Template-type: ReDIF-Paper 1.0 Author-Name: Michael Dickson Author-Name: Stephane Jacobzone Title: Pharmaceutical Use and Expenditure for Cardiovascular Disease and Stroke: A Study of 12 OECD Countries Abstract: This study presents the results of a joint analysis of patterns of consumption, expenditure, and unit expenditure for a core set of drugs aimed at preventing and treating cardiovascular disease. The current study examines the relationships among three pharmaceutical variables (expenditure, volume of drug use, and unit expenditure) classified according to eight therapeutic categories which are specific for the prevention and treatment of cardiovascular disease and stroke. It covers an 11-year time period, and specifies relevant country-specific structural features in a sample of 12 OECD countries. The data presented in this report show how the three descriptive pharmaceutical variables vary across these countries. The study also contains a preliminary exploration of factors associated with variation in these variables across countries and through time. Findings for each of the eight cardiovascular disease and stroke drug therapeutic categories investigated in this study are ...
Cette étude présente les résultats d'une analyse simultanée des tendances de consommation, de dépenses et de dépenses unitaires d’un ensemble de médicaments clés destinés à la prévention et au traitement de la pathologie cardiovasculaire. Elle examine les relations entre les trois variables pharmaceutiques (dépense, volume de médicaments et dépense unitaire) classées en huit catégories thérapeutiques, qui sont spécifiques à la prévention et au traitement des maladies cardiovasculaires et des attaques cérébrales. Elle couvre une période de onze années et met en lumière un certain nombre de caractéristiques structurelles nationales pertinentes pour un échantillon de douze pays membres de l’OCDE. Les données présentées dans le rapport comparent les variations de ces trois variables à travers les pays. L’étude menée comprend également une recherchce préliminaire sur les facteurs associés à l’évolution de ces variables à travers les pays et au cours du temps. Les résultats pour chacune ... Classification-JEL: I11; I18; L65 Creation-Date: 2003-02-20 Number: 1 Handle: RePEc:oec:elsaad:1-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jan Bennett Title: Investment in Population Health in Five OECD Countries Abstract: There is growing interest in the potential for preventive interventions to improve average health status in OECD countries and to tackle remaining health inequalities. The interest is in a wide range of interventions spanning not only health services but also measures to influence behaviour and lifestyles and action to improve the contribution of the social, economic and physical environments to health. These interventions are referred to in this paper as examples of a government’s ‘population health investment’effort. The paper notes the evidence on trends in health and health inequalities in OECD countries and reviews the general case for population health investments and the evidence on the effectiveness of selected interventions. It focuses on population health investment strategies and institutions in five member countries: Australia, Canada, Korea, Sweden and Switzerland. In particular, it reviews the methods of financing population health investments and levels of ...
Un intérêt croissant se manifeste pour les possibilités d’interventions préventives visant à améliorer l’état de santé moyen dans les pays de l’OCDE et à remédier aux inégalités de santé persistantes. Cet intérêt est porté à un large éventail d’interventions couvrant non seulement les services de santé mais aussi les mesures destinées à agir sur les comportements et les modes de vie et les actions visant à accroître la contribution des environnements social, économique et physique en matière de santé. L’éventail de ces interventions peut être désigné sous le terme “investissement dans la santé des populations”. Ce document présente les informations recueillies sur les tendances en matière de santé et d’inégalités de santé dans les pays de l’OCDE et examine la question générale des investissements dans la santé des populations ainsi que les preuves de l’efficacité de certaines interventions. Il est centré sur les stratégies d’investissement dans la santé des populations ... Classification-JEL: I1 Creation-Date: 2003-04-22 Number: 2 Handle: RePEc:oec:elsaad:2-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pierre Moïse Author-Name: Stephane Jacobzone Title: OECD Study of Cross-National Differences in the Treatment, Costs and Outcomes of Ischaemic Heart Disease Abstract: The Ageing-Related Diseases study compares treatment trends and health outcomes on a disease-by-disease basis. Most of the day-to-day decisions that determine health care system performance are made in treating specific diseases. Therefore, the ARD’s bottom-up approach to comparing health care system performance at the disease level, rather than the more common top-down approach, goes to the heart of health care system performance. This paper presents such an analysis for ischaemic heart disease. There is considerable variation in treatment trends for the same diseases across countries and much of this variation can be explained by differences in structural characteristics of health care systems. A disease-level analysis begins with an examination of these characteristics: the economic incentives, policies and regulations that affect individual providers’ decisions for treating a specific disease, defining a particular health care system’s approach. In order to properly assess ...
