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Italy - From measuring the past to strategically framing challenges in the healthcare sector. The role of balance scorecard

The balanced scorecard (BSC) is a planning and management system used by organizations to prioritize projects and services, measure progress toward targets, and align daily work with strategy. This paper investigates potential roles for the balanced scorecard in health care and evaluates how its multidimensional framework might effectively link strategy and performance management in the sector’s fast-paced work environment. The paper includes a case study.

Canada - Value of Physician Assistants: Recommandations for Action

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

International - Health at a Glance 2017. OECD Indicators

This new edition of Health at a Glance presents the most recent comparable data on the health status of populations and health system performance in OECD countries. Where possible, it also reports data for partner countries (Brazil, China, Colombia, Costa Rica, India, Indonesia, Lithuania, Russian Federation and South Africa). This edition contains a range of new indicators, particularly on risk factors for health. It also places greater emphasis on time trend analysis.

Australia - Shifting the Dial: 5 year productivity review

This report by an Australian government commission assesses market efficiency and government productivity over the past five years, and reviews specific private and government sectors. In health care, the report recommends national and state governments increase funding for primary health networks to improve population health, manage chronic conditions and reduce hospitalizations.

Denmark - Hospital centralization and performance in Denmark – ten years on

In 2007, Denmark restructured its 13 counties into five regions, creating administrative units large enough to allow the centralization of specialized care in fewer hospitals. This paper analyses the reorganization of the Danish hospital sector after 2007 and discusses the mechanisms behind the changes. Since the reform, hospital productivity has increased by more than 2% per year and costs have been stable.

UK - Leading Large Scale Change: A practical guide

Prepared by the National Health Service (NHS), this guide to leading large-scale organizational change in complex healthcare environments rounds up all the latest thinking and tools that can be used to advance operational change. It contains an eight-element strategic plan developed by the NHS, updates on other leading transformational change models, case studies, and links to online resources including presentations and videos.

Europe - Special Collection. Project INTEGRATE: Lessons for Policy, Management and Implementation of Integrated Care in Europe

Project INTEGRATE was a 2012-2016 research project investigating the leadership, management and delivery of integrated care in Europe. This collection provides some of the papers published by researchers involved, and focuses on work undertaken in the project’s final phases that examined factors in integrated care design, management, and policy. It includes case studies of care integration in four countries.

Canada - Comparing Performance of Universal Health Care Countries, 2017

The comparable data assembled in this study suggests that although Canada has one of the most expensive healthcare systems in the OECD, its performance is modest to poor. The study compares the cost and performance of universal healthcare systems in 29 high-income countries. Levels of expenditure are measured by two indicators, while system performance is measured using 42.

France – Health savings accounts: towards a new funding model for care?

This report explores the possible benefits of using health savings accounts in France. These would have the advantage of allowing intertemporal funding of care and ensuring portability. The report describes the systems implemented in the United States and Singapore and stresses the need to remain vigilant with regard to equity of access to this type of system.

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.

International - What do we know about the needs and challenges of health systems? A scoping review of the international literature

Classifying types of health system challenges studied by researchers, this scoping review analyzed 292 papers. It found that the most frequently researched areas were mental health, infectious diseases, and primary care. Frequently studied target populations included elderly people, minorities, those living in remote or poor places, and children. The most reported health system challenges concerned human resources, governance, and health service delivery.

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

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

UK - Embedding a culture of quality improvement

This King’s Fund report identifies factors that help organizations launch successful quality improvement (QI) strategies. The report lists five key enablers for embedding QI culture: inclusive leadership, staff support, adequate resources, effective patient engagement, and fidelity to a chosen approach. The report finds that leadership plays a central role in creating the right conditions for quality improvement.

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

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

International - Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

Authored by a German academic, this systematic literature review of 40 studies analyzes barriers to integrated care in inter-organizational settings. The review identifies 20 types of barriers, which are categorized into six groups: administration and regulation, funding, intra-organizational and inter-organizational domains, service delivery, and clinical practices. The review notes that some barriers are set up intentionally.

UK - Good Work, Wellbeing and Changes in Performance Outcomes

Produced by independent consultants, this report analyzes people management within the National Health Service (NHS). It finds that NHS organizations using good people management practices were three times more likely to have the lowest levels of staff absences, and four times more likely to have the most satisfied patients. No link was found between people management practices and patient mortality.

Canada - Reality Bites: How Canada’s Healthcare System Compares to its International Peers

Canadian provincial healthcare systems fare poorly compared to peer countries according to new research from the C.D. Howe Institute. In “Reality Bites: How Canada’s Healthcare System Compares to its International Peers,” authors Colin Busby, Ramya Muthukaran and Aaron Jacobs examine how the provinces, the major healthcare deliverers in Canada, fare compared to other nations in healthcare provision.

UK - Against the Odds: Successfully scaling innovation in the NHS

Setting out what is known about the scale and spread of innovation in healthcare, this report describes common themes that have emerged from research and synthesizes insights from 10 case studies to provide a set of considerations for thinking about how to scale healthcare innovations in the future. The case studies are presented in full in an appendix to the report.

International - Association between organisational and workplace cultures, and patient outcomes: systematic review

This systematic review of 62 international studies of healthcare facilities (hospitals, general practices, pharmacies, and aged care and mental health institutions) found that positive organizational and workplace cultures were consistently associated with a wide range of beneficial patient outcomes, including reduced mortality rates, falls, and hospital acquired infections.

Canada - Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study

This study used retrospective data from provincial expenditure reports (1981-2011) to model the effects of social and health spending on life expectancy and potentially avoidable mortality. Findings showed that a one-cent increase in social spending per dollar spent on health was associated with increased life expectancy and decreased mortality. The authors conclude that health outcomes benefit from reallocating government dollars from health to social spending.

Switzerland - Development of a monitoring instrument to assess the performance of the Swiss primary care system

Conducted under the auspices of the Swiss Primary Care Active Monitoring (SPAM) program, this study developed an instrument to describe the performance and efficacy of Switzerland’s primary care system. Selecting 56 primary and 80 secondary indicators, the new instrument was deemed capable of effectively monitoring primary care within the Swiss health system’s complex blend of private and public health providers.

International - Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis

Conducted by Brazilian and western Canadian researchers, this knowledge synthesis identifies indicator domains and tools to measure progress towards integrated care. Establishing measurement domains, the researchers reviewed 7,133 studies and identified 114 tools to measure the integration of care across 16 domains. Few tools were found in the domains of performance measurement, information systems, organizational goal alignment and resource allocation.

UK - Some assembly required: implementing new models of care. Lessons from the new care models programme

In 2015, the National Health Service (NHS) selected 50 local vanguard sites to implement innovative models of care. This report draws on the experiences of those leading the vanguard sites over the past three years to set out lessons for systematic improvement across local health and care services. It emphasises the value of local co-creation and extensive testing of new care models.

