Post on 23-Sep-2020
Monitoring the efficiency of health systems and
health system reform effects
Christoph Schwierz, Policy Analyst Sustainability of public finances
DG Economic and Financial Affairs (DG ECFIN), European Commission
NIHDI OSE Brussels
28th January 2016
What happened since 2009
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Health system reforms:
o Health system reforms after 2009 largely focused on short-term strategies through budgetary ceilings and reducing operational costs (wages, consumables) Capital expenditure and expenditure on prevention policies was reduced
o Outpatient pharmaceutical spending reduced as % of expenditure
o Expenditure growth contained, but growth is resuming again
o Major structural reforms are still pending
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Annual Growth Survey 2016
Investment: It is essential that Member States promote social investment more broadly, including in healthcare… Fiscal responsibility: Longer and healthier lives are a remarkable achievement for our societies. A healthier population will also improve labour market participation and labour productivity. Responsible policies are now needed to ensure that pension, healthcare and long-term care systems are financially sustainable and can provide adequate protection for all. Structural reforms: Regarding health care and long-term care systems, reforms need to continue to enhance their cost-effectiveness and to ensure adequate access.
Fiscal sustainability
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2015 Country-specific recommendations
Broad Category Policy areas AT BE BG CZ DE DK EE ES FI FR HR HU IE IT LT LU LV MT NL PL PT RO SE SI SK UK
Fiscal policy & fiscal governance
Long-term sustainability of public finances, inc. pensions
Reduce the tax burden on labour
Broaden tax bases
Reduce the debt bias
Fight against tax evasion, improve tax administration & tackle tax avoidance
Financial services
Housing market
Access to finance
Private indebtedness
Employment protection legislation & framework for labour contracts
Unemployment benefits
Active labour market policies
Incentives to work, job creation, labour market participation
Wages & wage setting
Childcare
Health & long-term care
Poverty reduction & social inclusion
Education
Skills & life-long learning
Research & innovation
Competition & regulatory framework
Competition in services
Telecom, postal services & local public services
Energy, resources & climate change
Transport
Business environment
Insolvency framework
Public administration
State-owned enterprises
Civil justice
Shadow economy & corruption
Structural policies
Public administration &
business environment
Public finances & taxation
Financial sector
Labour market, education
& social policies
The CSRs on health system reform
Monitoring of health systems
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Commission assessment frameworks based on international and national data sources and analyses
Supported by ESO and expert advice
Peer reviews of health system performance
In-depths sessions with external experts
Discussions with MS in various committees, e.g. in the Social Protection Committee with the Council Working Party on Public Health at Senior Level
What are (some of) the inputs to create CSRs?
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Slovakia
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CSR: Improve the cost-effectiveness of the healthcare sector, including by improving the management of hospital care and strengthening primary healthcare.
Challenges:
• Low macro level efficiency of health system Long-term increase in healthcare expenditure is a fiscal challenge
• Diverse issues deserve attention related to implementation progress of the Strategic framework for health for 2014-30 hospital payment system, debt accumulation, irregularities in public procurement….
Monitoring:
• Dedicated meetings with the government incl. Ministry of Health
• Detailed questionnaire to the MoH
• Session with the Health Policy Institute, Chamber of Doctors, Associations of Hospital
Structural-fiscal reforms (2/5)
Degree of progress in 2014 CSR implementation*
* Equally weighting across all CSRs.
Monitoring progress with CSR implementation
Challenges of monitoring health system reform effects
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• Limited information, reforms take time, impact assessments of policy
reforms are not the standard and are difficult to assess
• there is no consensus among health policy
makers/analysts/international institutions such as OECD, WHO or EC
on a single set of health policy goals.
• There is accordingly not yet a common framework for health system
performance assessment
• EXPH: Opinion on "Typology of Health Policy Reforms"
Thank you!
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The 2015 CSRs on health system reform
Country 2015 CSR Healthcare
BG CSR 1: Improve the cost-effectiveness of the health care system, in particular, by
reviewing the pricing of health care and strengthening outpatient and primary care.
CZ CSR 1: Further improve the cost-effectiveness and governance of the healthcare
sector.
IE
CSR 2: Take measures to increase cost-effectiveness of the healthcare, including
by reducing spending on patented medicines and gradually mandating the adequate
prescribing practices. Roll out activity-based funding throughout the health system.
ES CSR 1: [part on SGP to be added] Improve the cost-effectiveness of the healthcare
sector, and rationalise hospital pharmaceutical spending. […]
HR CSR 2: […]Tackle the fiscal risks in healthcare..
LV CSR 2: […]Take action to improve accessibility, cost-effectiveness and quality of
the healthcare system and link hospital financing to performance mechanisms.
LT
CSR 2: Address the challenge of a shrinking working-age population by
improving the
labour-market relevance of education, increasing attainment in basic skills, and
improving the performance of the healthcare system;
RO CSR 3: Pursue the national health strategy 2014-2020 to remedy issues of poor
accessibility, low funding and inefficient resources.
SI CSR 1: […]By end of 2015 adopt a healthcare and long-term care reform.
SK CSR 1: Improve the cost-effectiveness of the healthcare sector, including by
improving the management of hospital care and strengthening primary healthcare.
FI
CSR2: …Ensure effective design and implementation of the administrative reforms
concerning municipal structure and social and healthcare services, with a view to
increasing the cost-effectiveness in the provision of public services, while ensuring
their quality.
The 2015 CSRs on health system reform
Country 2015 CSR Long-term care
AT
CSR 2: … Strengthen measures to increase the labour market participation of older
workers and
women, including by improving the provision of childcare and long-term care
services.
SI CSR 1: […]By end of 2015 adopt a healthcare and long-term care reform.