L’étude sur les maladies liées au vieillissement compare les tendances en matière de traitements et de résultats par type de maladie. La plupart des décisions prises quotidiennement et qui déterminent la performance des systèmes de soins de santé le sont au moment du traitement d’une maladie spécifique. Ainsi, lors de la comparaison de la performance des systèmes de soins de santé par maladie, le projet des maladies liées au vieillissement effectue une approche du bas vers le haut plutôt que l’approche plus habituelle, et va ainsi au cœur de la performance des systèmes de soins de santé. Ce document présente une telle analyse en ce qui concerne la cardiopathie ischémique. Les tendances dans les traitements préconisés varient considérablement d’un pays à l’autre pour les mêmes maladies et peuvent s’expliquer par des différences caractéristiques structurelles propre à chaque système de santé. Une analyse par type de maladie commence par l’examen de ces caractéristiques : les ... Classification-JEL: I10; I18; I19 Creation-Date: 2003-04-22 Number: 3 Handle: RePEc:oec:elsaad:3-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michael Dickson Author-Name: Jeremy Hurst Author-Name: Stephane Jacobzone Title: Survey of Pharmacoeconomic Assessment Activity in Eleven Countries Abstract: Policy-makers responsible for publicly-funded drug programmes face continual pressures between the demand to accommodate a steady stream of new and more effective drugs and the ongoing requirement to control costs. In the face of these pressures, a growing number of OECD countries are applying ‘pharmacoeconomic assessment’ (health technology assessment for drugs) - to new drugs to guide decisions about accepting such products for reimbursement under their public programme, or to inform negotiations about pricing. This paper provides an analytical overview of the developing practice of pharmacoeconomic assessment in eleven OECD countries. It looks at the objectives of the activity, some of its processes and some of its impacts. It does this by drawing on a literature review and on an exploratory survey of the activities of pharmacoeconomic agencies in the eleven countries. It also reviews briefly the state of pharmacoeconomic assessment in the United States. The main conclusions are as ...
Les responsables des programmes et dispositifs assurant la couverture des frais pharmaceutiques à l'aide de fonds publics sont en permanence tiraillés entre une demande de prise en charge d'un flot incessant de médicaments nouveaux et plus efficaces et la nécessité constante d'une maîtrise des dépenses. Face à cette situation, un nombre croissant de pays de l'OCDE ont entrepris de soumettre les nouveaux médicaments à une "évaluation pharmacoéconomique" (évaluation des technologies de la santé appliquée aux médicaments) - pour fonder leur décision de déclarer ou non ces produits remboursables par leur dispositif public ou pour éclairer les négociations sur les prix. Le présent document donne une vue analytique d'ensemble de la pratique d'évaluation pharmacoéconomique, telle qu'elle commence à se développer dans onze pays de l'OCDE; Sont envisagés les objectifs de l'activité, quelques-unes des procédures mises en œuvre et certaines conséquences. Le rapport s'appuie sur une ... Classification-JEL: I11 Creation-Date: 2003-05-16 Number: 4 Handle: RePEc:oec:elsaad:4-EN Template-type: ReDIF-Paper 1.0 Author-Name: Lynelle Moon Author-Name: Pierre Moïse Author-Name: Stephane Jacobzone Title: Stroke Care in OECD Countries: A Comparison of Treatment, Costs and Outcomes in 17 Countries Abstract: The Ageing-Related Diseases study compares health care systems by examining treatment trends and health outcomes on a disease-by-disease basis. Most of the day-to-day decisions that determine health care system performance are made in treating specific diseases. Therefore, the ARD’s bottom-up approach to comparing health care system performance at the disease level, rather than the more common top-down approach, goes to the heart of health care system performance. This paper presents such an analysis for stroke.There is considerable variation in treatment trends for the same diseases across countries and much of this variation can be explained by differences in structural characteristics of health care systems. A diseaselevel analysis begins with an examination of these characteristics: the economic incentives, policies and regulations that affect individual providers’ decisions for treating a specific disease, defining a particular health care system’s approach. In order ...