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

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

France: improving the efficiency of the health-care system

France’s health-care system offers high-quality care according to a new report from the OECD. Average health outcomes are good, public satisfaction with the health-care system is high, and average household out-of-pocket expenditures are low. As in other OECD countries, technology is expanding possibilities for life extension and quality, and spending is rising steadily, while an ageing population requires substantially more and different services. The main challenges are to promote prevention and cost-efficient behaviour by care providers, tackle the high spending on pharmaceuticals, strengthen the role of health insurers as purchasing agents and secure cost containment.

USA - Hospital-community partnerships to build a culture of health: a compendium of case studies

Published by the American Hospital Association (AHA), this collection of case studies discusses 10 hospital-community partnerships established in different locations and service types, and their joint initiatives to build a Culture of Health where all individuals have equal opportunities for optimum health. The case studies highlight the wide variety of effective, sustainable strategies and programs in specific local contexts.

New Zealand - Developing accountable care systems. Lessons from Canterbury, New Zealand

Examining how the UK can reduce demand for acute hospital care, this comparative study looks at an example of municipal health care organization in Canterbury, New Zealand. The example demonstrates that expanding hospital capacity is not needed if sizeable investments are made in primary care and community services. Compared to the UK, the New Zealand model has lower acute medical admission rates and spends considerably less on emergency hospital care.

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.

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.

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

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

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

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

Canada - Ideas on health care for Québec

This report describes the results of a project that included constructive discussions about the future of the health and social services system in Quebec. Focus groups, expert consultations and the public highlighted areas of consensus. Among the most important, both citizens and network actors want to reverse current dynamics and put citizens and local actors in charge of their health choices.

International - Understanding Variations in Hospital Length of Stay and Cost: Results of a Pilot Project

Published by the OECD, this comparative study of France, Ireland, Israel and Canada measures hospital length of stay and cost for a given condition to explore variations in efficiency. It shows that variations are more likely to exist at hospital level for cardiac surgery, and at the country level for hysterectomies and caesarean sections.

UK - Does The Primary Care Home Make A Difference? Understanding its impact

The primary care home (PCH) model was developed by Britain’s National Association of Primary Care (NAPC) to strengthen primary care in the National Health Service (NHS). This report summarizes progress in three of 15 PCH rapid test sites and finds that PCH could support the delivery of NHS Sustainability and Transformation Plans (STPs) across the UK. The report highlights improved staff retention, productivity, and satisfaction.

International - The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review

Updating a prior review of the effects of pay-for-performance (P4P) programs on processes of care and patient outcomes in ambulatory and inpatient settings, this systematic review of 69 studies finds low-strength evidence suggesting that P4P programs in ambulatory settings may improve process-of-care outcomes over the short term. Many of the positive studies were conducted in the UK, where incentives were larger than in the US.

Europe - BLOCKS: tools and methodologies to assess integrated care in Europe

Released by the EU Expert Group on Health Systems Performance Assessment, this report summarizes tools and methodologies to assess integrated care in Europe. It discusses interrelated system levers for the effective design and implementation of integrated care frameworks that relate to politics, governance, stakeholder engagement, organizational change, leadership, workforce education and training, patient empowerment, infrastructure, financing, monitoring and evaluation.

International - Measuring social protection for long-term care

The OECD released this report presenting the first international comparison of levels of social protection for long-term care (LTC) in 14 OECD countries. Focusing on five scenarios with different LTC needs and services, it quantifies the cost of care; the level of coverage by social protection systems and out-of-pocket costs; and the affordability of these costs.

USA - State Policy Capacity and Leadership for Health Reform

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

UK - Leading across the health and care system: lessons from experience

This article conceptualizes system leadership during the ongoing reorganization and decentralization of health and social services in the UK, providing case studies of collaborative leadership at the local government level. It emphasizes new care models, sustainability planning, and measures to assure local accountable care in the face of national funding cutbacks.

UK - Mental health and new models of care: lessons from the vanguards

This report for the UK's National Health Service (NHS) explores an integrated response to mental health in the context of new models of care. It focuses on lessons from 50 integrated mental health pilot projects known as vanguard sites, and incorporates scoping interviews with 22 vanguard leaders, as well as summaries of expert workshops and roundtables. Profiles of three vanguard case study sites are included.

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

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

Canada - An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012–2014

Published in BMC Health Services Research, this study estimates cost involved in the first two years of the province’s implementation of Lean, including poorly documented costs such as health leader training, along with more transparent costs for consultancy services. The authors examine the types of event involved in implementation and the costs associated with them. Cost estimates show that the annual cost of Lean in Saskatchewan during the 2012–2014 period was about $23.4 million.

International - Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

This Commonwealth Fund report compares health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Seventy-two indicators were selected in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands.

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.

Europe - Strengthening general practice/family medicine in Europe—advice from professionals from 30 European countries

This study is based on a survey of medical teaching professionals from 30 European countries on how to strengthen general practice and family medicine (GP/FM). It finds substantial variations among GPs/FMs across Europe with regards to governance, workforce competence and performance, and academic standing. Respondents strongly agree that securing GP/FM as an academic teaching and research discipline is essential, as is cementing GP/FM’s position as a highly regarded specialty.

International - Future trends in health care expenditure. A modelling framework for cross-country forecasts

In the 34 countries of the OECD, healthcare spending is outpacing economic growth. This OECD paper presents a modelling framework for cross-country forecasts of projected healthcare expenditure growth that identifies common healthcare spending drivers across countries. These include: population aging, technological progress, sector productivity and rising staff, infrastructure, and service and material costs.

Europe - Measuring efficiency in health care

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

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.

USA - Leading a Culture of Safety: A Blueprint for Success

This guide was developed to provide healthcare leaders a tool for assessing and advancing their organization’s culture of safety. It can be used to help determine the current state of an organization’s journey; inform dialogue with the boards and leadership teams; and help leaders set priorities. The guide contains both high-level strategies and practical tactics.

Europe - Private health insurance companies in six European countries

This report describes the role of private insurance companies in health coverage in Europe, looking at six countries: France, Germany, the Netherlands, Switzerland, Spain and the United Kingdom. These countries have basic and compulsory health coverage, but some entrust the management of this coverage to private insurers. There are significant government constraints on these markets, and these are found to exhibit trends toward concentration.

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

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

International - The Impact of Supply Chain Transformation in Global Health Systems

Changing supply chain processes improves safety, quality and performance in health systems. Examining the impact of transformations to health system supply chain infrastructure in Canada, the UK and the US, the research reveals that substantial savings can be achieved through inventory optimization and waste reduction, while automation can increase clinician time for patient care.

Europe - 20 Years of Health System Reforms in Europe: What’s New?

Appearing in the periodical Eurohealth, this article looks at the changing agenda of heath reform in Europe over the last two decades. While reforms implemented 20 years ago focused on improving efficiency, more recent reforms have concentrated on improving quality, strengthening primary care services, and promoting integrated care. Examples are given of this shift with regard to payment mechanisms, primary care, and hospitals.

