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

9

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.