement tools and resources.

International - Governments must tackle regional variations in health care use, says OECD

Health care use varies widely across countries but can also vary as much or more within countries. Governments should do more to improve their health systems to prevent unnecessary interventions and ensure that everyone has the same access to quality healthcare, wherever they live, according to a new OECD report. Geographic Variations in Health Care analyses the geographic variations across a range of high-volume and high-cost health care activities, such as heart bypass or knee replacement operations.

The Netherlands - Health System in Transition, 2016

Produced by the WHO, this review looks at the current state of health care in the Netherlands. While the country has some of Europe's highest per capita health expenditures, costs are slowing considerably following of the introduction of managed system competition and universal social health insurance. Out-of-pocket payments are low from an international perspective, and healthcare quality remains high.

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.

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

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

Canada - CFHI Shows Care Closer to Home Can Cut Hospitalizations and Improve Outcomes

This report from the Canadian Foundation for Healthcare Improvement (CFHI) says hospitalizations for chronic disease rarely meet patients’ needs. The report finds that hospitalizations due to COPD can be decreased by up to 80 percent when healthcare is provided to patients and their families at home. This transformational approach not only improves quality of care, but would also avoid 68,500 emergency department visits, 44,100 hospitalizations and 400,000 bed days - saving $688 million in hospital costs over the next five years.

Belgium - Multi-Criteria Decision Analysis for the Appraisal of Medical Needs: A Pilot Study

In Belgium, drug reimbursement decisions have traditionally been taken without consideration for the preferences of patients. The country’s Federal Centre for Health Care Knowledge (KCE) developed this pilot study to appraise medical needs and identify the reimbursement criteria most important to citizens. Results show that Belgians emphasize quality of life and drawbacks from existing treatments over the extension of life at all costs.

Sweden - Vision for eHealth 2025

Sweden’s national, regional and local governments have endorsed a countrywide eHealth strategy to make the Scandinavian nation a world leader in the digitization of health care and social services by 2025. The integrated vision for eHealth will promote accessible, equitable digital health and social care that prioritizes quality, efficiency, and privacy.

International - Universal health coverage: moving towards better health. Action framework for the Western Pacific Region

Published by the WHO for countries of the Western Pacific Region, this framework supports national road maps for universal health coverage. The framework prioritizes 15 relevant planning domains, which it categorizes using five attributes of high-performance health systems: quality, efficiency, equity, accountability, and sustainability and resilience.

UK - The Spending Challenge: how to cut spending while maintaining quality

Looking at the immense challenges confronting the UK government’s austerity approach to spending and maintenance of services in the context of “Brexit”, this study draws on public polling to suggest policy priorities.

International - The Role of Private Non-Profit Healthcare Organizations in NHS Systems: Implications for the Portuguese Hospital Devolution Program

The national health systems of many countries are based on the principle of an integrated public sector payer-provider. However, in some systems private non-profit organizations (NPOs) continue to play a role. This paper compares the international position of NPOs in public health systems with Portugal’s ongoing program to devolve public hospitals to NPOs. Evidence on the Portuguese program suggests it improved efficiency and access without sacrificing quality.

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 - WHO Europe launches new action plan for noncommunicable diseases

In September 2016, the WHO launched a new action plan for noncommunicable diseases (NCDs) in Europe that outlines actions to reduce the burden of NCDs, improve quality of life, and make healthy life expectancy more equitable. Along with early detection of NCDs, the plan advocates the use of marketing restrictions to promote healthy eating.

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

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

International - Transformational change in healthcare: an examination of four case studies

Investigating examples of transformational change in the health care sector, this Australian study focuses on case studies from the US, the UK, and Australia that exemplify well communicated strategies, innovative redesign, extensive consultation, efficient performance management and high-quality leadership. Despite differences between the case studies, the overall characteristics of success were found to be similar.

Canada - Ambulatory EMR Use Delivers Health System and Patient Benefits

According to a study by Canada Health Infoway, electronic medical record (EMR) use in ambulatory care is yielding benefits in improved patient safety and clinic efficiency. The study found that 57% of clinics using EMRs report quality improvements and that 1.2 million additional patient visits in 2015 resulted from enhanced efficiency.

UK - Digital requirements for new primary care models

Drawing on case studies of new health technology use, this briefing examines how technology can enable primary care in the UK to better solve funding issues, workforce shortages, and demands for improved quality of care. The briefing examines innovations such as shared health records, patient portals for appointment booking, remote consultations and telehealth.

Canada - Taking seniors off antipsychotics shows dramatic improvement in care

A Canadian Foundation for Healthcare Improvement (CFHI) initiative to reduce antipsychotic use by seniors in long-term care (LTC) has shown dramatic results — far fewer falls, less aggression, and improved quality of life. Contrary to expectations, inappropriate behaviours decreased by over 50% in the sample of 416 LTC residents whose antipsychotic use was discontinued.

International - Are better health outcomes related to social expenditure? A cross-national empirical analysis of social expenditure and population health measures

Studies have shown that social spending and the ratio of social to health spending are associated with better health outcomes. This paper builds on this finding by incorporating other factors — social capital and income inequality — into its assessment at the cross-national level. It finds that public social expenditure by government seems to have a particularly strong relationship with population health outcomes.

USA - Systems Practices for the Care of Socially At-Risk Populations

Since 2010, US Medicare and Medicaid services have been moving to value-based payments (VBPs) that include incentive programs and risk-based alternative payment models. This article discusses evidence from these programs showing that providers serving patients with social risk factors for poor health outcomes are more likely to fare poorly on quality rankings and are less likely to receive financial rewards.

France - Payment for performance in public health. Continual improvement on quality and the pertinence of care. 4-year assessment

Four years into its implementation, the results of the payment for performance program in France known as ROSP shows the practice to be a change lever among more than 110,000 eligible private physicians. Between 2011 and 2015, it encouraged improvements in the management of patients with chronic diseases and more relevant and effective prescriptions that help to control health spending; furthermore, the practice prompted a modernization of medical practices for the benefit of patients.

UK - On targets: How targets can be most effective in the English NHS

The use of encompassing targets in England’s National Health Service (NHS) divides expert opinion. This report focuses on how country-wide targets can improve care quality and uses the evidence supporting their positive impacts to discuss tailoring their scope to effectively confront key challenges facing the NHS.

Canada – Fiscal Sustainability and the Transformation of Canada's Healthcare System: A Shifting Gears Report

This report from Toronto’s Mowat Centre is intended to help facilitate long-term decision-making in Canadian health care. It calls for a shift in perspective through the application of four concepts: treating health care as a high-tech industry; utilizing disruptive innovation; focusing on quality improvement; recognizing that ”Moore’s Law” (of declining costs over time) applies to health care.

UK - Does hospital competition harm equity? Evidence from the English National Health Service

Although hospital competition under fixed prices can improve quality and reduce cost, the resulting competition may undermine equity in care. This new British study, published by the University of York’s Centre for Health Economics, tests this hypothesis in the context of the pro-competition reforms of the U.K.’s National Health Service (NHS), introduced between 2004 and 2006.