Canada - One province, one healthcare system: A decade of healthcare transformation in Alberta

Nearly a decade has passed since Alberta folded nine regional health authorities and three government agencies into one province-wide health system, Alberta Health Services (AHS). This article highlights specific examples of how AHS is strengthening partnerships, standardizing best practices, and driving innovation. It also shows how province-wide integration is being leveraged to change workplace culture, enhance patient safety and find operational efficiencies.

Europe - How do we ensure that innovation in health service delivery and organization is implemented, sustained and spread?

This WHO policy note reviews frameworks and factors supporting the successful introduction of innovation in health service organization and delivery. It illustrates these factors using examples of service innovations in European countries and describes the successful implementation, sustainability and spread of innovation in terms of health outcomes, administrative efficiency, cost-effectiveness, and user experience.

Canada - Balancing Effectiveness and Efficiency: Driving Value-Based Health Care through Clinician Engagement

This report by the Conference Board of Canada describes some of the foundational components of clinician engagement with the intention of helping stakeholders improve the effectiveness and efficiency of their organizations’ clinician engagement processes. The report is based on a literature review and interviews with 21 Canadian and international stakeholders to explore contexts and roles that encourage clinician engagement.

Europe - Organization and financing of public health services in Europe

Published by the WHO, this book examines the financing and organization of public health services across Europe. Looking at nine European countries, it contains an in-depth analysis of the budgets, funding, and cost-effectiveness of public health services, which are often organized differently at national, regional and local levels. Case studies of campaigns responding to alcohol abuse, obesity and antimicrobial resistance are included.

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

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

UK - Private Provision of Publicly Funded Health Care: The Economics of Ownership

The private ownership of organizations providing services to the public National Health Service (NHS) is controversial in the UK, especially with regard to private hospitals. The purpose of this paper is to provide a non-partisan view of the ‘ownership debate’ through the lens of economic value. The paper discusses the organization of production, theories of behaviour and motivation, and the role of incentives and payments.

Norway - A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care

Multi-professional collaboration (MPC) is essential for the delivery of effective and comprehensive care services. This Norwegian scoping review of 19 studies reports on the organizational, relational and contextual facilitators of collaboration between general practitioners (GPs) and other primary care professionals. It finds that advancements in work practices benefit from an initial system-level foundation with a focus on local management and MPC leadership.

UK - Understanding the effectiveness and mechanisms of a social prescribing service: a mixed method analysis

Social prescribing reflects the growing role of the voluntary and community sector in health and could help reduce the pressure on primary care services to manage patients with conditions that can be addressed without medical intervention. This research assesses a social prescribing scheme in Northern England in which ‘Wellbeing Coordinators’ offer support to individuals and provide advice on local community services. The study finds a range of positive outcomes as a result of service users engaging with the service.

International - An international comparison of long-term care funding and outcomes: insights for the social care green paper

In 2017, Age UK commissioned a comparative analysis exploring long-term care service structures, funding mechanisms, and outcomes in Italy, Spain, France, Germany and Japan to see what lessons could be learned and applied in the UK. Analysis showed that the UK had the largest private sector involvement, lowest public funding, strictest means testing and poorest outcomes of all the long-term care models studied.

Spain - Spain. Health system review

This review of Spain’s health system finds that public healthcare spending (71% of total health spending) is once again on the rise, further strengthening the primary care sector. While structural measures are needed to improve resource allocation, technical efficiencies, and the provision of patient-centred care, life expectancy in Spain continues to be the highest in the European Union (EU).

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

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

International - Designing Publicly Funded Healthcare Markets

This paper argues that there is a need for competition agencies to become more active and effective advocates for the use of choice and competition in healthcare markets. The authors of the paper examine a range of case studies and explore who chooses, who pays, how payments are structured, and the nature of the supply side of the market.

Canada - Aligning Outcomes and Spending. Canadian Experiences with Value-Based Healthcare

Value-based healthcare (VBHC) is a delivery model in which provider financing and budgets are based on patient health outcomes instead of the volume of services, processes, and products. This briefing reviews surveys, case studies and the scientific literature to explore the application of VBHC in health care across Canada. It focuses on the use of VBHC in new care models, innovative digital technology, and care integration.

Europe - Inequalities in access to healthcare - A study of national policies

Exploring inequalities in access to health care in European countries, this European Union (EU) report shows that important inequities persist both between and within countries. Sizeable vulnerable populations, especially women, minorities and the poor, continue to face multiple hurdles to accessing care and obtaining quality care. The report makes 20 recommendations concerning service availability, health coverage and insurance, system financing and initiatives for vulnerable populations.

Canada - The Generation of Integration: The Early Experience of Implementing Bundled Care in Ontario, Canada

Integrated healthcare models bundle services and encourage interprofessional and organizational collaboration to counter fragmented healthcare delivery and rising system costs. In this study, authors interviewed program stakeholders to provide examples of integration strategies in six Ontario pilot programs, suggest contexts that lend themselves to integration initiatives, and explore the generation of integration through the dynamic interplay of contexts, mechanisms, structures and subjects.

International - Health at a Glance: Asia/Pacific 2018. Measuring Progress towards Universal Health Coverage

Looking at health in the world's Asia-Pacific region, this handbook presents indicators of health status, healthcare resources and quality of care across 27 countries. It provides a series of dashboards to compare performance between countries, along with a thematic analysis of health inequalities. Major findings are analyzed and an annex provides additional information on demographic contexts and limitations in data comparability.

International - PLOS Medicine’s Special Issue on Machine Learning in Health and Biomedicine

Modern statistical modelling, or machine learning, has been presented as a transformative force for human health. However, comparisons to classical analyses of clinical data indicate that restraint may yet be warranted. This special issue of PLOS Medicine features research that applies machine-learning methods to health and biomedicine. The 37 articles are accompanied by expert editorial commentary on the application, impact, and ethics of these approaches.

International - The economics of patient safety in primary and ambulatory care. Flying blind

This paper examines safety lapses in primary and ambulatory care, finding that, internationally, four out of 10 patients experience safety issues in these settings. The paper estimates the direct costs of safety lapses in primary and ambulatory care to be around 2.5% of total global health expenditure. Safety lapses resulting in hospitalizations account for 6% of total annual hospital bed days worldwide.

Europe - Health system performance assessment – Integrated Care Assessment

Commissioned by the European Union (EU), this study reviews integrated care performance in the 28 EU countries and tests a performance assessment framework. Analyzing 71 integrated care policies and 550 initiatives, the review finds that the characteristics, depth and breadth of IC penetration vary considerably across Europe. The study's Integrated Care Performance Assessment Framework contains 58 indicators to track integrated care outcomes and patient experiences.

UK - Understanding the Performance and Potential of Specialist Hospitals

The National Health Service (NHS) is considering expanding its network of specialist hospitals, a policy shift applauded in this research, which finds that specialist hospitals are innovation leaders that improve quality standards, attract highly-qualified staff and deliver better outcomes. The authors make recommendations concerning the acceleration of innovation adoption and spread, along with lessons learned for non-specialist hospitals and the NHS overall.

