Global Institutions in Health Peter C. Smith Imperial College Business School and Institute for...
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Transcript of Global Institutions in Health Peter C. Smith Imperial College Business School and Institute for...
Global Institutions in Health
Peter C. Smith
Imperial College Business School and Institute for Global Health
Global Institutions in Health
• Funding and Development– World Bank
– International Monetary Fund
– Global Fund
• Coordinating, informing & technical support– World Health
Organization
– European Commission
• Forum and Advocacy– Global Health Council
– World Economic Forum
– Organization for Economic Cooperation and Development
– Commonwealth Fund
Millennium Development Goals (2000)
• to eradicate extreme poverty and hunger;
• to achieve universal primary education;
• to promote gender equality and empower women;
• to reduce child mortality;
• to improve maternal health;
• to combat HIV/AIDS, malaria, and other diseases;
• to ensure environmental sustainability; and
• to develop a global partnership for development.
World Health Report 2000
• The health system:
“… all the activities whose primary purpose is to promote, restore or maintain health.”
WHO 2000 Efficiency Rankings
WHR 2000 Composite Indicator of Attainment
• Overall health outcomes (measured by disability-adjusted life expectancy)
• Inequality in health (measured by an index based on child mortality)
• Overall health system responsiveness, reflecting respect for persons and client orientation (as assessed by a panel of 1,791 key informants in 35 countries)
• Inequality in health system responsiveness (as assessed by the key informants)
• Fairness of financing (measured by an index based on the proportion of non-food expenditure spent on health care).
The WHO approach to setting weights
• Ask 1,006 internet respondents from 125 countries to score the five aspects of performance on a 100 point scale
• Consistency across respondents
• But do they understand what is required? – Relative value of an additional unit of
achievement, at all levels of performance, given the chosen scales of measurement.
Objections in principle
nations legitimately have different objectives and priorities; nations operate in different environmental, economic and
political circumstances; the composite is not helpful as it offers no policy guidance; the methodology is too complex to understand and explain; many countries do not have the capacity to interpret the
implications of the index; media coverage may be unhelpful or misleading.
Tallinn Charter, 2008
“We, the member states, commit ourselves to:
o Promote shared values of solidarity, equity and participation ...
o Invest in health systems, and foster investment across sectors that influence health ...
o Promote transparency and be accountable ...o Make health systems more responsive ...o Engage stakeholders ...o Foster cross-country learning and
cooperation ...o Ensure that health systems are prepared and
able to respond to crises ...”
AMI hospital costs (€)
395.97
1025.76
1861.02
2866.36
5013.64
5916.455599.30
7450.22
592.15
1181.53
5369.53
3720.88
1415.79
2541.84
4161.15
6225.55
7616.89
308.88
2868.16
1282.55
4384.72
483.05
8282.36
9374.21
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Hungary(n=2)
Poland(n=5)
Spain(n=5)
Germany(n=13)
England(n=3)
France(n=3)
Netherlands(n=6)
Italy(n=5)
in €
none PCI performed in hospitals mixed PCI performed in all hospitals
395.97
1025.76
1861.02
2866.36
5013.64
5916.455599.30
7450.22
592.15
1181.53
5369.53
3720.88
1415.79
2541.84
4161.15
6225.55
7616.89
308.88
2868.16
1282.55
4384.72
483.05
8282.36
9374.21
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Hungary(n=2)
Poland(n=5)
Spain(n=5)
Germany(n=13)
England(n=3)
France(n=3)
Netherlands(n=6)
Italy(n=5)
in €
none PCI performed in hospitals mixed PCI performed in all hospitals
Tiemann, O. (2008), Variations in Hospitalisation Costs for Acute Myocardial Infarction: A Comparison across Europe, Health Economics, 17S.
Appendectomy hospital costs (€)
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Denmark England France Germany Netherlands Italy Spain Hungary Poland
in €
2,908
2,514
2,711
2,366
1,5141,466
2,037
2,193
1,702
2,027
2,920
1,547
1,922
2,150
1,552
1,898
2,195
1,461
1,632
694
517594 527
370469
673
200
466
Schreyögg, J. (2008), A micro-costing approach to estimating hospital costs for appendectomy in a cross-European context, Health Economics, 17S.