L’étude sur les maladies liées au vieillissement compare les divers systèmes de santé en examinant les tendances en matière de traitements et de résultats par type de maladie. La plupart des décisions prises quotidiennement et qui déterminent la performance des systèmes de soins de santé le sont au moment du traitement d’une maladie spécifique. Ainsi, lors de la comparaison de la performance des systèmes de soins de santé par maladie, le projet des maladies liées au vieillissement effectue une approche du bas vers le haut plutôt que l’approche plus habituelle, et va ainsi au cœur de la performance des systèmes de soins de santé. Ce document présente une telle analyse en ce qui concerne les accidents cérébrovasculaires.Les tendances dans les traitements préconisés varient considérablement d’un pays à l’autre pour les memes maladies et peuvent s’expliquer par des différences caractéristiques structurelles propre à chaque système de santé. Une analyse par type de maladie commence par ... Classification-JEL: I10; I18; I19 Creation-Date: 2003-06-06 Number: 5 Handle: RePEc:oec:elsaad:5-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jeremy Hurst Author-Name: Luigi Siciliani Title: Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries Abstract: Waiting times for elective (non-urgent) surgery are a main health policy concern in approximately half of OECD countries. Mean waiting times for elective surgical procedures are above three months in several countries and maximum waiting times can stretch into years. They generate dissatisfaction for the patients and among the general public. Is there a solution? This report discusses the waiting-time phenomenon and provides a comparative analysis of policies to tackle waiting times across 12 OECD countries.At worst, waiting times can lead to deterioration in health, loss of utility and extra costs. However, one surprising result is that there is little evidence of health deterioration from a review of studies of patients waiting for a few months for different elective procedures across a range of countries. Moreover, such patients are quite tolerant of short and moderate waits, although the general public often expresses more concern about waiting.It is argued that there will be both ...
Les délais d’attente précédant des interventions chirurgicales non urgentes constituent un problème de santé publique majeur dans pratiquement la moitié des pays de l’OCDE. Les délais d’attente médians sont supérieurs à trois mois dans plusieurs pays et les délais maximums peuvent atteindre plusieurs années. Ces attentes sont source d’insatisfaction pour les malades et dans l’opinion. Comment peut-on résoudre ce problème ? Le présent rapport examine le phénomène des délais d’attente et propose une analyse comparative des mesures prises pour tenter d’en venir à bout dans douze pays de l’OCDE.Les délais d’attente peuvent aller jusqu’à entraîner une détérioration de la santé et une perte de capacités des malades ainsi que des surcoûts. Paradoxalement, l’analyse d’études effectuées dans un certain nombre de pays au sujet de malades devant attendre quelques mois avant de subir différentes interventions non urgentes ne fait pas véritablement apparaître de détérioration de la santé des ... Classification-JEL: H4; I11; I18 Creation-Date: 2003-07-07 Number: 6 Handle: RePEc:oec:elsaad:6-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luigi Siciliani Author-Name: Jeremy Hurst Title: Explaining Waiting Times Variations for Elective Surgery Across OECD Countries Abstract: Waiting times for elective surgery are a significant health policy concern in approximately half of all OECD countries. The main objectives of the OECD Waiting Times project were to: i) review policy initiatives to reduce waiting times in 12 OECD countries; and ii) to investigate the causes of variations in waiting times for non-emergency surgery across countries. The first objective was addressed in an earlier report (Hurst and Siciliani, 2003; OECD Health Working paper, n.6). This report is devoted to the second objective. An interesting feature of OECD countries is that while some countries report significant waiting, others do not. Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom). Waiting times are not recorded administratively in a second group of countries ...