Canada - Scan of Mental Health Strategies

This document provides an overview of mental health and wellness strategies in Canada, with a particular emphasis on the promotion of mental health and the prevention of mental illness. The scan is presented in the form of three comparative tables: provincial and territorial mental health strategies; suicide prevention strategies; and Indigenous-specific mental health and wellness strategies.

China - The Luohu Model: A Template for Integrated Urban Healthcare Systems in China

In 2015, the southern city of Luohu introduced a new integrated care system that linked five hospitals with 23 community clinics and specialized medical institutions. China’s government has since encouraged other cities to emulate the highly successful Luohu model. This paper studies Luoho’s integration process, analyzes its core mechanisms, and evaluates the integration of policy development.

Canada - The Establishment of Ontario's Local Health Integration Networks: A Conflation of Regionalization with Integration of Health Services

In 2006, the province of Ontario introduced health services regionalization with the establishment of Local Health Integration Networks (LHINs). While LHINs were designed to integrate services, this article argues that an implicit objective may have been to shift accountability away from the provincial government by increasing bureaucracy and limiting stakeholder input. To date, there has been no robust evaluation of the LHINs' impact on service integration.

Canada - Assessment of scalability of evidence-based innovations in community-based primary health care: a cross-sectional study

In 2013, the Canadian Institutes of Health Research (CIHR) funded 12 community-based primary healthcare teams to develop evidence-based innovations focused on access to care and chronic disease management. This study explores the scalability of the resulting innovations, which varied from health interventions to methodological improvements. It concludes that scalability varied widely among the innovations.

International - The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

Presenting a review of the literature on care integration design, this research explores prerequisites to successful implementation across different international contexts. The study analyses 710 prior studies and focuses on chronic conditions (COPD, diabetes, and geriatric and mental health conditions), identifies core dimensions of integrated care and distinguishes 175 elements and factors associated with successful implementation.

Australia - Practical innovation: Closing the social infrastructure gap in health and ageing

This report from PriceWaterhouseCoopers (PWC) argues that Australia needs a health system model focused on wellbeing as much as illness and a more integrated, preventive and outcomes-focused approach to health care. The report identifies approaches to transform the current health system, improve integration, and implement a facility to fund and support new healthcare partnerships and collaborations.

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

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

Europe - Health system performance assessment in the WHO European Region: which domains and indicators have been used by Member States for its measurement?

Health systems performance assessment (HSPA) varies across Europe. This WHO review summarizes 14 HSPA domains and 1,485 indicators used in European HSPA reports. All countries had indicators of service delivery and health outcomes. Other domains, such as safety, efficiency, coverage or responsiveness, were included in only 30% of the documents. The review concludes that further refinement of frameworks is warranted.

Australia - Informing implementation of quality improvement in Australian primary care

While quality improvement initiatives (QI) are difficult to implement in primary care, meso-level structures offer opportunities to implement programs in primary care practices of a given area. This case study looks at the design and implementation of QI programs in the Australian Primary Care Collaborative. It identifies five factors that enable or impede implementation: leadership, organizational culture, funding incentives, data and clinical systems.

Europe - Service Integration across Sectors in Europe: Literature and Practice

This paper presents a preliminary review of service integration across sectors in Europe, between social services, health, employment and education. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Systems to monitor integration are not yet adequately developed and further study is needed to understand the processes involved in cross-sector service integration.

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

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

Europe - Leapfrogging health systems responses to noncommunicable diseases

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

Canada - Healthcare Costs in Canada: Stopping Bad News Getting Worse

This CD Howe Institute briefing raises concerns about the long-term fiscal sustainability of Canada’s healthcare system, noting that government health budgets have grown faster than Canada’s economy. It is based on large healthcare spending increases tracked by the 2017 National Health Expenditure (NHEX) report of the Canadian Institute for Health Information (CIHI). Addressing this tendency to overshoot budget targets will require reforms to encourage cost-conscious behaviour.

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

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

Canada - How Canadian Health Care Differs from Other Systems

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

Europe - A New Drive for Primary Care in Europe: Rethinking the Assessment Tools and Methodologies

Overseen by an expert panel convened by the European Union (EU), this report looks at tools used to assess performance in primary care. It explores indicators, methodologies, and quality assurance while seeking to understand the impact of performance assessment. It finds that Europe’s primary care performance assessment systems currently vary in strength and makes seven recommendations to embed performance assessment in policy processes.

Europe - Comparing public and private providers: a scoping review of hospital services in Europe

Authored by two Finnish academics, this scoping review of 24 prior studies (17 on economic issues and six on quality of care) compares the performance of 5,500 public and private hospitals in Europe. Public hospitals were most frequently found to have better economic performances and quality of care than private hospitals. Private for-profit hospitals performed worse on these measures than private non-profit hospitals.

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

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

Canada - Modernizing Canada’s Healthcare System through the Virtualization of Services

In Canada, investments in digital health currently amount to several billion dollars. This article suggests using the Quadruple Aim (QA) framework devised by the Institute for Healthcare Improvement (IHI) to further modernize care delivery using virtual services. The QA framework focuses on improved population health, patient and provider satisfaction, and reduced costs. The article proposes 10 strategies to improve virtual services in Canadian health care.

UK - Risk and reward sharing for NHS integrated care systems

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

UK - Driving improvement. Case studies from 10 GP practices

Produced by the Care Quality Commission (CQC), England’s healthcare regulator, this report examines how 10 substandard general practices made changes to improve their CQC ratings and standards of care. The authors interviewed a range of people at each practice, including general practitioners (GPs), managers, nurses, staff, patients and external stakeholders, to establish common improvement strategies and practices, most of which involved leadership, training, and communication.

Europe - What is the experience of decentralized hospital governance in Europe?

Published by the WHO, this brief explores experience with decentralized hospital governance in 10 European countries (Denmark, England, Finland, France, Germany, Italy, Netherlands, Scotland, Spain and Sweden). It finds examples of systems with decentralized hospital governance collaborating to overcome equity and efficiency concerns, but notes that the importance of institutional and political contexts makes it difficult to transfer successful models from one country to another.

UK - Identifying options for funding the NHS and social care in the UK: international evidence

Identifying options for health and social care funding in the UK, this paper explores how 16 other high-income countries have implemented changes to meet systemic challenges. Most of these countries have public health systems but rely more on private funding for social care. Internationally, funding reforms tend to be incremental and catalyzed by economic circumstances rather than demand for care.

International - Delivering Quality Health Services: A Global Imperative for Universal Health

As countries around the world institute universal health coverage, there is growing acknowledgement that optimal health care requires a deliberate focus on quality. Published by the OECD, this document describes how to develop, refine and execute national quality policies and strategies, and supplies 22 recommendations for improving and sustaining quality of care.

UK - Taking the value-based agenda forward: the five essential components of value-based approaches to health and care

Against a backdrop of financial pressures, growing demand for services, and the quest to transform local delivery systems, the concept of value in the UK health system has gained increasing prominence. This paper explores how to spread the adoption of value-based health care across all of the constituent parts of the National Health Service (NHS), and explores key factors in successful adaptation.

