Sean Boyle on English health reform
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Transcript of Sean Boyle on English health reform
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The English health system
Author:
Seán Boyle
LSE
Location:
The King’s Fund
23 March 2011
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Outline
• The structure of the report
• Some thoughts on the health system–Improvements in access–More spent and more staff–Why has productivity not improved?–Some quality improvement–Health improvement
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The report (1)
• Geographic, economic and political context
• Health status• Organisational structure • Financing• Regulation and planning• Physical and human resources • Provision of services
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The report (2)
• Public health • Primary care• Secondary and tertiary care • Emergency care• Pharmaceutical care• Intermediate care and rehabilitation • Long-term care• Services for informal or unpaid carers• Palliative care• Mental health• Dental care• Complementary and alternative medicine
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The report (3)
• Principal health care reforms
• Assessment of health system–Access–Equity–Efficiency–Quality–Health improvement
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Access (numbers waiting)
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Access (median waiting times)
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Access (referral to treatment within 18 weeks)
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Increase in staff 1996 – 2009
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Average annual change in staff numbers (1996 – 2009)
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Change in mean earnings (2000 – 2009)
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Comparison of changes in mean earnings (2000 and 2009)
Meanearnings
2000
Mean earnings
2009
Total %change
Between2000
and 2009
mean annual
% change
Consultants 71,900 120,900 68% 5.9%
Doctors in training & equivalent 35,000 51,800 48% 4.5%
Managers 35,700 47,900 34% 4.3%
Nurses and midwives 22,600 30,700 36% 3.5%
Maintenance and works 19,600 27,300 39% 3.8%
Admin & clerical 14,000 22,100 58% 5.2%
Healthcare assistants 12,400 18,700 51% 6.0%
Public sector 17,000 25,300 49% 4.5%
Private sector 19,800 27,500 39% 3.7%
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Productivity (1)
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Productivity (2)
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Improvements in quality (deaths per 100,000 hospital spells)
0
5,000
10,000
15,000
20,000
25,000
30,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Stroke
Hip fracture
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Improvements in quality (change in death rate)
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Mortality amenable to health care (absolute levels)
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Mortality amenable to health care – % change between 1997/98 and 2002/03
-30
-25
-20
-15
-10
-5
0
5
10
Irel
and
Aus
tria
Uni
ted
Kin
gdom
Fin
land
Nor
way
Aus
tral
ia
Por
tuga
l
Ital
y
New
Zea
land
Net
herla
nds
Ger
man
y
Fra
nce
Can
ada
Gre
ece
Japa
n
Spa
in
Den
mar
k
Sw
eden
Uni
ted
Sta
tes
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Mortality amenable to health care (absolute levels)
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Mortality amenable to health care – % change between 1997/98 and 2007
Gay, J. G. et al. (2011), “Mortality Amenable to Health Care in 31 OECD Countries: Estimates andMethodological Issues”, OECD Health Working Papers, No. 55, OECD Publishing
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What is the reason Ireland does so well?
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What is the reason Ireland does so well?