Canada - Learning From the Best: Benchmarking Canada’s Health System

Canada’s health system has mixed results in comparison with its peers in the Organisation for Economic Co-operation and Development (OECD), according to a new report released recently by the Canadian Institute for Health Information (CIHI). Learning From the Best: Benchmarking Canada’s Health System examines Canadians’ health status, non-medical determinants of health, quality of care and access to care. It is based on international results that appear in the OECD’s Health at a Glance 2011, also being released recently, which provides the latest statistics and indicators for comparing health systems across 34 member countries.

USA - To Reform Medicare, Reform Incentives and Organization

Authored by Professor Alain Enthoven, a pioneer of the concept of managed competition, this policy brief published by the Committee for Economic Development shows how to apply managed competition to Medicare in the U.S. The paper explains how the principles of cost-responsible consumer choice among competing health insurance plans can improve quality and reduce Medicare costs.

UK - Competition, integration and incentives: the quest for efficiency in the English NHS

Recent government health reforms in England have paved the way for a significant extension of market mechanisms in health care. Published in December 2011, the second issue of Nuffield Trust Viewpoints looks at new forms of care provision that stand to benefit British patients and taxpayers. The report examines areas where competition might improve quality and efficiency.

Improving estimates of exports and imports of health services and goods under the SHA framework

Brief analytical summaries or syntheses #31 Improving estimates of exports and imports of health services and goods under the SHA framework Summary This document is the final report of an OECD project that responds to increasing demand for statistics on the trade in health care goods and services. The report provides clear concepts, definitions and guidelines for the production of reliable, timely and comparable estimates of imports and exports of health services and goods within a standard health accounting framework. Background Trade in health services, and its best-known component, medical tourism, has attracted a great deal of media attention in recent years. This creates the impression that a large part of the population is regularly seeking health care abroad or buying pharmaceuticals over the internet from foreign providers. The apparent growth in such imports and exports has been fuelled by a number of factors. Technological advances in information systems and…

International - Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature

Legislation enabling nurses and allied heath professionals to prescribe medications exists in some countries, and others are considering introducing such legislation. Questions remain as to the contribution this type of legislation makes to the care of patients in primary care and the evidence base on which clinicians, commissioners of services and policy makers can consider this innovation. This study, published in BMC Health Services Research provides a review of the literature on non-medical prescribing in primary care, looking at its impact on health care quality.

International - International profiles of health care systems

This publication from the Commonwealth Fund presents overviews of health care systems in nine European countries, Japan, Australia, Canada, and the U.S. Each overview covers insurance, financing, organization, quality of care, health disparities, efficiency and integration, information technology usage, use of evidence-based practice, cost containment, and reform and innovation. Summary tables provide data on key characteristics and performance indicators.

USA - Obama Administration takes new steps to encourage doctors and hospitals to use health information technology to lower costs, improve quality, create jobs

On November 30, 2011, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a report showing that doctors’ adoption of health information technology (IT) doubled in two years. As well, a Centers for Disease Control and Prevention survey found that 52% of office-based physicians in the U.S. now intend to take advantage of the incentive payments available to doctors and hospitals through the Medicare and Medicaid electronic health record (EHR) incentive programs. In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs. Over 50,000 health IT-related jobs have been created since the enactment of the HITECH Act.

UK - Truly inefficient or providing better quality of care? Analysing the relationship between risk adjusted hospital costs and patients’ health outcomes

This study from the University of York’s Centre for Health Economics explores the link between hospital costs and health outcomes. Using data on patient-reported health measures (PROMs), collected for all British patients undergoing elective surgery, the study finds substantial variation among hospitals in the costs of treating elective surgery patients, even after accounting for health outcomes.

USA - The U.S. health care system achieves a score of 64 out of 100 in the third National Scorecard on U.S. Health System Performance

The new U.S. National Scorecard updates assessments of population health and health care quality and access. Across 42 performance indicators, the U.S. achieved a score of 64 out of a possible 100 when comparing national rates with international benchmarks. The Scorecard concludes that the American health system continues to fall short, especially considering how much the country spends on health.

UK — Does clinical coordination improve quality and save money?

This review of research presents evidence of the costs of under-coordination, the effectiveness and cost of interventions to improve coordination, and evidence of savings or losses to different parties. It also presents an analysis of the implications of the evidence for different parties and for future research.

UK — Integration in action: four international case studies

This report explores how to strengthen integration between services in order to improve health outcomes, patient experience of care and value for money from available resources. It describes work to improve integration in four international organisations: 1. a government-funded network to improve access to and quality of Medicaid services in North Carolina, United States (US) 2. an independent practice association in upstate New York, US 3. a Dutch organisation providing support to general practitioners (GPs) to deliver integrated care for diabetes and other chronic conditions, 4. a Scottish health and social care partnership.

Italy — The Lombardy Health Care System

In the very recent past, the Lombardy health care system - established on the quasi-market model – has caught the interest of researchers and politicians in different OECD countries. The merits of the model, compared to other Italian regional models, are the control of health care spending and the balanced budget, in a frame of good quality of services and patient choice. This paper stems from a literature review and tries to analyse the evolution of this regional system, the institutional path that brought to the implementation of the model, its theoretical basis, its merits and criticism. The period considered ranges from 1997, when the reform was enacted, to 2010.

UK — Review of Community Health Partnerships

The NHS Reform (Scotland) Act 2004 required NHS boards to establish one or more Community Health Partnerships (CHPs) in their local area to bridge the gap between primary and secondary healthcare, and also between health and social care. CHPs were expected to coordinate the planning and provision of a wide range of primary and community health services in their area. The overall aim of this audit was to examine whether CHPs are achieving what they were set up to deliver, including their contribution to moving care from hospital settings to the community and improving the health and quality of life of local people.

Austria - Reforming Austria’s Highly Regarded but Costly Health System

Austria’s health system delivers good quality and accessible services, but is costly. This Working Paper from the Organization for Economic Cooperation and Development (OECD) reviews the Austrian health system’s response to current financial challenges, and makes recommendations based on other OECD countries’ experiences.

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…

USA - HHS launches new Affordable Care Act initiative to strengthen primary care

This September 28, 2011, news release from the U.S. Department of Health and Human Services (HHS) announces the launch of a new Affordable Care Act initiative to help primary care practices deliver coordinated and high quality patient-centered care. Under the new initiative, Medicare will work with commercial and state health insurance plans to support primary care doctors who better coordinate care.

USA - Public Health Accreditation Board (PHAB) Launches National Accreditation for Health Departments

The goal of PHAB’s accreditation program, initiated and supported by the Robert Wood Johnson Foundation (RWJF) and the Centers for Disease Control and Prevention (CDC), is to protect and improve Americans’ health by advancing the quality and performance of all of the nation’s public health departments — state, local, territorial and tribal. It aims to create a national standard for public health. Accreditation is seen as a powerful way to publicly recognize that health departments are doing a good job, while at the same time driving them to continuously improve.

Canada - New Brunswick Health System Report Card: Access Challenges Remains despite Increase in Number of Providers

The New Brunswick Health Council (NBHC) released its second Health System Report Card in January 2012. An important tool measuring the quality of health services delivered in the province, the Report Card also indicates how New Brunswick compares with Canada’s other provinces. The 2012 Report Card gives New Brunswick a “C” as an overall performance grade, unchanged from 2011.