Hip replacement hospital costs (€)
€ 6,982
€ 6,364€ 6,101 € 5,932
€ 5,691 € 5,605
€ 3,599
€ 2,125
€ 1,294
€ 4,524
€ 5,466
€ 4,011 € 4,070
€ 3,190
€ 8,482
€ 7,622
€ 6,782
€ 7,853
€ 8,739
€ 5,380
€ 9,740
€ 8,332€ 8,646
€ 1,290€ 1,509
€ 5,683
€ 4,457€ 4,126
€ 1,298
€ 2,431
€ 6,925
€ 6,754€ 6,927
€ 0
€ 2,000
€ 4,000
€ 6,000
€ 8,000
€ 10,000
€ 12,000
Italy(N=5)
Germany(N=8)
France(N=5)
Denmark (N=2)
England(N=2)
Netherlands(N=7)
Spain(N=5)
Poland(N=6)
Hungary(N=2)
Results fromother studies
in €
UK 1996/1997:
US 1993-1996:
Canada 1988:
Sweden 2000:
Stargardt, T. (2008), Health Service Costs in Europe: Cost and Reimbursement of Primary Hip Replacement in Nine Countries, Health Economics, 17S.
Life expectancy at birth
Males Females
Total expenditure on health as % GDP
Source OECD HEALTH DATA 2008, June 08
0
2
4
6
8
10
12
14
16
18
1960 1970 1980 1990 2000
Australia
Canada
France
Germany
Italy
Japan
Netherlands
Norway
Spain
Sweden
Switzerland
UK
USA
Trends in out-of-pocket: % total health expenditure
Source: OECD Health Data 2009
OECD Health care quality indicators project
1. Breast cancer five-year survival rate
2. Mammography screening rate3. Cervical cancer five-year survival
rate4. Cervical cancer screening rate5. Colorectal cancer five-year
survival rate6. Incidence of vaccine preventable
diseases (Pertussis, measles, and hepatitis B)
7. Coverage for basic vaccination programme, age 2, (Pertussis, measles, and hepatitis B)
8. Asthma mortality rate, ages 5-39
9. In-hospital mortality rate within 30 days of hospital admission for acute myocardial infarction
10. In-hospital mortality rate within 30 days of hospital admission for stroke
11. Waiting times for surgery after hip fracture, over age 65
12. Influenza vaccination, over age 65
13. Smoking rate14. Retinal exams in diabetics 15. Asthma admission rate
Sandra Garcia Armesto, Maria Luisa Gil Lapetra, Lihan Wei, Edward Kelley and the Members of the HCQI Expert Group (2007)“Health care quality indicators project 2006: data collection update report”,Paris: OECD.
Health at a Glance OECD Indicators
https://www.oecd.org/health /hcqi
OECD RankingsCountry Unexplained life years
added
Australia 2.5
Canada -0.7
France 0.4
Germany -1.0
Hungary -3.1
Iceland 2.6
Netherlands -0.3
Norway -1.5
Sweden 0.5
Switzerland -0.4
UK 0.0
USA -4.0
• After adjusting for determinants of life expectancy– Health care spending
– Education
– GDP
– Pollution
– Alcohol
– Tobacco
– DietJoumard, I., C. Andre, C. Nicq and O. Chatal (2008) Health status determinants: lifestyle, environment, health care resources and efficiency. Economics Department WorkingPaper 627. Paris: OECD.
Access to Doctor When Sickor Need Medical Attention
42
10
2230
55
20
49
5 4
41
12
30
20
53
0
25
50
75
Same-day appointment Wait of 6 days or more
Percent
AUS CAN GER NETH NZ UK US AUS CAN GER NETH NZ UK US
Source: 2007 Commonwealth Fund International Health Policy Survey.Data collection: Harris Interactive, Inc.
C. Schoen, R. Osborn, M. Doty, M. Bishop, J. Peugh, N. Murukutla, “Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries, 2007,” Health Affairs Web Exclusive (Oct. 31, 2007).
Doctor-Patient CommunicationPercent reported doctor: AUS CAN GER NETH NZ UK US
Always knows important information about your medical history
69 67 78 71 69 63 62
Always explains things so you can understand
79 75 71 71 80 71 70
Always spends enough time with you
73 59 70 71 69 59 56
Always tells you about your treatment options and involves you in decisions about your treatment
66 62 62 60 67 54 61
Source: 2007 Commonwealth Fund International Health Policy Survey.Data collection: Harris Interactive, Inc.
C. Schoen, R. Osborn, M. Doty, M. Bishop, J. Peugh, N. Murukutla, “Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries, 2007,” Health Affairs Web Exclusive (Oct. 31, 2007).
Commonwealth Fund, May 2007
MIRROR, MIRROR ON THE WALL:AN INTERNATIONAL UPDATE ON THE COMPARATIVE PERFORMANCE OF AMERICAN HEALTH CAREKaren Davis, Cathy Schoen, Stephen C. Schoenbaum, Michelle M. Doty,Alyssa L. Holmgren, Jennifer L. Kriss, and Katherine K. Shea
Some concluding comments
• Objectives of international agencies
• Culture and history
• Opportunities and constraints– Obama health reforms (CMWF)
– Swine flu (WHO)
• Governance and bureaucracy