UK - Innovative models of general practice

Dealing with increasing and ever more complex workloads, general practices in the UK now face significant challenges. This report by a private think-tank says new general practice clinical delivery models are needed to meet the demands of Britain’s aging population and changing disease burden. It highlights team-based working, digital innovations, community-centred approaches and collaborative care. A large number of case studies are included.

Europe - Organization and financing of public health services in Europe: country reports (2018)

Describing the public health services of nine European countries, this study explores organization and financing along with training and workforce concerns. Covering England, France, Germany, Italy, the Netherlands, Slovenia, Sweden, Poland and Moldova, the study illustrates two different approaches to public health services: integration with curative health services (as in Slovenia or Sweden), or organization and provision through a separate parallel structure (Moldova and Poland).

USA - Nurse Practitioner–Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain

American nurse practitioners (NPs) are increasingly managing patient care as clinicians. This paper surveys 156 prior studies to develop a new model of clinical co-management between NPs and physicians. The model has three elements: effective communication, mutual respect, and clinical alignment of care. The paper also describes the legal and organizational barriers that continue to inhibit NP practice in the US.

Australia - Investing to Save: The economic benefits for Australia of investment in mental health reform

Australia’s Health Ministry outlines ‘win-win’ recommendations for investment in mental health that deliver economic returns to government and the economy while also achieving positive health and social outcomes for people experiencing mental health problems. It recommends workforce and employment support for individuals with mental health issues and calls for significant investments in prevention, early intervention, and mental health promotion.

Canada - Change in health care use after coordinated care planning: a quasi-experimental study

Conducted in southern Ontario’s Hamilton-Niagara region, this study investigated whether 600 patients with a coordinated care plan differed in their use of health care (number of ER visits, inpatient admissions, and length of hospital stays) compared with a control group of patients with no care plans. Results showed care plan beneficiaries had fewer ER visits but found no significant difference in admissions to, or length of stay in hospital.

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.

UK - Delivering an outcomes-based NHS: creating the right conditions

This paper from the CEO of Britain’s Capitated Outcomes Based Incentivized Care (COBIC) describes the development of an outcomes-centred approach in the UK National Health Service (NHS). It calls for reforms to incentives, infrastructure and service delivery. The paper defines a framework to look at outcomes domains, goals and indicators, and includes case studies.

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.

Canada - A 3-year study of high-cost users of health care

This study presents a 2009-2011 retrospective analysis of Ontario residents. It identifies the clinical diagnoses, demographic characteristics and costs of high-cost users of healthcare (users with the highest 5% of costs). Diagnoses included chronic diseases, infections, and palliative care. Most spending among high-cost users was for institutional care; costs were far more concentrated among children than older adults.

Europe - 2015 Euro Health Consumer Index

The Euro Health Consumer Index 2015 ranks consumer satisfaction with healthcare systems in 35 European countries. Its rankings show the Netherlands as the country with the best healthcare system, followed by Switzerland. The Index also indicates that survival rates of heart disease, stroke, and cancer continue to increase.

Australia - The new Australian Primary Health Networks: how will they integrate public health and primary care?

In 2015, Australia established 31 Primary Health Networks (PHNs) to improve care coordination and effectiveness, particularly in rural and remote areas and for populations at high risk. This study by a trio of researchers contrasts their different perspectives on how the new PHNs can help to integrate public health into the Australian primary healthcare landscape.

International - Priority Setting for Universal Health Coverage

This special issue of Health Systems and Reform presents articles prepared for a conference held in Bangkok in January 2016 on the theme of priority setting for universal health coverage. The issue features commentaries from top global health leaders, articles on the challenges of prioritization and remarks by World Bank representatives on priorities for universal health coverage.

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 - Spending cuts on health care in countries badly affected by the economic crisis impede access to care

This report, published by INSEE in France, examines the impact of the economic crisis begun in 2008, which caused a reversal in health spending trends that, in the 30 years before the crisis, grew fairly consistently in most European countries. The report finds that in some countries, measures implemented after the crisis have reduced access to care, and especially to medicines. Although life expectancy has not declined, life expectancy in good health has declined in Greece and Italy.

International - Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

Conducted in Australia, this review of 10 studies identifies characteristics of integrated primary-secondary care models that help deliver favourable clinical outcomes. Six common elements are identified: interdisciplinary teamwork, information exchange, shared guidelines, training, acceptability for patients, and viable funding. The authors note that integrated primary-secondary care’s actual impact on clinical outcomes is limited compared to usual care.

Canada - Comparison of Family Health Teams to Other Primary Care Models, 2004/05 to 2011/12

Produced by the Institute for Clinical Evaluative Sciences (ICES), this longitudinal analysis fills a longstanding knowledge gap by comparing outcomes of Family Health Team patients in relation to other Ontario primary care models over time. The report has been released in tandem with a paper addressing population variability in Ontario Community Health Centre (CHC) data.

International - Health in 2015: from MDGs to SDGs

This WHO report identifies the key drivers of progress in health under the United Nations Millennium Development Goals (MDGs). It lays out actions that countries and the international community should prioritize to achieve the new Sustainable Development Goals (SDGs), which come into effect on 1 January 2016.

Canada - Mapping the Journey—Success and Failure with Lean

Lean is an organizational management approach that supports the concept of continuous improvement. This briefing on the use of Lean in Canadian health care describes the tools, systems and principles involved, and outlines the challenges and rewards these brings to healthcare organizations. Examples from the recent Lean reorganization of the British Columbia Provincial Health Services Authority (PHSA) are highlighted.

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

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

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.

Europe - Healthcare privatisation in Europe. Mapping reforms

Privatisation de la santé en Europe. Un outil de classification des réformes This working paper prepared by researchers from the Centre d'économie de l'Université Paris Nord analyzes the privatization of healthcare that has occurred in many European countries over the past few decades. They characterized this privatization according to two criteria: the scope (financing and delivery of care) and the 'external' or 'internal' nature of privatization. The authors then empirically analyze privatization in the health systems of 14 European countries since 1980 and present a mapping of the privatization process.

UK - United Kingdom: Health system review. Health Systems in Transition, 2015

Conducted by the WHO, this analysis of the UK health system looks at the autonomous branches of the National Health Service (NHS) in the UK’s four parts (England, Northern Ireland, Scotland and Wales). The review notes that all four NHS branches function well compared to international peers and continue to demonstrate improvements in major health indicators despite increased financial constraint.

Canada - Transformation through Value and Innovation: Revitalizing Health Care in Ontario

Produced by the Ontario Chamber of Commerce (OCC), this report calls for healthcare reform in the province that preserves the publically funded single-payer model but increasingly incorporates the private sector as a productive partner. The report includes three case studies of collaborations by Ontario’s public and private sector to improve healthcare value and innovation.

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.

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 - Funding Canadian Health Care in 2035: Strategic Foresight Scenarios

In October 2015, the Conference Board invited a broad range of Canadian health care stakeholders to participate in a full-day workshop entitled “How will health care in Canada be funded in 2035?” The goal was to develop a number of plausible scenarios outlining how the funding of health care could evolve. This report presents four very different, plausible worlds that Canadians could face in the future when it comes to healthcare funding and the implications that need to be considered.