UK - NHS hospital mergers bring few benefits, research finds

According research from the U.K.’s Centre for Market and Public Organization (CMPO), mergers are unlikely to be the most effective way of dealing with Britain’s poorly performing National Health Service (NHS) hospitals. The study found that hospital consolidation brought few benefits: poor financial performance typically continued and few improvements in clinical quality were seen.

UK - The NHS could save millions and provide better care by involving more Allied Health Professionals such as podiatrists in patient care

New online tools are available to help the U.K. National Health Service (NHS) identify ways in which allied health professionals can improve patient care while reducing costs. Allied health professionals include physiotherapists, podiatrists and speech therapists. The new online tools include case studies from local NHS services that have optimised quality and savings.

Australia - The Australian Experiment: How Primary Health Care Organizations Supported the Evolution of a Primary Health Care System

Australian primary health care has undergone 20 years of change since the establishment of local Divisions of General Practice. This article from the Journal of the American Board of Family Medicine (JABFM) identifies how these organizations have helped the primary care system evolve by supporting national practice accreditation, quality improvement, regional integration, IT adoption, and improved access to care.

USA - Rising to the Challenge. Results from a Scorecard on Local Health Performance, 2012

In this Scorecard on Local Health System Performance, the Commonwealth Fund provides comparative data to help communities assess the performance of local healthcare systems. Comparing all 306 designated local health care areas in the U.S., the Scorecard finds that access, costs, quality and health outcomes vary significantly between communities, often with large variations in key indicators. Top-performing areas are concentrated in the American Midwest and Northeast.

USA - Reducing Costs through the Appropriate Use of Specialty Services

This white paper describes efforts by the Institute for Healthcare Improvement (IHI) to find ways to reduce overuse, with a focus on specialty services, a significant source of expense in the US health care system. Examples of success in identifying and reducing overuse without apparent negative impact on quality, and without using techniques experienced as coercive by physicians, are explored.

Europe – Health. Comparative analysis of public spending in France and Germany

Santé. Analyse comparative de la dépense publique en France et en Allemagne If France brought its public health expenditure per capita down to German levels, it would save 7.2 billion euros a year. This report describes a French system that is running on empty and, while it offers efficient care now, will not be able to respond to future challenges such as population aging. The comparative approach with Germany proposed by the author offers a vision of the magnitude of effort required to produce reform. The comparison with Germany is justified by population size and by its comparable quality of care.

UK - Productivity of the English National Health Service 2003-4 to 2009-10

This paper from the Centre for Health Economics estimates output, input, and productivity growth for the English National Health Service (NHS) between 2003 and 2010. The authors calculate productivity growth by comparing the growth of ‘output’ versus ‘input’ in health care. Output consists of the volume of all patient care services and accounts for quality improvements. Inputs include staff, general and clinical supplies, energy costs and capital resources.

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 2020health.org, 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…

Switzerland – Swiss health system

Système de santé suisse This report from the Confédération Suisse reflects health system actor responses to the assessment of the Swiss health system produced by the OECD and WHO in 2011. Among the issues discussed by the authors in this issue are the low investment in prevention, the coming challenge of health worker shortages, inadequate databases and higher levels of health inequality than those seen in comparable countries.

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.

Canada - Lung Disease Imposes Major Costs on Canada’s Economy

This cost-risk analysis by the Conference Board of Canada calculates the cost of three chronic lung diseases — lung cancer, asthma and chronic obstructive pulmonary disease — at $12 billion in 2012, a figure that is set to double by 2030. It also projects the potential for policy measures around smoking and air quality to attenuate the increase.

UK - Patients are getting excellent or very good care in the NHS but more needs to be done

On February 14, 2012, Britain’s Department of Health released results of the 2011 Patient Experience Outpatient Survey. Seventy-two thousand outpatients across the National Health Service (NHS) were interviewed. Almost 84% rated their experience as very good. However, 65% were not told how long they would have to wait for an appointment, and did not know what to expect.

Germany - The private sector within a public health care system: the German example

In Europe, where public financing is as prevalent as in Canada, if not more so, the private for-profit sector has an extensive role to play in delivering service. The German experience shows that private sector involvement and the search for profit, contrary to widespread fears, are correlated with better quality care and can improve the efficiency of low-performance establishments.

USA - Thomson Reuters Announces Top Health Systems

Thomson Reuters released its fourth annual study identifying the top U.S. health systems based on balanced system-wide clinical performance. The study examined data from more than 300 American organizations and singled out 15 hospital systems that achieved superior clinical outcomes based on measures of quality, patient perception of care and efficiency.

UK - The Very English Experience with Competition: Lessons from Britain’s National Health Service

This OECD report examines market-based healthcare reforms in the UK over the past decade. The report analyzes the introduction of competition into the English National Health Service (NHS), and reviews the impact reforms have had on equity, efficiency, and hospital quality.

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.

Korea - Better primary care is key to improving Korea’s healthcare system

South Korean healthcare depends too much on hospitals and not enough on community-based medical practices, according to this article in the OECD’s Health Care Quality Review. South Korea has 55 hospitals per million people with 8.3 beds per 1000 people, much more than most OECD countries.

Canada - Lean in British Columbia’s Health Sector. Annual Report 2010–11

Published in September 2011 by the British Columbia Ministry of Health, this annual report presents seven case studies of Lean process redesign work carried out by B.C. health authorities in 2010-11. In the health sector, Lean is a patient-focused approach that systematically eliminates waste in health care organizational processes in order to improve quality, productivity, and efficiency.

Baskets of services: Comparative analysis of management mechanisms

Brief analytical summaries or syntheses #34 Baskets of services Comparative analysis of management mechanisms Summary Managing the basket of healthcare services promises efficiency gains by rationalizing decisions around coverage and care. This literature review by Joanne Castonguay at CIRANO examines how the basket of services is managed in a sample of OECD countries. The exercise enabled the author to make a number of observations, compare Québec’s management of the basket of services to that in other countries and suggest ways to improve current practices. Background The sustainability of universal health systems is a concern in all OECD countries. The rapid growth in demand for health care and the difficulty in achieving commensurate increases in financing are pushing governments to rethink not only how health systems are organized, but also the way in which funds are allocated. One of the most important cost drivers is technological progress. Medicine is evolving rapidly…

New Zealand - New health website to allow clinicians to network online

The Ministry of Health is developing a new website which will allow doctors, nurses and other specialists in the health sector to come together online to share information and discuss specific topics. Formally called the Health Improvement and Innovation Resource Centre, the website (www.hiirc.org.nz) will feature a “knowledge library” of the latest New Zealand research on health sector productivity, and quality and access to health care. The website, which is being developed by Research New Zealand, will be up and running this July.

Australia - Widespread Support for Health Reform

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

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

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

USA - Performance Measurement in Fee-for-Service Medicaid: Emerging Best Practices

Through support from the California HealthCare Foundation, the Center for Health Care Strategies (CHCS), in collaboration with the California Department of Health Care Services (DHCS), sought to better understand how states are using performance measures for Medicaid FFS beneficiaries, particularly those with complex needs. This resulting report outlines emerging best practices for measuring the quality of FFS care culled from the firsthand experiences of nine states as well as numerous interviews with key stakeholders across the country.