Dans près de la moitié des pays de l’OCDE, les délais d’attente pour les interventions chirurgicales non urgentes constituent un important sujet de préoccupation pour les responsables de la politique de la santé. Le projet de l’OCDE sur ce sujet vise principalement les objectifs suivants : i) examiner les initiatives prises par les pouvoirs publics en vue de réduire ces délais d’attente dans douze pays Membres ; ii) rechercher les causes des différences observées d’un pays à l’autre quant à ces délais. Un précédent rapport a été consacré au premier de ces objectifs (Hurst et Siciliani, 2003 ; document de travail de l’OCDE sur la santé, n°6). Le présent document porte sur le second objectif. Il est intéressant de noter que, si certains pays de l’OCDE font état de délais d’attente non négligeables, ce n’est pas le cas pour d’autres. Ces délais posent un épineux problème de fond en matière de santé dans les douze pays qui participent au projet ... Creation-Date: 2003-10-07 Number: 7 Handle: RePEc:oec:elsaad:7-EN Template-type: ReDIF-Paper 1.0 Author-Name: Francesca Colombo Author-Name: Nicole Tapay Title: Private Health Insurance in Australia: A Case Study Abstract: Despite universal public insurance coverage, private health insurance (PHI) covers almost half of the Australian population – a high coverage rate in comparison with most other OECD countries. Reflecting the belief that a well-functioning health care system should be based on a mixed system of insurance and provision, Australia’s policy makers have encouraged the development of private financing and delivery arrangements operating in parallel to the public system. PHI is seen as a vehicle for enhancing individuals’ choice of provider and care options, and for reducing cost and demand pressures on public hospitals. Policy makers have intervened substantially in the private health insurance market. Regulation has promoted risk-pooling and incentive policies have stimulated the purchase of private cover. This paper analyses the Australian private health insurance market. It describes how PHI interacts with the public system, and assesses its contribution to equity, efficiency and ...
En dépit de l'assurance publique universelle, l'assurance maladie privée couvre presque la moitié de la population australienne -- un taux élevé d'assurance en comparaison de la plupart des autres pays de l'OCDE. En reflétant ( ?) la croyance qu'un système de santé qui fonctionne bien devrait être basé sur un système mixte d'assurance public et privé, les décisionnaires australiens ont encouragé le développement des arrangements privés de financement et de provision des soins de santé qui fonctionnent en parallèle du système public. L'assurance maladie privée est considérée comme un moteur pour augmenter le choix des fournisseurs de soins et des options de soins ainsi que pour réduire les coûts et la forte demande envers les hôpitaux publics. L’Australie est intervenue largement sur le marché de l'assurance maladie privée. La régulation a favorisé la prise en charge de risque et les politiques d'incitation ont stimulé l'adhésion à la couverture privée. Cet article analyse le marché ... Classification-JEL: I11; I18; I19 Creation-Date: 2003-10-30 Number: 8 Handle: RePEc:oec:elsaad:8-EN Template-type: ReDIF-Paper 1.0 Author-Name: Elizabeth Docteur Author-Name: Howard Oxley Title: Health-Care Systems: Lessons from the Reform Experience Abstract: This study presents a broad overview of health-system reforms in OECD countries over the past several decades. Reforms are assessed according to their impact on the following policy goals: ensuring access to needed health-care services; improving the quality of health care and its outcomes; allocating an “appropriate” level of pubic sector and economy-wide resources to health care (macroeconomic efficiency); and ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomic efficiency).While nearly all OECD countries have achieved universal coverage of health-care risks, initiatives to address persistent disparities in access are now being undertaken in a number of countries. In light of new evidence of serious problems with health-care quality, many countries have recently introduced reforms intended to improve this, but it is too soon to generalise as to the relative effects of alternative approaches. A variety of instruments aimed at ...This paper is also published under OECD Economics Department Working Papers Series.
