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Quality and Cost International Perspectives

Quality and Cost International Perspectives. Derek Feeley Director of Healthcare Policy and Strategy NHS Scotland. Health Care Spending per Capita in 2003 Adjusted for Differences in Cost of Living. a. a.

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Quality and Cost International Perspectives

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  1. Quality and CostInternational Perspectives Derek Feeley Director of Healthcare Policy and Strategy NHS Scotland

  2. Health Care Spending per Capita in 2003Adjusted for Differences in Cost of Living a a Source: Frogner and Anderson 2006; OECD Health Data 2005; AIHW Health Expenditure Australia 2003–04. a2002

  3. Percentage of Gross Domestic Product Spent on Health Care in 2003 a a Source: Frogner and Anderson 2006; OECD Health Data 2005; AIHW Health Expenditure Australia 2003–04. a2002

  4. Health Care Expenditure per Capitaby Source of Funding in 2003Adjusted for Differences in Cost of Living a a a2002 Source: Frogner and Anderson 2006; OECD Health Data 2005; AIHW Health Expenditure Australia 2003–04.

  5. Healthy life expectancyWHO World Health Report 2006

  6. % of total life expectancy lost to poor health (male and female)WHO Report 2006

  7. Infant Mortality Rates 2000Source NCHS

  8. Quality IndicatorsSource OECD, Hussey et al 2004

  9. Safety: Medical Mistake, Medication Error, or Test Error in Past Two Years Percent 2005 Commonwealth Fund International Health Policy Survey

  10. Effectiveness; Preventive Care 2004 Commonwealth Fund International Health Policy Survey

  11. Timeliness; Access to Doctor When Sick or Need Medical Attention Percent AUS CAN NZ UK US AUS CAN NZ UK US 2004 Commonwealth Fund International Health Policy Survey

  12. Patient Centered; Missed Opportunities to Engage Patient *Doctor only sometimes, rarely or never 2004 Commonwealth Fund International Health Policy Survey

  13. Efficiency; Coordination Problems by Number of Doctors Percent * Either records/results did not reach doctors office in timefor appointment OR doctors ordered a duplicate medical test 2005 Commonwealth Fund International Health Policy Survey

  14. Equity; Number of Measures Where Below Average Income Adults Have More Negative Experiences * Inequity counted when significant difference between income groupswhere p  .05 and gap of >5%; for U.S. p<.05 and gap>5%, or gap>5%. Source: Commonwealth Fund 2004 International Health Policy Survey.

  15. Cost = Quality?

  16. Limited to patient experience? Yes but…….. • Confirms earlier survey findings; • In line with WHO and OECD indicators which show a similar mixed story; • In line with findings at system and sub-system levels within countries.

  17. And so….. • No discernable relationship between quality and cost; • Comparable data hard to come by; • No one country has the answer – each has scope to learn; • Social as well as clinical factors at play;

  18. Questions and answers • Is international comparison worth the trouble? • Useful in; • Raising questions • Benchmarking best practice • Are we measuring the right things? • Current OECD 15 an important 1st step - but • Measuring what can be measured • Acute focussed • Fail to cover all dimensions of quality

  19. Policy Implications • Many of the indicators to which patients attach value require a different model of care; • New ways of delivering care will require a new quality paradigm • We need to change what we measure • We need a different mindset about the business case for quality (social as well as financial)

  20. Shifting the balance of care • Current viewEvolving model of care • Emphasises acute care Emphasises long-term conditions • Hospital centred Embedded in communities • Doctor dependent Team based • Episodic care Continuous care • Reactive care Preventative care • Patient as passive recipient Patient as partner • Carers undervalued Carers supported as partners • Low tech High tech

  21. Implications for National health systems, quality and costs • Population health as well as healthcare • Longitudinal measures rather than episodic • Patient activation • Improved ICT required • Incentives required for; • Whole system integration • Prevention

  22. Acknowledgement Thanks to the Commonwealth Fund for access to the data from international surveys, including; • Multinational Comparisons of Health Systems Data, 2005 (Frogner and Anderson) • The Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults in Six Countries (Schoen, Osborn, Huynh, Doty, and Fenley) • The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries (Schoen and Osborn) The views expressed are my own and should not be construed as representing CMWF.

  23. Coronary Bypass Proceduresper 100,000 Population in 2003 b a a b a2002 b2001 Source: OECD Health Data 2005.

  24. Spending on Physician Services per Capita in 2003Adjusted for Differences in Cost of Living a a2002 Source: OECD Health Data 2005; AIHW Health Expenditure Australia 2003–04.

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