USA – Healthy people 2020 - The nation’s new health promotion and disease prevention agenda

The U.S. Department of Health and Human Services recently unveiled Healthy People 2020, the nation’s new 10-year goals and objectives for health promotion and disease prevention. For the past 30 years, Healthy People has been committed to improving the quality of the Nation’s health by producing a framework for public health prevention priorities and actions.

France - Out-of-Pocket Maximum Rules under a Compulsory Health Care Insurance Scheme: A Choice between Equality and Equity

Using the microsimulation model ARAMMIS, this study attempts to measure the impacts of introducing an out-of-pocket (OOP) maximum threshold, or a safety net threshold, on consumer copayments for health care financed by the abolition of the Long-term Illness Regime (ALD) in France. The analysis is based on a comparison of different safety net threshold rules and their redistributive effects on patients’ OOP payments.

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

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

UK - Patient-centred NHS a step closer to reality: Health and Social Care Bill published

Plans to modernise the National Health Service and put patients at the heart of everything it does were set out in the Health and Social Care Bill, published recently. The proposed changes will lead to better quality care, more choice and improved outcomes for patients, as well as long-term financial savings for the NHS, which will be available for reinvestment to improve care.

Europe - Measuring and managing performance

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

UK – Launch of the First NHS outcomes framework 2011-12

The first NHS outcomes framework sets out the national outcome goals that the Secretary of State for Health will use to monitor the progress of the NHS Commissioning Board. The framework focuses on five domains: Preventing people from dying prematurely, Enhancing quality of life for people with long-term conditions, Helping people to recover from episodes of ill health or following injury, Ensuring that people have a positive experience of care, Treating and caring for people in a safe environment and protecting them from avoidable harm.

USA - Family Medicine Releases Issue on Rural Health

Throughout the history of the specialty, family medicine programs have graduated physicians that are capable and willing to provide health care to underserved populations. This issue of Family Medicine, dedicated to rural health education, celebrates that accomplishment by showcasing family medicine programs and educational strategies designed to produce high-quality rural family physicians.

Canada - Improving Rural And Northern Health Care. The Ontario Government Seeking Input To Address Unique Health Care Challenges

Ontarians are being asked for their feedback on how to provide the best access to quality health care services in rural and northern areas of the province. Specifically, Ontarians are invited to respond to recommendations made by the Rural and Northern Health Care Panel. There are a number of ways that the public can make its views known - including online, by phone and in-person at roundtable discussions in rural communities across the province.

The Netherlands - Dutch Health Care Performance Report 2010

The Dutch Health Care Performance Report 2010, published by the National Institute for Public Health and the Environment (RIVM), has recently become available in English. Commissioned by the Dutch Ministry of Health, RIVM monitors trends in the quality, accessibility and costs of health care. Using a finite set of indicators, this third edition of the report assesses the performance of the health care system in 2008 and 2009 and compares it to previous years and to other countries.

Canada - Bridging the Gap. Building Collaborative Foundations for an Effective and Efficient Health Care System

In its brief to the Standing Committee on Finance, Bridging the Gap, Building Collaborative Foundations for an Effective and Efficient Health Care System, the Royal College of Physicians and Surgeons of Canada identifies priorities for investments in health care that will contribute to a healthier society, better patient care, enhanced systems and improved productivity. The Royal College makes four recommendations to be included in the next federal government budget: 1. Leverage investment in human resources for health by laying the groundwork to create a pan-Canadian observatory to help jurisdictions optimize their expenditures in human capital; 2. Invest in health and health care research funding and enhance our ability to recruit and retain leading health, scientific and biomedical researchers; 3. Promote and support innovation in the delivery of high-quality health care to promote Canada as a leader in medical practices, innovation and best practices; and 4. Invest in the health and…

International - International Profiles of Health Care Systems

This publication presents overviews of the health care systems of 13 countries - Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each country summary provides information on insurance coverage and benefits, health system financing, delivery system organization, quality assurance mechanisms, efforts to improve efficiency and control costs, and recent innovations and reforms.

Canada – The health-care system achieves a reasonable balance of treatment quality, cost and health outcomes, but reforms are needed to contain expenditures pressures according to the OECD

The growth of public health spending must be reduced from an annual rate of about 8% seen over the last decade toward the trend rate of growth of nominal income in coming years (estimated to be less than 4% per year), the only alternative being to squeeze other public spending or to raise taxes or user charges. Regulation currently prohibiting private insurance for core services and mixed public-private contracts for doctors should be removed to spur more efficient service delivery and expanded capacity by way of private entry. Pharmaceuticals, home and therapeutic care should be integrated into the core public package. Revenues could be raised and excess demand curbed by carrying out some sort of capped patient co-payments and deductibles.

USA - Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and improve performance) likely depends on local resources. The authors of this study quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

Ireland - Minister for Health and Children, Mary Harney, launches Patient Safety First Initiatives

The Minister for Health and Children, Mary Harney, T.D along with other key participants, recently announced a number of significant initiatives including the establishment of a new National Framework to drive Clinical Effectiveness through which patients will be assured of the provision of high-quality care based on established best practice. The Minister and other stakeholders also signed the ‘Patient Safety First’ declaration of commitment as part of the National Framework for Clinical Effectiveness.

Japan - Economies of Scale and Hospital Productivity: An empirical analysis of medical area level panel data

This paper estimates the total factor productivity (TFP) of hospitals by using panel data drawn from prefectures and secondary medical areas. The study focuses on the economies of scale in the medical area and at hospital levels. It uses the average length of stay as a measure of medical quality. The results show that hospital size affects productivity: the larger the hospital, the higher the productivity.

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.

Canada - A Provincial Cancer Control Policy Framework for Newfoundland and Labrador

Following a significant investment of over $125 million in cancer prevention and treatment over the last seven years, the Williams Government recently released a provincial cancer control strategy entitled Gaining Ground: A Provincial Cancer Control Policy Framework for Newfoundland and Labrador. The goal of the strategy is to reduce the incidence and impact of cancer and to improve the quality of life of those living with cancer in Newfoundland and Labrador.

International - Nurses’ Reports on Hospital Care in Five Countries

A new study of more than 43,000 nurses practicing in more than 700 hospitals in five countries indicates that fundamental problems in the design of work are widespread in hospitals in Europe and North America. Its findings further suggest that major workforce management problems in hospitals must be corrected to ensure acceptable quality of care and an adequate nurse workforce for the future.

Canada - Charting a Path to Sustainable Health Care in Ontario. Tenproposals to restrain cost growth without compromising quality of care

Urgent action is required to place Ontario’s health care system on more sustainable ground according to a new report by TD Economics. The report’s ten recommendations, which were submitted to Ontario’s Ministry of Health, represent significant change from the current system. Combined, they should help keep healthcare spending in line with the projected provincial growth rate of four percent.

Canada - Evidence-informed options for hospital funding. Are hospital funding mechanisms in Canada designed to provide efficient care?

Based on a paper commissioned by the Canadian Health Services Research Foundation, this brief provides a summary of the available evidence on promising hospital funding options and their impact on the following goals: timely and equitable access, optimal volume of care, quality, efficiency and constraining future cost increases.

