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Citizen involvement and health system reform

Citizen involvement and health system reform. Josep Figueras European Health Forum Gastein 5 th October 2005. Are health system reforms increasing citizen involvement? What are the available strategies?

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Citizen involvement and health system reform

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  1. Citizen involvementand health system reform Josep Figueras European Health Forum Gastein 5th October 2005

  2. Are health system reforms increasing citizen involvement? • What are the available strategies? • Do they make a difference in the outcome (including responsiveness) of the health services?

  3. Citizen involvement / Strategies • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005)

  4. Citizen involvement / StrategiesVoiceand Exit • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005)

  5. Citizen involvement / StrategiesVoiceand Exit • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005)

  6. Citizen involvement / Strategies Public / Citizen / Patient Collective - Public • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005) Individual - Citizen Individual - Patient

  7. Citizen involvement / Strategies Areas of involvement Priority setting • Informing the public / benchmarking • Assessing public views / priorities • Advocacy (patient & consumer) groups • Formal representation (purchaser & providers) • Patients rights legislation • Increasing choice (insurer & provider) • Participation in clinical decision making Adapted from den Exter in Figueras et al (2005) Planning Delivery

  8. Satisfaction with the health care system In Busse et al. (2005) Sources: (A) Pescosolido et al. 1985; (B) Blendon et al. 1990, # Blendon et al. 1991; (C) Blendon et al. 1995; (D), (F) (G) (H) Eurobarometer, Mossialos, Figueras et al. 2004, (E) & (I) Blendon et al. 2002 ; (J) OECD 2005; (K) Harris poll 2004

  9. Overall levels of responsiveness WHO 2000-2001 Survey Source: Valentine et al (2003)

  10. Stockholm network 2004

  11. Formal representation • HTA / Setting the benefit package • E.g. Germany: federal joint committee; UK NICE • Insurers / purchasers • In all SHI: representation in sickness funds boards • Primary care and hospital providers • E.g. Patient forums in NHS trusts in the UK • Whose representatives? • Dominance of medical & managerial elites?

  12. Patients rights • Statutory establishment of packages of care • Patient charters /laws: access, treatment coverage • E.g. guarantees on waiting times and opting out • Complaints mechanisms • Ombudsperson • Backed by legal / financial sanctions?

  13. Thomson and Dixon, EuroObserver 2004

  14. Responsiveness Efficiency Access

  15. Opportunities for choice Score: 1 (very bad) 2 (bad), 3 (moderate), 4 (good) 5 (very good) Source: Coulter & Jenkinson (2005)

  16. Levels of choice WHO 2000-2001 Survey Source: Valentine et al (2003)

  17. Reforms to increase choice • Choice of sickness funds in SHI countries • Belgium, Switzerland, Germany, The Netherlands • Choice of hospital providers in NHS type systems in UK, Northern and Mediterranean countries • Sufficient information / benchmarking? • Trade offs with equity and efficiency? • Inverse participation law (R. Klein)

  18. Citizen involvementConcluding points • Increasing number and range of strategies • Impact on health sytems Involving patients has contributed to changes in the provision of services accross a range of settings but the effects of this process on the quality and effectiveness of services is unknown. Crawford et al 2002.

  19. Citizen involvementConcluding points • Voice mechanisms have a limted impact • However key role of accountability, legal and financial sanctions in increasing impact • Exit (choice) strategies have larger impact, but equity and efficiency trade offs

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