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Health care systems: efficiency and policies

Health care systems: efficiency and policies. Isabelle Joumard, OECD, Economics Department “New Directions in Welfare” OECD Universities’ Joint Congress, 6-8 July 2011. Weak link between health care spending and outcomes. Source: OECD Health Data 2010 . Presentation outline.

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Health care systems: efficiency and policies

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  1. Health care systems: efficiency and policies Isabelle Joumard, OECD, Economics Department “New Directions in Welfare” OECD Universities’ Joint Congress, 6-8 July 2011

  2. Weak link between health care spendingand outcomes Source: OECD Health Data 2010.

  3. Presentation outline • Measuringhealth care spendingefficiency • Reapingefficiency gains: why(effect on public spending) and how

  4. 1. Measuring health care efficiency: difficulties • No obviousdefinition of health care outcomes and inputs; cross-country data on outcomes are imperfect • A large variety of actors (hospitals, outpatientphysicians, drugcompanies, etc.) and co-ordinationmatters a great deal • Mix of public and privatespending

  5. 1. Measuringhealth care efficiency:OECD approach • Choose an outcome indicator • … and an input indicator • Identify the other determinants • Implement various approaches (panel regressions and DEA) and robustness checks • Complement/compare the overall efficiency index with other performance indicators

  6. Life expectancy at birth Source: Health at a Glance 2009, OECD Indicators.

  7. Amenable mortality Source: Gay et al. (2011), "Mortality Amenable to Health Care in 31 OECD Countries: Estimates and Methodological Issues", OECD Health Working Paper, No. 55.

  8. No trade-off between raising equity and the average health status Source: OECD Health Data.

  9. Life expectancy at 65, women Source: Health at a Glance 2009, OECD Indicators.

  10. Correlationsbetweenoutcomemeasures(level and rank) Source: Joumard , André and Nicq (2010), "Health Care Systems: Efficiency  and Institutions", OECD Economics Department Working Papers, No. 769.

  11. Health care spending2008 Source: OECD Health Data 2010.

  12. Practising physiciansper 1000 population, 2007 Source: Health at a Glance 2009, OECD Indicators.

  13. Remuneration of specialists Source: OECD Health Data 2010.

  14. Remuneration of general practitioners (GPs) Source: OECD Health Data 2010.

  15. Health status determinants • Health care resources • Lifestylefactors: diet, alcohol and tobbacoconsumption • Socioeconomicenvironment: income and education • Pollution

  16. DEA – defining the efficiency frontier and potential efficiency gains

  17. DEA – results and sensitivityanalysis(for differentoutcomeindicators) Potential gains in life expectancy, years Potential gains in amenable mortality, % Source: Joumard , André and Nicq (2010), "Health Care Systems: Efficiency  and Institutions", OECD Economics Department Working Papers, No. 769.

  18. DEA – results and sensitivityanalysis(for different input indicators) Potential gains in life expectancy, years Source: Joumard , André and Nicq (2010), "Health Care Systems: Efficiency  and Institutions", OECD Economics Department Working Papers, No. 769.

  19. Panel regressions – model specification(log form)

  20. Panel regressions: contribution of main explanatory variables to cross-country differences in life expectancy Source: Joumard , André, Nicq and Chatal (2008), "Health Status Determinants: Lifestyle, Environment, Health Care Resources and Efficiency ", OECD Economics Department Working Papers, No. 627.

  21. Panel regressions:years of life not explained by the model Source: Joumard , André, Nicq and Chatal (2008), "Health Status Determinants: Lifestyle, Environment, Health Care Resources and Efficiency ", OECD Economics Department Working Paper, No. 627.

  22. Comparingefficiencyindicatorsderivedfrom panel regressions and DEA

  23. Complementingoverallefficiency score by other performance measures -- France Source: OECD Health Data 2010.

  24. 2. Reapingefficiency gains –Large potentialsavings in public spending % 2017 GDP Source: OECD Health Data 2009; OECD calculations.

  25. Characterisinghealth care systems: a new set of OECD indicators • Level of basic insurance coverage • Market mechanisms and regulations to steer demand and supply of care affecting users, providers and insurers • Budget and management approaches

  26. Characterisinghealth care systems:country groups Source: Joumard, André and Nicq (2010), "Health Care Systems: Efficiency  and Institutions " , OECD Economics Department Working Papers. No. 769.

  27. No health care system clearlyoutperforms the othersNo big-bang reformiswarranted Source: Joumard, André and Nicq (2010), "Health Care Systems: Efficiency  and Institutions", OECD Economics Department Working Papers, No. 769.

  28. How to reapefficiency gains? The new set of policyindicatorsprovides guidance

  29. To conclude • Indicators of health care spendingefficiency at the system levelcanbebuilt and are relativelyrobust • Theycanbecomplemented by indicators of the quality of care and other performance indicators • Exploitingpotentialefficiency gains would help contain public spending and result in large savings for some countries (on average 2% of GDP by 2017) • No health care model clearlyoutperformsothers. Best practices among pair countries shouldbeidentified

  30. For more information • OECD (2010), Health Care Systems: Efficiency and Policy Settings. • Joumard, André, Nicq and Chatal (2008), "HealthStatusDeterminants: Lifestyle, Environment, Health Care Resources and Efficiency", OECD Economics Department WorkingPapers, No. 627. • OECD, Health at a Glance(bi-annual publication).

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