UK — NHS productivity: new estimates for 1995 to 2009

Spending on public healthcare and the output it generated both rose substantially between 1995 and 2009. Quality also rose but productivity fell slightly over the same period. These are key findings in an article Public Service Output, Inputs and Productivity: Healthcare, published recently by the Office for National Statistics.

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.

New Zealand - Targeting Emergencies: Shorter Stays in Emergency Departments

In July 2009 the Government demonstrated its commitment to improving the quality and timeliness of the care New Zealanders receive at an ED, by introducing a Health Target of ‘Shorter Stays in Emergency Departments’. The Health Target requires District Health Boards, who run the country’s public hospitals, to ensure that: 95% of patients will be admitted, discharged or transferred from an ED within six hours. This publication looks at how District Health Boards (DHBs) are working to achieve this Health Target, and discusses the real gains which are being made thanks to the creativity, teamwork and dedication of hospital staff.

UK – United Kingdom (England): Health system review. Health Systems in Transition, 2011

The new Health System in Transition (HiT) report on England provides a detailed analysis of the changes made to the health care system in England between 1997 and 2010. The report’s author assesses the impact that these changes have had in terms of access, equity, efficiency, quality and health outcomes.

USA — Review of recent studies shows predominantly positive results for health information technology

A study completed by the Office of the National Coordinator for Health Information Technology (ONC) and published in the journal Health Affairs finds growing evidence of the benefits of health information technology (HIT). Using methods that were employed by two previous independent reviews, the new study finds that 92 percent of articles on HIT reached conclusions that showed overall positive effects of HIT on key aspects of care including quality and efficiency of health care.

Europe — Digital Agenda: European Commission seeks views on improving healthcare by applying ICT (eHealth)

The European Commission is seeking citizens' and other interested parties' views on how the EU can help to deliver widespread benefits to the quality and efficiency of healthcare by applying information and communication technologies (ICT) (so-called 'eHealth'). The online public consultation runs until 25 May. The answers will feed into the preparation of the eHealth Action Plan 2012-2020 that the Commission is due to present before the end of 2011.

USA — Partnership for Patients: Better Care, Lower Costs

The Obama Administration has launched the Partnership for Patients, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans. Using as much as $1 billion in new funding provided by the Affordable Care Act and leveraging a number of ongoing programs, the Department of Health and Human Services (HHS) will work with a wide variety of public and private partners to achieve the two core goals of this partnership – keeping patients from getting injured or sicker in the health care system and helping patients heal without complication by improving transitions from acute-care hospitals to other care settings.

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

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

Ireland — Strategic Framework for Role Expansion of Nurses and Midwives: Promoting Quality Patient Care

This strategic document sets policy direction for the enhancement of nursing and midwifery roles. A six step process provides a framework for nursing and midwifery role expansion in line with service need and national policy direction. Each of the six steps outlines necessary considerations for nurse and midwife role expansion. It promotes clinical care that is delivered in a timely and evidence-based manner that reflects patients’ needs.

Performance Measurement for Health System Improvement

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

Canada — Accreditation Canada International Launches Global Health Care Services Standards

Accreditation Canada International is proud to announce the release of its Global Health Care Services Standards. The standards were developed to address the need for uniformity and standardization in the growing health tourism industry. Due to an increasing number of patients crossing borders to receive health care and concerns about the quality of care in these institutions, the need for international health services standards has never been greater.

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

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

New Zealand - National Health IT Board - Draft National Health IT Plan

On Friday (23/4) the DRAFT national Health IT plan was introduced at a Partnership Summit for key stakeholders. The National Health IT Board will be completing the national Health IT Plan for Ministerial approval before 30 June 2010. The plan will define and monitor the development of a sustainable, effective nationwide information and technology environment that fosters safety and quality care, is person-centred, is provider-friendly and increases productivity of the system as a whole.

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

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

Financing long-term care in Scandinavian countries

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

USA - Achieving Universal Coverage through Comprehensive Health Reform: The Vermont Experience – Evaluation Results

In 2006, Vermont passed the Health Care Affordability Acts (HCAA) to create universal access to affordable health care, contain costs and improve the quality of care. Five years after comprehensive health reform legislation, the percentage of residents with health care coverage has rapidly increased, as has the take-up of Catamount Health, the public insurance program created under the HCAA. This brief from the State Health Access Reform Evaluation (SHARE) initiative examines these impacts in the context of the Affordable Care Act (ACA), and evaluates the potential implications for national health reform.

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.…

UK — A cross-Government mental health outcomes strategy for people of all ages

This strategy sets out six shared objectives to improve the mental health and well-being of the nation, and to improve outcomes for people with mental health problems through high quality services. It supports the Government's aim of achieving parity of esteem between physical and mental health. The interconnections between mental health, housing, employment and the criminal justice system are stressed.

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?

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

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

UK — Financial squeeze biggest worry for healthcare leaders

Balancing finances and making cost savings will be by far the biggest worry to healthcare leaders as they try to provide high-quality services over the next 12 months, according to an NHS Confederation survey released on 7 March.

UK - Reshaping the System: Implications for Northern Ireland's Health and Social Care Services of the 2010 Spending Review

This document provides the Minister for Health, Social Services and Public Safety with possible plans that would deliver high quality, cost effective health and social care services for Northern Ireland in the coming years taking account of the likely reduced funding levels anticipated in the Current Spending Review.

Canada - Manitoba’s Plan to Protect Universal Health Care

This report from the Government of Manitoba, entitled Focused on What Matters Most, looks at the province’s achievements over the past few decades on assuring quality cost-effective health care, and plots the path ahead. It is summed up by the following equation: healthier Manitobans + better health services + better value = sustainable health care.

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.

USA - Medicare Hospital Readmissions Reduction Program. To improve care and lower costs, Medicare imposes a financial penalty on hospitals with excess readmissions

Hospitals with high readmission rates may also offer low quality care. This article analyzes the US Medicare Hospital Readmissions Reduction Program (HRRP), which gives hospitals an incentive to lower readmission rates by financially penalizing institutions with high rates. Some critics of HRRP fear the program will have unintended consequences and threaten care for vulnerable populations.

International - A Comparative Analysis of Hospital Care Payments in Five Countries

This report from the Belgian Health Care Knowledge Centre examines how hospitals and medical specialists paid in a selection of countries. It looks at the intended and unintended consequences of a case prospective hospital payment system. It also examines how incentives for improving quality and for stimulating integrated care systems are introduced in hospital payment systems.

UK - Monitor sets out how to secure the future of the NHS

Britain’s health regulator has warned the country’s National Health Service (NHS) it must change radically to close a £30 billion ($48 billion) funding gap while also providing quality services free to patients. The health sector regulator, called Monitor, has issued a report outlining 20 cost-effective ways to deliver better care and close the gap.

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

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

International - International Profiles of Health Care Systems, 2013

This publication presents overviews of health systems in Australia, Canada, Denmark, Great Britain, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the US. Each overview covers health insurance, public and private financing, system organization and governance, healthcare quality and coordination, efficiency and integration, information technology use and evidence-based practice, cost containment, and recent reforms and innovations.

