Rational resource use in European health care

1. Rational resource use in European health care EHMA, Athens - Greece 26 June 2008 Dung Ngo Researcher Erasmus University Rotterdam The Netherlands

2. Contents • Background • Research question • Methods • Results • Conclusion • Discussion

3. Background • Project European Commission • Paper served as background document for workshop in November 2007 • Aim workshop was to support Member States in their efforts to modernize health care systems • Unsustainable growth in health care expenditure  How to improve efficiency in health care systems?

4. Total expenditure on health(1970 – 2000, % of GDP)

5. Research question “How can social protection encourage a rational use of resources while promoting quality and ensuring equitable access to care?”

6. Methods • Literature research on following topics: primary care, care coordination, patient empowerment, competition, IT and eHealth, pharmaceuticals • OECD database: comparison 13 European countries • Results workshop • This presentation focuses on primary care and care coordination only!

7. GP consultation (2000, number per capita)

8. Expenditure by service type(2000, % of total health expenditure)

9. Results workshop: gatekeeping in NL & FR • NL: gatekeeping leads to referral 180 times out of 1000 visits • FR: 86% of consultations through gatekeeping system • System requires knowledge of health care organization and patients’ trusts • Unclear whether gatekeeping leads to cost savings: when gatekeeping is used to promote quality of care, the potential for reducing expenditures becomes limited

10. Results workshop: care coordination in MT, BE, LU & PT (1) • MT: focus on better organization of primary and community care • BE: health care trajectories for specific patient groups for optimal patient care, with financial incentives for patients to enter trajectory • LU: home care coordination after hospital discharge in order to optimize patient care, introduction of linking nurse for integration of services • PT: disease management program to improve care coordination over three levels of patient support

11. Results workshop: care coordination in MT, BE, LU & PT (2) • Targeted programs aimed at better disease management are an attractive alternative in care coordination, because in theory both payers and patients can benefit from improved care BUT: • Difficulties found in care coordination: - Insufficient information flows concerning patients; - Inadequate capacity among coordinators; - Weak incentives to carry out optimal care coordination; - Regulatory barriers

12. Conclusion • Different health care systems and historical backgrounds in the 13 European countries complicate the comparison of outcomes of health care policies in terms of quality and equitable access  effect-outcome relationships are difficult to prove for single reforms or interventions! • When promoting rational resource use, it does not automatically lead to lower expenditures • To prove effect-outcome relationships, which indicate a rational use of resources, models are needed that combine inputs, processes and outcome data

13. Discussion • What can we actually learn from country comparisons? Is it possible to make comparisons and formulate general conclusions based on country-specific examples and data? • In what way do these kind of workshops contribute to policy-making? To what extent can countries actually learn from each other? Or do these workshops only stimulate and motivate countries to think about the topic?

14. More information Ngo, D. et al. 2007. Background document for the PROGRESS Workshop on “Policy options for promoting rational resource use in the areas of health care and long-term care”. Brussels: European Commission