THE HONG KONG POLYTECHNIC UNIVERSITY MSc. In Management (Health Services) Health Systems Reform in...
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Transcript of THE HONG KONG POLYTECHNIC UNIVERSITY MSc. In Management (Health Services) Health Systems Reform in...
THE HONG KONG POLYTECHNIC UNIVERSITY
MSc. In Management (Health Services)
Health Systems Reform in Tax based Systems in Sweden
Problem3: How effective are these measures and policies?
Current Issues in Health Services Management MGT 557
Group Members
• Cho Lai Shan, Doris 04703507G
• Kwong Pui Man, Monica 02715793G
• Lam Ka Yin, Katherine 05412738G
• Lo Chi Yung, Owen 03700833G
• Siu Chun Bong 03705299G
• Tam Fung Kit, Sandy 04717905G
Health Care System Sweden
From each according to ability
To each according to needs
Health Care System Sweden
Offers UNIVERSAL ACCESS to health care for the entire population
Desire to provide equal access regardless of residence
The system provides quality health care by international standards
Health Care System Sweden
The physician, as the Fiscal gatekeeper
may not have the incentive for social
insurance cost containment
Social Democracy
• Economic development & efficiency
• Economic well-being for ALL
• Solidarity• Universality &
Equality
• Democracy & cooperation
• Education & Access to information
• Pragmatism
Social Democracy
• Egalitarian approach
Successful when
the mean of level of health
reduced inequality exists
Average Unemployment Rates for Sweden,the U.S. and Other Developed Countries, 1960-1994
Country or Group Average Rate ofof Countries Unemployment Sweden 2.4%
All OECD countries 5.2%
15 European Union Members 5.6% United States 6.0%
Canada 7.3%
Source: Olsen 1999.
Health Care System Sweden
Single-payer system
Vs
Multiple sources of finance
Health Care System Sweden
Identify DEMAND for Health Care
Evaluate the MEANS to fulfill
Health Care System Sweden
Health resources between
Acute in-patient care
Ambulatory services
Pharmaceuticals
Health Care System Sweden
Collective bargaining structure with separate negotiations amongst
Central Government
Municipals
County Councils
Health Care System Sweden
Primary Care Services
Integration of Medical and Social Services for the elderly
Health Care System Sweden
Regulated market
Separation of purchaser & provider roles within the County Councils
Health Care System Sweden
Budgetary incentives
Introduction of performance-related reimbursement for hospitals
Health Care System Sweden
Patient Choice
Rationing
Major problems and challengesProblems and challenges Measures and policies adopted
1. Increasing medical expenditure
2. Resources allocation
Cost containment
3. Facing aging population and longer life expectancy
Promoting community care
4. Long waiting time National Treatment Guarantee
Promoting community care
• Output of Elderly (Adel) reform (Sundstrom & Johanss
on, 2005)
– Shift care from public hospital to community care
– ↓no. of hospital bed & length of stay– Service contracted out to private provider– Income support payment ->informal caregive
r– Swedish care leave
Promoting community care
• Elderly reform, achievement:– ↓societal cost– ↑efficiency & effectiveness in acute care settin
g
Promoting community care
• ↓no. of hospital bed & length of stay
– ↓no. of Bed blocker – The rapid reduction of institutional beds for
elderly care increases the pressure on other parts of the care system
Promoting community care
0
2
4
6
1980 1985 1990 1995 2000
Year
Fig 1: Acute care bed, density per 1000 population, 1980 to 2000of Sweden
Source: Health at a glance: OECD indicators 2005
Promoting community care• ↑expenditure on community care
Current expenditure by medical services, medical goods & collective care, 2003
Source: Health at a glance: OECD indicators 2005
Promoting community care
• ↓length of stayAverage length of stay for acute care, 1990 & 2002
Source: Health at a glance: OECD indicators 2005
Source: Health at a glance: OECD indicators 2005
• The cost of elerly patient with long term care need could be significantly reduced by:
• Decrease in length of stay in acute care hospital• Decrease in number of acute bed in hospital• Increase in expenditure for ambulatory care and
home care
Summary
Major problems and challengesProblems and challenges Measures and policies adopted
1. Increasing medical expenditure
2. Resources allocation
Cost containment
3. Facing aging population and longer life expectancy
Promoting community care
4. Long waiting time National Treatment Guarantee
Maximum waiting time guarantee (MWG)
• Offered for 12 selected procedures
• <3/12<
• If not, patient be treated in other hospital at the expense of home hospital
Maximum waiting time guarantee (MWG)
• Output– ↓No. of patient waiting >3/1
2 – ↓backlog– ↑provider awareness the n
eed to ↓waiting time– Improved resource use
within hospitals– Not crowding out other
procedures that were not subject to the maximum waiting time (Hanning, 1996)
Maximum waiting time guarantee (MWG)
0%
20%
40%
60%
80%
100%
Aug-91 Feb-92 Aug-92 Feb-93 Aug-93 Feb-94
% of waiting time <3/12
Source: Hanning, M. (2005). Maximum waiting-time guarantee- a remedy to long waiting lists? Assessment of the Swedish waiting-time guarantee policy 1992-1996
• Hanning study in 2005 shows that most departments can offer care to patients within the stipulated time limit. It was the result of better resource use because of better efficiency and improved medical technology.
Summary
Health Care System Sweden
Home of the People
From Cradle to Grave