Cette étude présente un survol des réformes des systèmes de santé des pays de l’OCDE qui se sont opérées au cours des dernières décennies. Ces réformes sont évaluées en fonction de leur impact sur les objectifs de politique économique suivants : assurer l’accès aux services de santé indispensables; améliorer la qualité des soins et leurs résultats; allouer un niveau « approprié » des ressources du secteur public et de l’ensemble de l’économie à la santé (efficience macroéconomique) ; et s’assurer que les services soient dispensés de façon à optimiser les rapports efficience-coût et efficacité-coût (efficience microéconomique). Alors que presque tous les pays de l’OCDE ont mis en place une couverture universelle des risques santé, les initiatives se multiplient dans un certain nombre de pays pour résoudre les problèmes de disparités résiduelles d’accès aux soins. Confrontés à l’apparition de sérieux problèmes liés à la qualité des soins de santé, un grand nombre de pays ont ... Classification-JEL: I10; I11; I18 Creation-Date: 2003-12-05 Number: 9 Handle: RePEc:oec:elsaad:9-EN Template-type: ReDIF-Paper 1.0 Author-Name: Francesca Colombo Author-Name: Nicole Tapay Title: Private Health Insurance in Ireland: A Case Study Abstract: This paper analyses the Irish private health insurance (PHI) market. It describes how PHI interacts with the public system, and assesses its contribution to equity, efficiency and responsiveness of the health system. The analysis identifies some of the factors affecting insurance market performance and its impact on the health system, including market characteristics, the regulatory and fiscal environment, health system organisation, and any actors’ incentives and behaviours. PHI plays a prominent role in Ireland. The health system is designed to offer comprehensive publicly funded health services to low-income groups, and universal public hospital coverage. Policies have encouraged the development of PHI to provide all individuals with a private alternative to the public system, as well as a means of funding cost-sharing and services not covered by the public system. With the implementation of the requirements of the Third EU Non-Life Directive, the PHI market, historically ...
Cet article analyse le marché de l'assurance maladie privée (AMP) en Irlande. Il décrit comment l'assurance maladie privée interagit avec le système public et évalue sa contribution à l’équité, l'efficacité et la réactivité du système de santé. Cette analyse identifie certains facteurs affectant la performance, y compris les caractéristiques du marché de l'assurance privée, la régulation et le cadre financier, l'organisation du système de santé, ainsi que les incitations et le comportement des différents acteurs. L'AMP joue un rôle important en Irlande. Le système de santé offre des services de santé complets financés par des fonds publics aux groupes à bas revenus ainsi qu’une couverture universelle de frais d’hospitalisation. Les politiques de la santé ont encouragé le développement de l'AMP afin d’assurer à tous les individus une alternative au système public ainsi qu’un moyen pour financier le ticket modérateur et les services qui ne sont pas couverts par le système public ... Classification-JEL: I11; I18; I19 Creation-Date: 2004-02-12 Number: 10 Handle: RePEc:oec:elsaad:10-EN Template-type: ReDIF-Paper 1.0 Author-Name: Francesca Colombo Author-Name: Nicole Tapay Title: The Slovak Health Insurance System and The Potential Role for Private Health Insurance: Policy Challenges Abstract: This paper analyses the Slovak health insurance system and the policy challenges it faces. It describes the structure of health coverage and health sector reforms being implemented by the Slovak government. It provides a preliminary assessment of the possible impact of such reforms, with a focus on the health insurance system and the possible introduction of private health insurance (PHI). It assesses how private health insurance would impact upon the health system, particularly equity, efficiency incentives facing providers and insurers, and responsiveness. The Slovak health system is based upon a mandatory Bismarck-style social health insurance system. Contributions are shared between employers and employees and the state contributes for the inactive population. Five non-profit and non-competing insurers operate nationwide, one of which covers two-thirds of the population. Individuals can freely enrol with any of the insurance companies and a risk equalisation system ...