France - Account certification: The first 31 hospitals begin the process

On December 30, 2013, the Ministère des Affaires sociales et de la Santé of France announced a decree formalizing the first wave of certification of public hospitals accounts. The process has been piloted since 2011 and aims to improving the quality of accounting.

UK - Essential reading for smart spending: Dr Foster hospital guide 2013

This year’s edition looks at how financial austerity is affecting the way hospitals spend money on hospital treatment. It also examines the impact of drug and alcohol problems on patients and hospitals, the quality of care at weekends, and hospital mortality.

Canada - Non-Profit Community-Based Specialty Clinics in Ontario

Ontario is establishing new community-based specialty clinics offering select OHIP-insured, low-risk routine procedures. These clinics will focus on providing high volume services, such as cataract and colonoscopy procedures that do not require an overnight hospital stay. Moving low-risk routine procedures from hospitals to community specialty clinics will help improve the overall patient experience while resulting in better value for taxpayers. Specialty clinics will work closely with Local Health Integration Networks (LHINs) and hospitals and operate under existing legislation and quality assurance frameworks to ensure oversight and accountability.

International - The world health report 2013: research for universal health coverage

Everyone should have access to the health services they need without being forced into poverty when paying for them. The World health report 2013 "Research for universal health coverage" argues that universal health coverage – with full access to high-quality services for prevention, treatment and financial risk protection – cannot be achieved without the evidence provided by scientific research.

International - Resources, attitudes and culture: an understanding of the factors that influence the functioning of accountability mechanisms in primary health care settings

Webs of accountability relationships exist within every health system. There is a need to strike a balance between achieving accountability upwards within the health system while at the same time allowing for the local level innovation that could improve quality of care and patient responsiveness. Published in BMC Health Services Research, this literature review examines factors that influence the functioning of accountability mechanisms.

Canada - Valuing health in Canada. Who, how, and how much?

Published by the Canada 2020 think tank, this paper examines Canadian healthcare treatments and services, identifies discrepancies and makes recommendations. It highlights the importance of cost-effectiveness in system sustainability, and emphasizes public input. The author explains how Quality Adjusted Life Years (QALYs) compare different spending options in a meaningful way.

China - Hospital Reforms in Rural China Increased Patient Satisfaction

In 2009, the Chinese province of Henan began reforms in rural public hospitals that included adopting computerized clinical pathways, shifting from fee-for service to case-based payment, and introducing performance-based payment for care providers. This World Bank article describes how the reforms have reduced medical expenses, improved quality of care, and dramatically increased patient satisfaction in Henan.

International - We must take better care of the elderly, say OECD and the European Commission

The number of people over 80 will double by 2050 rising from 3.9% of the population to 9.1% in 2050 across OECD countries and from 4.7% to 11.3% across 27 EU members. Estimates are that up to half of them will need help to cope with their daily needs. Yet even today governments are struggling to deliver high-quality care to elderly people with reduced physical and mental abilities, says a new OECD/EC report, A good life in old age?. Most countries have legislation to prevent abuse, including encouraging public disclosure of specific cases, complaint mechanisms and an ombudsman to deal with concerns. However very few countries systematically measure whether long-term care is safe, effective, and meets the needs of care recipients.

UK - Lining Up: How do improvement programmes work? Lessons from an ethnographic research study of interventions to reduce central line infections

This study from Britain’s Health Foundation looks at the reproduction of health improvement programs in new settings. The authors examine the adoption in the UK of an American intervention to reduce central line infections. They describe contextual influences, including local factors and prior initiatives, which can impact the transfer of established programs to different settings.

Canada - Prelude to a Systematic Review of Activity-Based Funding of Hospitals: Effects on Health Care System Cost, Quality, Access, Efficiency, and Equity

While decision-makers in Canada contemplate introducing activity-based funding (ABF) models for hospitals, the authors of this study published in Open Medicine point out that there are presently no systematic reviews of evidence on the potential effects of this model. This commentary is intended to alert decision-makers to the upcoming release of a series of papers based on the authors' systematic review of ABF, in the hope that there will be an appetite for this knowledge at a time when they are being asked to make decisions in its absence.

USA - Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

This scorecard from the Commonwealth Fund identifies opportunities for states to improve their health systems for economically disadvantaged populations and provides state benchmarks of achievement. Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the scorecard documents sharp healthcare disparities among states.

Europe - European Vacancy Monitor highlights growing job opportunities in healthcare sector

The European Commission finds that employment in the EU healthcare sector has grown almost 2% annually between 2008 and 2012. This is attributed to the combined effects of an ageing population, advances in technology and treatments, people expecting higher quality service and greater emphasis on preventative care. In 2012 almost one million people were hired to work in health care.

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

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

UK - Care Bill becomes Care Act 2014

Britain’s Parliament has passed the 2014 Care Act creating a single care and support framework built on user wellbeing, quality and safety reform, and service integration. The legislation imposes limits on care costs, introduces new rights for caregivers, and establishes an eligibility threshold for care.

Norway - Norway should strengthen primary care to address evolving healthcare needs, says OECD

Improving primary care systems and co-ordination between health services would help Norway meet the changing needs of its healthcare system, as the population ages and hospital stays become shorter, according to a new OECD report. OECD Health Care Quality Review of Norway says that the country has a world-class health system and consistently out-performs most OECD countries on hospital care indicators. With health expenditure at 9.4% of GDP, it is also one of the more generous health spenders in the OECD.

USA - Aiming Higher: Results from a Scorecard on State Health System Performance, 2014

The Commonwealth Fund’s 2014 Scorecard assesses US states on 42 indicators of healthcare access, quality, costs, and outcomes between 2007 and 2012, a period that includes the last recession and precedes the expansion of insurance coverage under Obamacare. Changes in health system performance were mixed, with states making progress on some indicators but losing ground on others.

Canada - Procurement Can Drive Innovation and Better Care in Canada's Health System

According to the Conference Board of Canada, procurement strategies used internationally in health systems could improve Canadians’ access to innovative technologies and better care without increasing costs. In this report, the Conference Board highlights procurement practices used outside Canada to introduce cost-effective, quality-conscious innovations into public health systems.

France - Public health insurance aims to cut €10 billion without affecting the quality of care

The French government announced that health spending would not rise by more than 2% per year on average between 2015 and 2017, the lowest level since 1997. A three-year savings plan will be accomplished by reorganizing the care trajectory; avoiding unnecessary and redundant medical acts; lowering drug prices and making more use of generics; and improving hospital management.

France - Physician payment for meeting public health goals, two years on. Significant progress made on the quality and appropriateness of care

France's Caisse nationale de l'Assurance Maladie published this report on progress made two years after the implementation of a new payment model based on achieving public health goals. The success rate in meeting objectives improved significantly in one year, from 51.1% to 59.7% for GPs. Public opinion is supportive of the mechanism and medical opinion is evolving positively.

USA - Hospital Guide to Reducing Medicaid Readmissions

The US Agency for Healthcare Research and Quality commissioned this guide to identify ways evidence-based strategies to reduce readmissions can be adapted or expanded to better address the transitional care needs of the adult Medicaid population. It presents a roadmap of tools and discusses their use.