Europe - Person-centred care in Europe: a cross-country comparison of health system performance, strategies and structures

Published by the Picker Institute, an international charity based in England, this policy briefing compares patient or person-centred care within healthcare systems in the UK, Germany, Italy, Spain and the Netherlands. The briefing considers health system performance, strategies and structures, along with the cost-effectiveness of national person-centred care schemes.

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

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

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.

Canada - Integrating Long-Term Care into a Community-Based Continuum. Shifting from “Beds” to “Places”

The authors of this IRPP study argue that if more community support were available, the tipping point at which patients with greater care needs require residential long-term care would be higher, and people would be able to stay at home longer. Drawing on research in Ontario and overseas, the authors examine some promising community--based rural and urban initiatives. Through the lens of neo-institutional political theory, they analyze the hurdles encountered in attempting to scale up or replicate such initiatives.

International - Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

Investigating primary care interprofessional teamwork innovations in Australia, Canada and the US, this Australian review examined 12 studies to assess the impact and local context of reforms. Variations were associated with contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included conflict between medical and nonmedical professional groups.

Australia - Australian Health Care Reform: Challenges, Opportunities and the Role of PHNs

Australia’s public healthcare system is currently undergoing reforms to introduce Primary Health Networks (PHNs) and widespread use of electronic health records. The reforms will also extend mental health services and change key health system funding measures. This paper explores the reform challenges facing Australia’s healthcare system and examines opportunities related to the introduction of PHNs.

USA - Intentional whole health system redesign: Southcentral Foundation’s ‘Nuka’ system of care

This article looks at Alaska’s Southcentral Foundation, regarded as one of the world’s most successful examples of health system redesign. State-funded, run by Alaskan Natives, and responsible for the health care of Alaska’s indigenous peoples, Southcentral drastically improved its health services and outcomes by integrating service delivery and instituting a culturally-responsive system of care. The article considers lessons learned and analyzes key messages.

Europe - Healthcare Reform in Italy and Spain: Do these tax-financed, decentralised systems facilitate better reform implementation than in the NHS?

Like Britain’s National Health Service (NHS), Italy and Spain have tax-financed and decentralized healthcare systems and have recently undergone reforms prompted by austerity. This UK report investigates the effects of each country’s reforms on healthcare outcomes, primary care, and core values. It finds that health outcomes are poorer in the UK and that primary health care in Italy and Spain remains more efficient, equitable and decentralized.

Europe - Efficiency estimates of health care systems in the EU

This paper estimates the relative efficiency of European Union (EU) healthcare systems. Results show that average EU life expectancy could be increased by 1.8 years if lower performing systems moved to the highest efficiency levels. Belgium, Cyprus, Spain, France, Luxembourg, Sweden and the Netherlands consistently score among the top seven performers.

USA - Redefining Health Care Systems

Published by the RAND Corporation, this downloadable 144-page book discusses health services research over the past 50 years and how this research base can stimulate innovation to make patient-centred healthcare systems safer, more efficient, and cost-effective in their responses to increasingly diverse communities. The role physicians can play as thought leaders is emphasized.

France - Theoretical basis for health system performance assessment

This article proposes a theoretical framework for the concept of performance and performance assessment in France’s health sector. The authors review influential theories on the application of performance assessment.

UK - Seven Day Services: An Evidence Base of Enablers for Transformation

The National Health Service (NHS) Seven Day Services Team leads a service improvement program across England to support access to health care every day of the week. This Team document shares findings from 42 interviews at NHS providers working towards seven-day service. Key enablers identified include delivery mechanisms, systems alignment, distributed leadership, and baseline and ongoing measurement.

International - Emergency Care Services: Trends, Drivers and Interventions to Manage the Demand

Emergency departments (EDs) often face high demand for their services. This report from the OECD summarizes trends in the volume of ED visits across 21 OECD countries. It describes the main drivers of visits, paying attention to both demand and supply side determinants. National approaches to improving emergency resources are presented.

UK - Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

An aging population, specialized clinical services, and diverse provider governance all make healthcare coordination difficult in the UK. This research paper examines how organizational integration impacts the coordination of primary care and concludes that integration seems more likely to develop continuity of care than networks that divide hospitals, general practices and community health services.

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.

Belgium – Implementation of Hospital at Home: Orientations for Belgium

This scientific report from KCE analyses the effectiveness and the safety of different international models of hospital at home (HAH). It explores practical considerations regarding the coordination of the care plan, patient and family empowerment, as well as workforce, financing, information technology and other supports required to implement HAH in Belgium.

Canada - Consolidating mental health services in Québec: the 2005-2010 Mental Health Action Plan

The study published by the Health Reform Observer examines results of Québec's 2005-2010 Mental Health Action Plan, which aimed to consolidate medical services and community group services under a local needs-based approach. The author concludes that the plan did not achieve the desired results and required multiple adjustments.

Europe - Practice conditions of family physicians in 5 European countries

In response to the passage, over the last several years, of regulations intended to organize the supply of general practitioners in France, the Observatoire national de la démographie des professions de santé undertook this study on the practice conditions of family doctors in France. The study is accompanied by a publication of case studies from different countries: Germany, Belgium, Spain, Netherlands and United Kingdom.

Canada - Unleashing Innovation: Excellent Healthcare for Canada Report of the Advisory Panel on Healthcare Innovation

This panel, chaired by Dr. David Naylor for Health Canada, undertook wide-ranging consultations and commissioned research in order to identify the five most promising areas for innovation in Canadian healthcare to be acted upon by the federal government. Top among them is patient engagement and empowerment, with system integration, technological transformation, better procurement and regulation also found to be key to breaking the gridlock. The report examines how federal institutions can be restructured to support the spread of innovative practices.

International - Healthcare costs unsustainable in advanced economies without reform

The OECD finds in this report that most OECD countries regularly go over budget on health care. It cautions that funding future medical advances will be difficult without major reforms that will require health and finance ministries to work together. The OECD expects spending to increase from an average 6% of GDP today to 9% of GDP by 2030.

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

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

Canada – Measuring Outcomes in the Canadian Health Sector: Driving Better Value from Healthcare

While Canada has a well-established tradition of transparency and accountability for health-system performance comparisons, few measures of outcomes are reported, according to a new report from the C.D. Howe Institute. In “Measuring Outcomes in the Canadian Health Sector: Driving Better Value from Healthcare,” authors Jeremy Veillard, Omid Fekri, Irfan Dhalla, and Niek Klazinga examine the state of outcomes measurement in Canada, and offer recommendations so that the generation of better information on health system outcomes can help achieve greater value in the health sector.

Europe - A cost/benefit analysis of self-care systems in the European Union

This European Union study explores the added value of self-care systems in Europe and assesses their economic and societal impacts. It provides evidence of the added value of self-care for five minor ailments (athlete’s foot, cold, cough, heartburn, urinary tract infection), analyzes costs and savings, and develops a strategy to disseminate benefits and best practices.

