Lessons from the canadanish experience
This presentation is the property of its rightful owner.
Sponsored Links
1 / 18

Lessons from the “Canadanish” experience PowerPoint PPT Presentation


  • 32 Views
  • Uploaded on
  • Presentation posted in: General

Lessons from the “Canadanish” experience. Lieven Annemans. Universiteit Gent, VUB. Content. Recommendations for improved health (care) policy (VGR) Similarities and differences with Can/Den Towards a blueprint for a Flemish health system Objections against decentralization Final thoughts.

Download Presentation

Lessons from the “Canadanish” experience

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Lessons from the canadanish experience

Lessons from the “Canadanish” experience

Lieven Annemans

Universiteit Gent, VUB


Content

Content

  • Recommendations for improved health (care) policy (VGR)

  • Similarities and differences with Can/Den

  • Towards a blueprint for a Flemish health system

  • Objections against decentralization

  • Final thoughts


Recommendations for health care policy

Recommendations for health (care) policy

  • Setting health objectives

    • According to population needs

  • Increase focus on prevention

  • Revise the way health care providers are paid: mix of payment

    • per practice, per patient, per service, for quality

  • Improve cost-effectiveness of interventions in health

  • Better alignment (between prevention and cure; between health and social services, between health and socio-economic status,...)

  • Adapt education of health care providers to societal challenges

VGR , 2006


Recommendations for health care policy1

Recommendations for health (care) policy

  • Setting health objectives

    • According to population needs

  • Increase focus on prevention

  • Revise the way health care providers are paid: mix of payment

    • per practice, per patient, per service, for quality

  • Improve cost-effectiveness of interventions in health

  • Better alignment (between prevention and cure; between health and social services, between health and socio-economic status,...)

  • Adapt education of health care providers to societal challenges

VGR , 2006


Why further decentralization

 why further decentralization?

  • More efficient health objectives (also including cure and care)

  • Payment in function of quality and meeting objectives

  • Alignment

    • Between health and social services

    • Between prevention and cure

    • Between health and education, work and housing (determinants of health)

    • Between health and training of health professionals

  • Better guarantees for integrated care

  • Avoid blaming, cost shifting, overlap, contradictions, inefficiency, double use, gaps, .... existing in current “semi-decentralized” situation

VGR , 2006


Content1

Content

  • Recommendations for improved health (care) policy (VGR)

  • Similarities and differences with Can/Den

  • Towards a blueprint for a Flemish health system

  • Objections against decentralization

  • Final thoughts


Similarities and differences with can den

Similarities and differences with Can/Den

  • Similarities

    • Federal state - regions - subregions

    • (Socio)economic differences between regions (Can)

    • Language issue (Can)

    • Health insurers (Can)

  • Differences

    • Only “decidecentralized”

    • Cultural differences stronger (cfr J. De Maeseneer)

    • Bismarck system (social insurance)

    • Brussels


Content2

Content

  • Recommendations for improved health (care) policy (VGR)

  • Similarities and differences with Can/Den

  • Towards a blueprint for a Flemish health system

  • Objections against decentralization

  • Final thoughts


Towards a blueprint for a flemish health system

Towards a blueprint for a Flemish health system

  • Financial and political accountability

  • Spending power

  • Full responsibility for programming, norms and quality

  • Integration of prevention, cure and care, and of first, second and third line (double integration)

  • Alignment with social services and other determinants of health

  • Central role of the general practioner as gatekeeper (cfr WHO)

  • Three-layer health care system

  • Maintaining solidarity, at least for a well defined and agreed period of time

  • Maintain some functions at the central level (HTA, information system)

  • Respecting values of equity, effectiveness and cost-effectiveness


Integrated

Integrated

P

C

R

C

A

E

U

R

V

R

E

E

E

N

T

Promote health

Caring for patients

W. De Meester, 2005

Cfr RHA’s, cfr LHIN in Ontario


Solidarity cfr health care expenses

Solidarity? Cfr health care expenses

100,00

90,00

80,00

70,00

60,00

cumulative percentage of health care costs

50,00

40,00

30,00

20,00

10,00

0,00

0,00

10,00

20,00

30,00

40,00

50,00

60,00

70,00

80,00

90,00

100,00

sample Belgium population ranked according to medical consumption


Three layer health care

Three layer health care

Prevention, cure and care not covered by public insurance

Regulated competitionbetween insurers

Package 2: cost-effective prevention and treatment, not in package 1

Package 1: primary prevention, screening, family and elderly care, chronic diseases

No competitionbetween insurers

W. Demeester, 1999


Content3

Content

  • Recommendations for improved health (care) policy (VGR)

  • Similarities and differences with Can/Den

  • Towards a blueprint for a Flemish health system

  • Objections against decentralization

  • Final thoughts


Objections yes but

Objections (yes, but...)

  • What about Brussels?

    • Option 1: population chooses (cfr education

    • Option 2: Brussels as a separate entity (own health challenges; same size of several Canadian provinces)

  • What about the RIZIV/INAMI?

    • Transition to regional health agencies, responsible for steering (layer 1), regulating (layer 2) and facilitating (layer 3)

    • Feasibility and plan to be established with RIZIV/INAMI top

  • Cross-border care?

    • Cfr. European legislation with this regard

  • What about solidarity? See earlier argumentation

    • Plus: see Figures about affordability in Denmark

  • Why not recentralizing? See next slide


Lessons from the canadanish experience

Why recentralization is less of an option

  • Are we then going to recentralize social services, labour, education, …? If not, the same problems remain; if yes, decreasing efficiency in those fields

  • Regional models have succeeded in improving efficiency; making the system more patient-oriented; and enhancing cost-consciousness (Bergman, 1998)

  • Centralization hinders integrated care, leads to information overload and being out of touch with providers (adversely affecting motivation, and makes it difficult to respond to complex local conditions (Mur-Veeman, 2008)

  • HOWEVER: limits to decentralization

    • Cfr HTA in Canada (CCADTH),

    • Cfr. NBOH’s role in Denmark

    • Cfr. Health information system in Canada (CIHI)


Content4

Content

  • Recommendations for improved health (care) policy (VGR)

  • Similarities and differences with Can/Den

  • Towards a blueprint for a Flemish health system

  • Objections against decentralization

  • Final thoughts


Final thoughts

Final thoughts

  • Decentralization is not strange nor unrealistic

  • “Whatever the approach, strong leadership and trust are required for effective planning and sustainability”. (Stoto, 2008) (the devil lies in the detail)

  • Two attitudes:

    • Decentralization as goal

      • “decentralization makes everything better”

    • Decentralization as a means

      • “many recommendations for improving our health care can be made; with a decentralization, most of these recommendations can be better realized” (VGR, 2006)

  • Equity means solidarity based on objective criteria and does not mean supporting inefficiency (cfr unjustified overconsumption)


  • Lessons from the canadanish experience thank you

    Lessons from the “Canadanish” experienceTHANK YOU

    Lieven Annemans

    Universiteit Gent, VUB


  • Login