OECD REVIEW OF QUALITY OF HEALTH CARE RAISING STANDARDS : CZECH REPUBLIC

1. OECD REVIEW OF QUALITY OF HEALTH CARERAISING STANDARDS: CZECH REPUBLIC Francesca Colombo Acting Head OECD Health Division 25 June 2014

2. Where is the Czech Republic today? • Significant progress in improving quality. • Czech Health Services Act (2012) contains requirements linked to quality of care. • Stakeholders have developed mechanisms to improve effectiveness, safety and patient-centredness. • Strong emphasis on preventive health care • Ambitious screening programmes, including one of the first for colorectal cancer in the world. • More focus on patients’ rights.

3. But the quality agenda is narrowly oriented and still poorly enforced… • Only 20% of hospitals report adverse events. • One-time mandatory hospital accreditation rather than continuous monitoring. • Lack of incentives to drive quality improvement on the ground • Uncertain whether current preventive health initiatives are effective and good value for money. Underpinning all of this - more effective data collection, analysis and dissemination

4. A health system that has made good progress

5. Strong improvement in case-fatality rate after a heart attack

6. … and significant decline in deaths after stroke

7. A focus on preventive health care and early diagnosis • Breast cancer screening since 2002. • Cervical cancer screening since 2008 • Colorectal cancer screening since 2009 – one of the first in the world. • Bi-annualhealthchecks for alladults

8. THE NEXT CHALLENGES TO TACKLE WILL BE…

9. Increasing demands Population aged over 65 … and % reporting good health

10. Some worsening health indicators More adults smoking daily … high rates of adult obesity

11. Need to do more with less

12. … and reduce dependence on the hospital sector

13. HOW WELL PLACED IS THE CZECH REPUBLIC TO MEET THESE CHALLENGES ?

14. How well placed is the Czech Republic to meet these challenges? Governance: • The Czech Republic trails other OECD countries in moving towards a systemic and continuous focus on quality of care. • Governance around quality depends largely on one-time accreditation of minimum standards. • Lack of a coherent governance structure, many split responsibilities.

15. How well placed is the Czech Republic to meet these challenges? • Data infrastructure is weak and fragmented. • A substantial amount of information is gathered across the health system, but most of it is used for billing and is focused on volumes of care and resources – not quality. • The openness of the data infrastructure is low and patients have very limited access to information on performance. This makes it difficult for patients to make informed choices. Information:

16. Examples of weaknesses in the information infrastructure • Data is narrowly used. For example, although the Czech Republic has one of the longest-established national cancer registers in the OECD, it is mostly used for epidemiological analysis. • Data doesn’t yield the full picture because it doesn’t link-up. For example, a much richer assessment of cancer screening programmes could be achieved if clinical outcomes in the cancer register were linked to screening histories. • Important data gaps persist. For example, there is a national register for type I diabetes, but not for the much more common type II diabetes.

17. How well placed is the Czech Republic to meet these challenges? Services: • Primary prevention efforts are failing. • Prevention efforts and programmes for people with diabetes need to be strengthened. • Cancer screening remains opportunistic, rather than population-based.

18. Primary care seems weak • High avoidable hospital admissions • High diabetes hospitalisation rate of 221 per 100,000 population (OECD 164.4 per 100,000). • Asthma and COPD hospital admissions lower than OECD average. • Careisnotalwayspatientcentred • 97.2% of patients report doctors spend enough time with them during consultations, and 94% report doctors give an opportunity to ask questions. • BUT only 81.8% report doctor involves patient in decision making (OECD 86.1%)

19. Programs to prevent chronic disease don’t appear to be effective • Significant risk factors: Obesity • Adult obesity rose from 14% in 2000 to 21% in 2011, and is higher than the OECD average of 17.2%. • Overweight and obesity among Czech 15-year-olds rose from 9% to 15%. • Smoking rates are rising, contrary to other OECD • Daily adult tobacco consumption increased by 5% between 2000 and 2011, compared to an OECD average reduction of 21%. • 24.6% of Czech adults smoke daily, compared to 20.9% across the OECD.

20. Cervical cancer screening is low in women aged 20 to 69

21. Mixed outcomes on diabetes care • Prevalence in Czech Republic of 8%, compared to OECD average of 6.9%. • Burden of disease rising with increasing rates of obesity and ageing population. • Mortality and some complication rates have fallen, but diabetic retinopathy incidence rising.

22. WHAT THE CZECH REPUBLIC COULD DO…

23. Improve quality-based governance • Shift from the current emphasis on ensuring basic minimum standards are met, to continuous monitoring and improvement • Shift from a voluntary approach to quality assurance, to an approach underpinned by tougher requirements and stronger incentives • Open up quality and performance data to the public scrutiny

24. Strengthen data collection, analysis and dissemination • Streamline whilst developing the data infrastructure - to make it less fragmented and enable more data sharing. • Produce more sophisticated analyses giving a detailed picture of health needs and outcomes, to inform the policy-making process. • Ensure analysis and reporting is patient-oriented as well

25. Strengthen primary care in diabetes management • Promote the role of primary care professionals in co-ordinating care for patients with diabetes, by giving GPs incentives and training to take on more complex patients. • Establish a patient register for type 2 diabetes, and strengthen the existing type 1 and gestational diabetes registers. • Explore the introduction of Disease Management Programmes to promote well co-ordinated care.

26. Encourage GPs to adopt a leading role in assuring quality and outcomes Coordination Governance Information

27. Improve screening and prevention • Move to a population-based cancer screening program. Particular attention should be paid to screening rates of socially disadvantaged people. • Place an emphasis on preventive health, particularly aimed at children. • Evaluate its comprehensive health check, and abandon it if it is not good value for money. • Link screening data to clinical outcomes to gain a richer picture of gaps in coverage.

28. TO CONCLUDE…

29. Key policy recommendations • Shift governance toward continuous quality improvement. • Strengthen data collection, analysis and reporting. • Promote prevention of chronic disease. • Give primary care practitioners incentives to manage complex patients.

30. OECD Reviews of Health Care Quality www.oecd.org/health/qualityreviews • Published: Korea, Israel, Denmark, Turkey, Sweden, Norway, Czech Republic • 2014: Italy, Australia, Japan, Portugal, others • Final report after completion of reviews

31. Thank you Contact: Francesca.Colombo@oecd.org Read more about our work Follow us on Twitter: @OECD_Social Website: www.oecd.org/health Newsletter: http://www.oecd.org/health/update