Europe - Promoting Health, Preventing Disease: The economic case

Available for download, this book by British and French authors provides an economic perspective on health promotion and chronic disease prevention, and gives a rationale for assessing the economic case for action. It provides a review of the international evidence base for public health interventions that addresses effectiveness, implementation costs, impacts on health expenditures, and wider economic consequences.

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.

Canada - Policy Capacity for Health System Reform

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

Canada - Adding it all up: A value-based allocation process for child and youth mental health services

Focused on Ontario, this report examines ways to efficiently allocate provincial resources for child and youth mental health services. It recommends a process whereby the Ontario Ministry of Children and Youth Services (MCYS) and its agencies clarify the value and cost of services when determining allocations. The process would involve data collection, determination of service value, and collaborative planning.

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

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

International – World report on ageing and health

With advances in medicine helping more people to live longer lives, the number of people over the age of 60 is expected to double by 2050 and will require radical societal change, according to a new report released by the World Health Organization. The Report highlights 3 key areas for action which will require a fundamental shift in the way society thinks about ageing and older people.

Europe - Out-of-pocket payments in healthcare systems in the European Union

Analyzing the extent to which hospital care in 25 European Union (EU) countries is financed by out-of-pocket payments, this report relies on national and EU data to examine direct payment, cost sharing, and indirect payment schemes. A majority of the countries under study utilize forms of cost sharing, but different hospital financing strategies are also evident.

International - Long-term care (LTC) protection for older persons: A review of coverage deficits in 46 countries

Published by the International Labour Organization (ILO), this report examines long-term care (LTC) services in 46 developing and developed countries that, together, make up 80% of the world’s population. The report provides data on gaps in access, coverage deficits, and the impact of insufficient funding. It calls for recognizing LTC as a right, and making it a priority in national policy agendas.

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.

Canada - Impacts of Québec primary healthcare reforms on patients' experience of care, unmet needs, and use of services

Québec’s healthcare reforms in the early 2000s involved primary care reorganization. Based on surveys conducted in two regions of the province in 2005 and 2010, this study examines how the new organization impacted patients’ care experience, use of services, and unmet needs. Results showed slight improvements in care accessibility but no impact on continuity, care outcomes, service use and unmet needs.

Canada - Economic arguments for shifting health dollars upstream

Economists have long provided evidence that Canada’s health sector would work better at lower cost if more funds were spent on improvements to Canadians’ living and working conditions. This paper advocates a re-invigoration of this approach and reviews health system spending and arguments for moving dollars upstream, especially in the areas of early child development and food security.

International - Building a Framework. The makings of a lean health care transformation

Written by a US hospital administrator, this article describes a framework for successfully instituting Lean management techniques in hospitals, arguing that the sector has too often applied Lean tools without the behaviors and principles required for improvements. The article discusses the roles of the "model cell" (the incubator within the organization for Lean techniques); the central improvement office; and management and administrative systems.

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

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

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.

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

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

International - Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

Seeking to understand the nature and scope of service provision in community hospitals, this UK review examined 75 studies from 10 high-income countries. It found that most community hospitals provide a diverse range of services catering to local needs, and that they collaborate with other local health care organizations on co-location of services, shared primary care workforces, and access to specialists.

Canada - Breadth vs. depth: How to start deploying the daily management system for your lean transformation

The Lean Daily Management System (LDMS) addresses the management of daily operations during continuous improvement at the process level. This paper proposes a framework for healthcare organizations deploying an LDMS model. It examines whether to deploy LDMS in one area at a time or introduce a simplified version across the organization. Field research was conducted at three hospitals to test different deployment strategies.

International - How OECD health systems define the range of good and services to be financed collectively

Universal health coverage has been achieved in nearly all the 35 countries of the OECD. This paper describes how countries delineate the range of benefits covered, including the role of health technology assessment and criteria informing the decision-making process. The paper also looks at the boundaries of healthcare coverage and services for which coverage varies widely.

UK - New care models. Emerging innovations in governance and organisational form

Prepared by The King's Fund for the National Health Service (NHS), this report describes two new care models essential to current NHS strategy: integrated primary and acute care systems (PACS), and multispecialty community providers (MCPs). The report identifies fiscal and care benefits.

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.

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.

Canada - Triple Aim in Canada: developing capacity to lead to better health, care and cost

Many health systems strive for Triple Aim — better population health, improved patient care, and lower costs. This paper describes the participation of nine Canadian teams in an international Triple Aim improvement community offering support for design, implementation, assessment and sustainability through a program of webinars and activities. An evaluation of the Canadian cohort examines their progress in building Triple Aim infrastructure across healthcare settings.

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.

International - The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review

This systematic review of 69 studies examines the effects of pay-for-performance (P4P) programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. It finds that P4P programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting.

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.

UK - Saving STPs: achieving meaningful health and social care reform

This report, from the think tank Reform, looks at the progress of sustainability and transformation plans (STPs) in England. They have been developed in 44 jurisdictions to break down barriers between different levels of health and social service on a local basis. Interviews with experts across the system reveal some progress, especially in places that already had integration efforts in place, and raise issues that contribute to difficulties.

The Netherlands - The Dutch Healthcare System in International Perspective

This article by a Dutch academic discusses aspects of the Netherlands' healthcare system of managed competition from an economic perspective that highlights both the system’s merits and the major challenges posed by its adoption. The article goes on to compare the outcomes achieved with those of different countries and suggest improvements to the Dutch system.

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.

International - Cyclical VS Structural Effects on Health Care Expenditure Trends in OECD Countries

This paper explores common trends in the growth rate of health care expenditure since 1996 in a set of 22 countries of the Organisation for Economic Co-operation and Development (OECD). Authors conclude that structural changes in publicly financed health care have constrained the growth of care volumes (especially) and prices leading to a marked reduction in health care expenditure growth rates, beyond what could be expected based on cyclical economic fluctuations.

Germany - Causes of regional variation in healthcare utilization in Germany

Healthcare utilization varies widely between regions in Germany. This study examines patient migration to see how much of the variation in German ambulatory care use can be attributed to demand and supply factors. Based on administrative data, the authors find that regional variation is overwhelmingly explained by patient characteristics. These results contrast with previous findings for other European countries.

Europe - Costs of unsafe care and costeffectiveness of patient safety programmes

This European Union (EU) study investigates the costs of unsafe care and the cost-effectiveness of patient safety programs. It finds that up to 17% of EU patients experience adverse events, up to half of which are preventable, at a cost of €21 billion. Calculating the return on investment for two safety programs suggests EU-wide savings of €300 million for a program to reduce adverse events and €6 billion for an electronic medication ordering system.

Canada - CHT Conundrum. Ontario Case Study

Ontario has yet to agree to decreases in the Canada Health Transfer (CHT) proposed by the federal government. As Ontario’s healthcare costs are expected to rise at a pace well above the previously agreed CHT, the health transfer will fall as a share of provincial expenditures even if it is not cut as anticipated. This paper urges a quick return to the negotiating table to resolve the issue.