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

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

USA - Small Primary Care Physician Practices Have Low Rates of Preventable Hospital Admissions

This Commonwealth Fund study examines the relationship between quality of care and practice size. It finds that practices with one or two physicians had 33 percent fewer preventable hospital admissions than practices with 10 to 19 physicians, and practices with three to nine physicians had 27 percent fewer admissions. As well, practices owned by physicians had significantly lower ambulatory care–sensitive admission rates than those owned by hospitals.

UK - Going with change: allowing new models of health care to be provided for NHS patients

Reform is an independent British think tank whose mission is to set out a better way to deliver public services and economic prosperity. The author of this report states that old organizations in health care cannot make the shift to new models that can assure high quality and lower cost. He presents private sector business models such as the hub and spoke design of grocery retail and zero error approach to car manufacturing as potential means of moving forward toward a technologically integrated model of care provision.

Australia - Healthcare in Australia 2012-13: Five years of performance

The COAG Reform Council has released its final report on the National Healthcare Agreement. It shows that Australians have overall good health and enjoy a high quality healthcare system. It notes areas of concern such as obesity and chronic diseases that could put strain on the healthcare system and require attention from governments.

Australia - Appointment Zen—Shaping demand and matching capacity

This article, published in Australian Family Physician, describes how general practitioners can, by actively managing the appointment systems, reduce waiting times and delays, improve patient care, improve physician quality of life and improve practice financial viability. It presents a proactive, smarter way to plan and manage a primary care practice.

UK - NHS safe staffing: not just a number

Despite the fact that the greatest recurring cost in Britain’s National Health Service (NHS) is its workforce, a system for planning, monitoring and recording NHS staff numbers does not currently exist. This study identifies the clinical, safety, and financial benefits of keeping more robust workforce data. It also describes barriers to the adoption of digital technology for staff rosters, payment, and quality assurance.

Turkey - Turkish health system reform from the people's perspective: a cross sectional study

Since 2003, Turkey has implemented major health sector reforms to make high-quality services more accessible and efficient. This study surveyed 482 Turkish households to assess public perspectives on the reform process and the adoption of a new healthcare system. Over 77% of respondents were in favour of the new system.

UK - Making our health and care systems fit for an ageing population

Improving health and social care for the elderly requires consideration of many components of care. This UK paper presents evidence and guidance on the key components of high-quality care for older people, including the use of timely comprehensive geriatric assessments and the provision of accessible and coordinated primary, community and social care services.

Canada - Primary Care Measurement Initiative

In 2010, Alberta’s Health Quality Council (HQCA) undertook a measurement initiative to understand the impact of the province’s primary care networks (PCNs), which were developed to improve access to care and health outcomes. This report shows that PCNs decreased use of acute care services but primarily served a population with fewer acute health problems.

UK - The four health systems of the United Kingdom: how do they compare?

This report is the fourth in a series looking at how the publicly financed healthcare systems in the four countries of the UK (England, Wales, Scotland and Northern Ireland) compare in terms of quality and productivity. The report finds that mortality rates are considerably lower in England, as are median wait times for medical procedures.

Europe - Public health: Commission stresses need for greater effectiveness, accessibility and resilience for EU’s health systems

On April 4, 2014, the European Commission laid out an agenda for making Europe's health systems fit to face current challenges and pressures and meet expectations for high quality care. It provides methods and tools to help achieve greater health system effectiveness, accessibility and resilience.

USA - Patients Are Loyal to Their Doctors, Despite Performance Scores

A new study reveals that US patients selecting a doctor for a first-time visit were likely to choose someone highly ranked by insurance companies, whereas patients who already had a doctor were unlikely to switch to more highly-rated physicians. The study compared information on 171,581 patients who were in a tiered Massachusetts physician network that ranked quality, performance and health plan efficiency.

Canada - AQESSS launches a new report on the performance of Quebec health care facilities

The report, entitled "Le réseau en quatre questions: un regard ciblé sur la performance" presents information collected by AQESSS to answer four questions of interest to the public regarding health facilities: Is access adequate? Are care and services of high quality? Is the institution productive? Does it contribute to improving the health of patients and the population? Three performance levels were set: excellent, good and requiring improvement. AQESSS intends to repeat this exercise every two years.

USA - NGA Launches Virtual Health Resource Center

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

Canada - How to Pay Family Doctors: Why “Pay per Patient” is Better Than Fee for Service

The authors of this paper review the incentive effects of different physician payment mechanisms and propose options to improve the quality and value for money in provincial healthcare systems.

International - Large-System Transformation in Health Care: A Realist Review

Published by the Milbank Quarterly, this review examines policy focused on patient- and family-centered care, primary healthcare renewal, quality improvement, and surgical wait lists in the province of Saskatchewan. The review analyzes transformation initiatives and the role of government, and outlines evaluation options.

New Zealand - Primary care for the 21st century

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

International - International Profiles of Health Care Systems: Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States

This publication from the Commonwealth Fund provides overviews of healthcare systems in 15 countries, giving information on insurance, financing, organization, cost containment, efficiency, quality of care, health disparities, care coordination, and the use of information technology and evidence-based practice. Summary tables provide data on key health system characteristics and performance indicators.

International - Health at a Glance: Asia/Pacific 2012

Produced by the OECD, this second edition of Health at a Glance: Asia/Pacific looks at health in 27 Asia/Pacific countries. It presents key indicators covering health status and health determinants along with many aspects of healthcare systems, including utilization of resources, expenditure and financing, and quality of care.

International - Global Telehealth 2012 - Delivering Quality Healthcare Anywhere Through Telehealth – Selected Papers from Global Telehealth 2012 (GT2012)

This book contains selected contributions of papers deemed to have lasting value and which capture the international diversity and variations of scope of contemporary telehealth developments, in keeping with the theme of the conference.

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

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

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

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

USA - A CEO Checklist for High-Value Health Care

This discussion paper reflects an Institute of Medicine Roundtable Discussion among the CEOs of major American health systems. It provides a checklist of 10 strategies that, in their experience, have proven effective and essential to improving quality and reducing costs.

UK - Clinicians in management: does it make a difference?

This report from the Centre for Innovation in Health Management at the University of Leeds adds to the evidence base to support the benefits of clinical leadership by focusing on the strategic governance of NHS hospital trusts in England. The qualifications of board members were matched against performance results in 102 trusts. Among the findings: Increasing the number of doctors on boards significantly increases quality assessed by ratings, lower morbidity rates and increased patient satisfaction.

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

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

Europe - Euro health consumer index 2012

Published by the Health Consumer Powerhouse, the sixth edition of the Euro Health Consumer Index offers a performance-related comparison of 34 national healthcare systems across Europe. This year’s report says user-friendliness has become a major quality performance driver.

Canada - Saskatchewan Accelerates Lean Journey to Improve Health Care

More than 200 Lean projects are currently underway in Saskatchewan health regions, the Ministry of Health and the Saskatchewan Cancer Agency. They have already resulted in significant improvements in care and millions of dollars in savings. On August 30, 2012, Health Minister Dustin Duncan stated a continued commitment to using Lean as the foundation for the province’s quality improvement efforts.

