The High Performance Health System Dov Chernichovsky, Ph.D. Ben-Gurion University of the Negev,...
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The High Performance Health System Dov Chernichovsky, Ph.D. Ben-Gurion University of the Negev, Israel
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Transcript of The High Performance Health System Dov Chernichovsky, Ph.D. Ben-Gurion University of the Negev,...
The High Performance Health System
Dov Chernichovsky, Ph.D.Ben-Gurion University of the Negev,
Israel
June 21, 2006 Dov Chernichovsky - Draft 2
Objectives of Presentation
Articulate goals and objectives of the health care system
Examine (some) performance indicators
Identify structural features of health systems associated with actual and potentially good performance
June 21, 2006 Dov Chernichovsky - Draft 3
Background
““The Emerging Paradigm in Health Systems”The Emerging Paradigm in Health Systems” Study -- Funded by the Commonwealth
Fund -- of the health systems of eight developed nations: Australia, Canada, Germany, France, Israel, The Netherlands, the U.K. and the U.S.
Audience: U.S. policy makers Approach: technocratic, to the extent
possible
June 21, 2006 Dov Chernichovsky - Draft 4
Goals & Objectives of Society Regarding the Healthcare System
Invest in health, balancing between spending on medical care and on other means to enhance health
Objectives: (Health) Equity Cost containment Efficient production of quality medical care Client satisfaction
June 21, 2006 Dov Chernichovsky - Draft 5
Health – Life Expectancy(data sources in full paper)
Country
Life Expectancy at birth in 2003 (years)
FemaleMaleTotal PopulationDifference Between Genders
Australia82.877.880.35.0
Canada82.1´¹77.2´¹79.7´¹4.9
France82.975.879.47.1
Germany81.375.578.45.8
Israel81.877.679.74.2
Netherlands80.976.278.64.7
United Kingdom80.776.278.54.5
United States79.9´¹74.5´¹77.2´¹4.4
June 21, 2006 Dov Chernichovsky - Draft 6
Equity – Instrumental Rationale
Equitable distribution of medical resources can improve average health
Protection of household non-medical consumption from ‘catastrophic’ medical spending
June 21, 2006 Dov Chernichovsky - Draft 7
Equity - Equitability of Funding Resources
Country
Source of FundingGeneral RevenuesSocial security
Private expenditureScore
%of Total HealthSpending
%of Total HealthSpending
%of Total HealthSpending
)higher, more equitable(
Australia65.00.035.065.00
Canada68.41.530.169.45
France2.573.823.754.16
Germany9.868.421.857.68
Israel43.027.030.061.90
Netherlands4.458.037.645.00
United Kingdom83.50.016.583.50
United States31.513.055.540.60
June 21, 2006 Dov Chernichovsky - Draft 8
Cost Containment – (Instr.) Rationale
Helps protect household income and spending
Contributes to lower production costs, competitiveness, and employment
June 21, 2006 Dov Chernichovsky - Draft 9
Cost Containment (a) -Relative Price Increases in Medical Care
90
100
110
120
130
140
150
160
1985 1990 1995 2000 2002
Australia
Canada
France
Israel
US
June 21, 2006 Dov Chernichovsky - Draft 10
Cost Containment (b) – Real (General Price Index) Per Capita Growth in Health Spending
100
125
150
175
200
225
250
275
1980 1985 1990 1995 2001
Australia
Canada
France
Germany
Israel
Netherlands
UK
US
June 21, 2006 Dov Chernichovsky - Draft 11
Production Efficiency - Rationale
More resources for quality care and other uses
June 21, 2006 Dov Chernichovsky - Draft 12
Production Efficiency – Spending
Country Expenditure as a % of
GDPSpending Per Capita
(US$)
Australia9.3´¹2699´¹
Canada9.9 e3001 e
France10.1 e2903 e
Germany11.12996
Israel8.51953
Netherlands9.82976
United Kingdom7.7´¹2231´¹
United States15.05635
June 21, 2006 Dov Chernichovsky - Draft 13
Client Satisfaction – Client Desire for Reform
Country
%Responding about Required Reform
Minimal ReformSubstantial
ReformTotal Reform
Australia194930
Canada205623
France......
Germany......
Israel374913
The Netherlands......
United Kingdom255814
United States174633
June 21, 2006 Dov Chernichovsky - Draft 14
Preliminary Conclusions
Systems in-between the U.K. and U.S.A do better in balancing health system goals
They are more relevant to the U.S.A., anyhow
June 21, 2006 Dov Chernichovsky - Draft 15
Principles for Success
Universal entitlement
Centralized funding of care -- not necessarily by the state budget -- for Equity Cost containment
Competition and choice– not necessarily in private markets -- for Efficient production of quality care Client satisfaction
June 21, 2006 Dov Chernichovsky - Draft 16
Apparently Successful Dual Internal Market Structure
State
Funding Pool,Real or Virtual
Regulation
Contracting
Purchasing
First Market
Second Market
Non-state Fund holding, OMCC Institutions:Sickness Funds, HMOs, etc.
Providers
June 21, 2006 Dov Chernichovsky - Draft 17
Reform Directions
K
P
Z
A
FullyCentralized
Competitive
Out ofPocket,Private
TransitionalEconomies
GeneralRevenues,FullyPublic
Transitional poor nations
The U.S & poor nations
← Funding→
↑OMCC
&Provision
↓
Europe
June 21, 2006 Dov Chernichovsky - Draft 18
Basic Features of Dual Internal Market
Enables multiple Lines of accountability
Enables pluralism and choice in Form of entitlement Content of entitlement Enables client empowerment vis a vis
state, on the one hand, and providers, on the other
June 21, 2006 Dov Chernichovsky - Draft 19
Multiple Lines of Accountability
OMCC Institution
Providers
Fundraising&
Allocation
Finance Accountability
OMCC Institutions2
June 21, 2006 Dov Chernichovsky - Draft 20
Multiple Forms of Care
Primary care
OMCC
Primary care
OMCC
Model DModel C
Professional care and hospitalization
Professional care and hospitalization
OMCC
Primary CarePrimary care
Professional care and hospitalization
Model A Model B
OMCC
Primary Care
Professional care and hospitalization
June 21, 2006 Dov Chernichovsky - Draft 21
Multiple Content of Entitlement
Expansion of Entitlement
Private entitlement and finance
Discretionary public entitlement, financed by a pre-set portion of public-based finance
Core public entitlement – common to all groups
Key Function & Institution
Organization and Management of Care Consumption (OMCC) / Competing Budget Holder
June 21, 2006 Dov Chernichovsky - Draft 23
Basic References
Chernichovsky, D. 1995. “Health System Reforms in Industrialized Economies; An Emerging Paradigm”. The Milbank Quarterly Vol. 73, no. 3: 339-372.
Chernichovsky, D. 2002. “Pluralism, Choice, and the Sate in the Emerging Paradigm in Health Systems.” The Milbank Quarterly. Vol. 80, No.1:5-40.
June 21, 2006 Dov Chernichovsky - Draft 24
Thanks