International - Tackling Wasteful Spending on Health

Produced by the OECD, this report reviews strategies put in place by the 34 OECD member countries to limit ineffective healthcare spending and waste. Preventable clinical errors and low-value care are discussed, as are ways to obtain lower prices for medical goods. The report examines different countries' attempts to contain administrative costs and reduce errors.

Canada - Integrated Funding: Connecting the Silos for the Healthcare We Need

According to this article from the C.D. Howe Institute, healthcare delivery silos are impeding Canada’s ability to adapt to changing demands. The article points to experiences in the US and Europe with integrated payment models that distribute funding envelopes across providers. The authors consider this the best way to reduce healthcare costs and increase efficiency and effectiveness.

UK - Outcome-focused integrated care: lessons from experience

Published by Britain’s Institute of Public Care (IPC), which runs programs to support National Health Service (NHS) organizations in health system transformation, this study examines structure and process requirements for delivering integrated care. It draws on IPCs experience with both operational design and support for cultural and organisational change.

International - A systematic review of experiences of advanced practice nursing in general practice

In an effort to understand why advanced practice nurses (APNs) struggle to gain acceptance within healthcare, this Australian systematic review of 20 studies looks at the experience of patients and general practitioners (GPs) with APNs. It finds that GPs and patients continue to have concerns around responsibility, trust and accountability, and that GPs have particular trouble with a lack of clarity around APN scope of practice.

UK - Integrated primary and acute care systems (PACS) - Describing the care model and the business model

Published by the National Health Service (NHS) in England, this framework document explains two new care models considered essential to NHS strategy going forward: integrated primary and acute care systems (PACS), and multispecialty community providers (MCPs). Using lessons from PACS and MCP pilot projects, the document supports local health and care systems planning to implement the models and describes benefits to care and decreased costs.

Europe - Scaling up projects and initiatives for better health: from concepts to practice

Scaling up means expanding or replicating innovative pilot or small-scale projects to reach more people and broaden an intervention’s effectiveness. Using a literature review and results from a survey of policymakers and experts in 10 European countries, this WHO booklet and toolkit addresses the practical challenges of public and private scaling-up activities within national health systems.

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 - Health care coverage in OECD countries in 2012

This paper describes health coverage in the 34 OECD countries. It includes information on health coverage, benefits, cost-sharing requirements and voluntary health insurance. Combining qualitative information collected through a survey of OECD countries, and spending data collected through health accounts for 2012, the paper provides valuable, timely information on OECD healthcare coverage.

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

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

International - An International Comparative Study of Financing Healthcare: The Case of Eight Developed Countries in 1990s- 2000s

In this discussion paper from the Institute for Economic Studies at Keio University in Japan, country-level health care expenditures in countries with social insurance programs (Japan, the Netherlands and France) and in countries with taxation models (the UK, Sweden, Denmark and Norway) are compared according to financial structures. It finds that healthcare expenditures have increased in centralized countries that have an authority to set insurance premiums or tax rates, regardless of population aging.

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

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

Europe - Voluntary health insurance in Europe: country experience

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

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.

Canada - Primary Care in Ontario, Canada: New Proposals after 15 Years of Reform

Ontario has led the way in Canada in implementing innovative primary care practice models, but funding constraints have led to increased conflict with physicians. In response, Ontario’s government is now considering more changes to primary care governance. This article discusses preliminary policy proposals suggested by a provincial primary care advisory committee.

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

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

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.

International - Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services

Priority setting is inevitable on any path towards universal health coverage as all countries experience a gap between their population’s health needs and what is economically feasible for government to provide. This Norwegian commentary asks if priority setting can ever be fair and ethically acceptable, and sets three criteria for governments: cost-effectiveness, giving priority to the worse-off, and financial risk protection.

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

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

International - Waiting time policies in the health sector

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

Canada - Less Ottawa, More Province: How Decentralization is Key to Health Care Reform

Based on Canada’s experience with welfare reform, this paper by the Fraser Institute recommends the devolution of healthcare decision-making powers to the provinces, with the federal government permitting each province maximum flexibility (within a portable and universal system) to provide and regulate healthcare provision as they see fit.

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.

Canada - Canada's International Health System Performance Over 50 years: Examining Potential Years of Life Lost

This report and accompanying web tool compare Canada's international performance in premature mortality — measured by potential years of life lost (PYLL) — with the performance of 17 other high-income countries in the Organisation for Economic Co-operation and Development (OECD) from 1960 to 2010. The report examines how Canada performed overall on PYLL, how Canadian men and women performed in relation to men and women internationally and how Canada performed on 4 specific causes of premature mortality (cancer, heart disease, stroke, and deaths due to external causes).

UK - Fiscal sustainability and public spending on health

This paper examines the determinants of health spending in the UK and implications for spending projections. It finds that income effects are a more important driver of health spending than demographic change, as are cost pressures arising from innovation in health technology.

Canada - Economic arguments for shifting health dollars upstream

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

Canada - Learning from Kaiser Permanente: Integrated systems and healthcare improvement in Canada

Written by a UK academic for the Canadian Foundation for Healthcare Improvement, this paper compares two distinctive approaches to health service provision: a US non-profit insurance and managed care system, and two provincial tax-funded, single insurer systems in Ontario and Saskatchewan. The report finds that the US system, Kaiser Permanente, invested heavily in an integrated clinical system that holds many lessons for Canadian systems.

USA - Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

This study analyzes data from the 2009–2011 Medical Expenditure Panel Survey to compare the healthcare experiences of high-need adults with those of other adults. The study finds that adults with three or more chronic diseases reported unmet medical needs most often and were less likely to experience good patient–provider communication. Privately insured high-need adults reported the greatest difficulties in having their needs met.

Canada - Is the Budget Balance Fragile or Robust? Quebec Faces Health Funding Challenges

The Institut du Quebec produced this paper looking at whether the province's newly balanced budget can withstand health spending increases. It finds Quebec now has enough financial leeway to increase health spending by 4.2% a year. If the economy slows substantially, a balanced budget could be preserved if the federal government reverted to 6% annual growth in the Canada Health Transfer.

Canada - Hold the Applause: Why Provincial Restraint on Healthcare Spending Might Not Last

According to this report by the CD Howe Institute, the recent downward bending of provincial healthcare cost curves across Canada (an average 0.6% drop in 2015) will likely be temporary due to rising drug cost pressures and an inability to maintain large decreases in capital spending. The authors recommend that the federal government ensure provincial health transfers never fall below 3% annually.

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 - Improving the Health Care System: Seven State Strategies

State legislatures play an important role in cutting healthcare waste and improving health systems. This briefing note from the National Conference of State Legislators (NCSL) describes healthcare improvement strategies showing results in Connecticut, Hawaii, Massachusetts, Minnesota, New Hampshire, Rhode Island and Vermont. The state strategies highlight new payment models, patient-centred integrated care, reliance on data, and investments in prevention and safety.

Suggested articles or documents

The documents suggested in this section are chosen based on a review conducted by the team working on the Observatory. You will find recent publications on the modes of organization and best practices in the fields of health and social services.