Finland - Health-care tourism booming

Finland’s health-care services are particularly popular among Russians due to short waiting times and high quality. Demand has grown immensely in the past few years, and markets are expected to triple in size by the year 2020. Doing its part to boost the business is the portal www.healthcarefinland.ru, which is helping more and more Russians to find Finnish speciality health-care services.

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

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

UK - Consultations launched on sector regulation of health services

In August 2012, Britain’s Department of Health announced two new measures to strengthen regulation within the National Health Service (NHS). Private and voluntary healthcare providers will be licensed in order to ensure patients receive the best quality care, while new requirements for procurement, choice and competition will improve value.

Canada - Lifetime Distributional Effects of Publicly Financed Health Care in Canada

Who pays for and who uses publicly financed health care in Canada? Does it affect income inequality? This report explores these questions and sheds light on the patterns that emerge when health care costs and associated tax payments are examined over the life course.

USA - Lower Mortality in Magnet Hospitals

Magnet hospitals are hospitals recognized for nursing excellence. This study compared 56 Magnet hospitals with 508 non-Magnet hospitals and found lower risk-adjusted mortality rates in Magnet hospitals. This is attributed to high quality standards and positive organizational behaviour.

International – Strengthening Health Information Infrastructure for Health Care Quality Governance

This OECD report examines the progress made by OECD countries in developing national health information infrastructures. The report focuses on the linkage of health data and the utilization of electronic health records, and finds substantial differences between OECD countries.

Canada - The Experience of GP Surgeons in Western Canada: The Influence of Interprofessional Relationships in Training and Practice

This article from the Journal of Research in Interprofessional Practice and Education surveys the barriers faced today by GP surgeons in British Columbia and Alberta, and highlights the need for new training programs. Barriers include lack of interprofessional support and a culture of specialist care. The authors maintain that the goal of treating patients close to home cannot be achieved until enhanced-skill generalist physicians are equipped and trusted to provide quality care.

Canada - Healthcare Reform in the NHS England: More Lessons for Ontario

Two years of hard bargaining led to legislation in 2012 to transform England’s National Health Service (NHS). This Change Foundation report comparing health reform in England and Ontario examines the journey to the UK Health and Social Care Act. The report describes how Ontario can learn from England’s experience in patient engagement, performance measurement, and service provision and quality of care.

Vietnam - The Political Economy of Healthcare Commercialization in Vietnam

Published by Oxford University, this paper addresses the impact of the commercialization of healthcare services in Vietnam. Drawing on analyses and field studies, the paper suggests that changes in both health financing and the institutions that govern access to services are needed to reduce individual financial burdens, increase access, and improve the quality and effectiveness of health care.

Australia - Healthcare 2011-12: Comparing performance across Australia

This fourth report on the National Healthcare Agreement shows that the overall health of Australians and the quality of the healthcare system is improving. Life expectancy is increasing and rates of smoking, low birthweight babies and infant mortality are all improving. However the chronic disease burden is growing, as are costs.

International - World Bank Group President Urges Countries to Deliver Universal Health Coverage to Help End Poverty

According to worldwide estimates, out-of-pocket health spending forces 100 million people into extreme poverty every year and inflicts severe financial hardship on another 150 million people. At the World Health Assembly held on May 21, 2013, Jim Yong Kim, President of the World Bank Group, called on countries to ensure universal access to quality, affordable health services.

Canada - Report on Ontario’s Cancer System Highlights Need for Better Integration for Patient Care

The Cancer Quality Council of Ontario finds that Ontarians receive some of the best cancer care in the world. More needs to be done, however, to integrate the individual pieces of the cancer system and the overall health system to improve the patient experience.

USA - HHS announces 2013 agenda to bring down costs and improve quality of care through implementation of health information technology

The US Department of Health and Human Services (HHS) has announced a new agenda to accelerate health information exchange (HIE) and build a secure flow of information across the system. The HHS will emphasize interoperability, implement new rules on data exchange, ensure program security, and work to enhance the effective use of electronic health records.

Europe - Building European reference networks in health care. Exploring concepts and national practices in the European Union

Under the European Directive on the application of patients’ rights in cross-border health care, the development of European reference networks was promoted as one of the prime areas for cross-border cooperation among Member States. These networks are meant to improve access to and provision of high-quality specialized health care to those patients who need it, and to act as focal points for medical training and research, information dissemination and evaluation, especially for rare diseases. This book examines the ways in which reference networks have developed in European countries, for what kind of medical conditions or interventions, the motivations behind their establishment, the regulatory and administrative processes involved, and the financial arrangements needed.

USA - HHS Health IT Safety Plan open for public comment

In December 2012, the US Department of Health and Human Services (HHS) released the Health IT Patient Safety Action and Surveillance Plan, a report on the ways health information technology can eliminate medical errors, improve quality of care, and make health care more efficient. The plan builds on a 2011 report from the Institute of Medicine (IOM).

USA – Health Care Payment Reform Could Save U.S. $200 Billion-$600 Billion over Coming Decade, but Implementation Challenges are Substantial

According to this report by the Center for Health Reform & Modernization, the US could save $600 billion over the coming decade by reforming healthcare provider payment incentives, including the fee-for-service model. The report notes that physicians say care costs can be cut 18% without impacting quality.

UK - More people are waiting longer to see a doctor or nurse at A&E departments

Results from a survey by the UK’s Care Quality Commission show that British patients are waiting longer for medical attention in hospital emergency rooms (ERs). The results showed that 33% of the 46,000 patients visiting ERs in 2012 waited over 30 minutes before receiving attention, an increase from 29% in 2008.

Canada - How do Quebec primary care physicians rate the health system?

The Commissaire à la santé et au bien-être du Québec collaborated with the Commonwealth Fund and the Canadian Health Council to present survey data on the Quebec health care system. The 2012 survey collected information from primary care physicians in Quebec and compared it to other Canadian and international jurisdictions. Quebec physicians have a rather negative perception of the health system and more than half indicate deterioration in the quality of care over the last three years.

International - Universal Healthcare on the rise in Latin America

World Bank studies highlight the successes of nine Latin American countries in expanding health coverage. The nine countries have applied strategies from explicitly defined benefits packages to reforms of public health services provision to ensure that quality coverage reaches previously excluded populations.

Australia - Health Care Lessons from Australia

This paper is the first in a series from the Fraser Institute that examines the way health services are funded and delivered in other nations. The nations profiled all aim to achieve the noble goal of Canada’s health care system: access to high quality care regardless of ability to pay. The first nation studied in this series is Australia, which provides some of the best outcomes among developed nations with universal health care insurance.

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

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

USA - Why the Geographic Variation in Health Care Spending Can't Tell Us Much about the Efficiency or Quality of our Health Care System

This study from the Federal Reserve Board examines geographic variation in Medicare and non-Medicare health spending in the US. It finds the variation to be more attributable to socioeconomic factors than differences in practice style. The study goes on to show that geographic variation in health spending does not provide a useful inefficiency measure because of the difficulty in isolating effects.

UK - CMO Professor Dame Sally Davies makes 14 recommendations to improve public mental health services

This report looks at the epidemiology of mental health in the UK, the quality of evidence, possible future innovations in science and technology, and the economic case for good mental health. It also outlines the importance of treating mental health as equal to physical health. The Chief Medical Officer's recommendations target changes required from specific organizations in the UK.