Ce document présente une analyse du système d’assurance de santé Slovaque et les défis politiques que celui-ci engendre. Une description de la structure de couverture santé et des réformes mises en oeuvre par le gouvernement Slovaque y est présentée ainsi qu’une évaluation préliminaire de l’impact possible de telles réformes. L’accent est porté sur le système d’assurance-maladie et l’introduction possible d’une assurance maladie privée (AMP). Y figure également une évaluation de la manière dont une AMP aura des répercussions sur le système de santé lui-même et plus particulièrement en ce qui concerne l’équité et les incitations à l’efficience auxquelles sont confrontés les fournisseurs de services et les assureurs et la réactivité du système de santé face aux besoins des utilisateurs. Le système de santé Slovaque et basé sur un système d’assurance maladie sociale obligatoire du style Bismarck. Les contributions sont partagées entre les employeurs et les employés avec une ... Classification-JEL: I11; I18; I19 Creation-Date: 2004-03-05 Number: 11 Handle: RePEc:oec:elsaad:11-EN Template-type: ReDIF-Paper 1.0 Author-Name: Thomas C. Buchmueller Author-Workplace-Name: University of California Author-Name: Agnès Couffinhal Author-Workplace-Name: Centre de recherche, d'études et de documentation en économie de la santé Title: Private Health Insurance in France Abstract: While France has a universal public health insurance system, the coverage it provides is incomplete and the vast majority the French population has private complementary health insurance. Among OECD countries, the share of health care financed by private insurance is third highest behind the US and the Netherlands, two countries where private coverage is the primary source of payment for a large percentage of the population. France’s high rate of private insurance coverage is partly explained by historical factors and partly by the preferential tax treatment of employer-sponsored coverage. Because of the high rate of employerprovision – roughly half of all contracts are obtained through the workplace – coverage tends to vary with activity and industry classification. Historically, coverage was also positively related with income. In 2000, the French government introduced a new program, the Couverture Maladie Universelle (CMU), which extended eligibility for publicly funded ...
Si la France a un système d'assurance maladie publique universel, la couverture qu'il propose n'est pas complète et la majorité de la population française a une assurance complémentaire privée. La France est le troisième pays de l'OCDE en ce qui concerne la part des dépenses de santé financée par l'assurance privée, après les Etats-Unis et les Pays-Bas, deux pays où l'assurance privée représente la seule source de couverture pour une grande partie de la population. L'importance de l'assurance privée en France s'explique pour partie par des facteurs historiques mais aussi par le traitement fiscal préférentiel dont bénéficient les assurances de groupe. Etant donnée qu'environ la moitié des contrats sont obtenus par le biais de l'emploi, la couverture est très liée à la participation au marché du travail et au secteur d'activité. Historiquement, le taux couverture de la population augmentait avec le revenu. En 2000, le gouvernement a mis en place un nouveau programme public, la ... Classification-JEL: I11; I18; I19 Creation-Date: 2004-03-11 Number: 12 Handle: RePEc:oec:elsaad:12-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pierre Moïse Author-Name: Michael Schwarzinger Author-Name: Myung-Yong Um Title: Dementia Care in 9 OECD Countries: A Comparative Analysis Abstract: Dementia and its most common manifestation, Alzheimer’s disease, is a complex disorder that afflicts primarily the elderly, affecting an estimated 10 million people in OECD member countries. The complexity of the disease makes treating dementia extremely difficult, involving a wide variety of social and health care interventions. Typically, these two aspects of dementia care are examined separately. This paper adopts a conceptual model that examines both types of interventions and how they interact along the dementia care continuum. There are no effective health care treatments for stopping dementia, which is why the social care aspect plays an important role in treating the disease, with family members an integral part of this process. This paper shows that programs designed to help alleviate the burden of family members caring for a relative with dementia can have positive health benefits to both patient and family. In particular, the use of group-living, where dementia ...
La démence et la maladie d’Alzheimer, sa manifestation la plus courante, sont des troubles complexes qui touchent principalement les personnes âgées. D’après les estimations, elles concernent quelque 10 millions d’individus dans les pays de l’OCDE. La complexité de ces pathologies rend extrêmement difficile toute méthode de soins et nécessite une prise en charge à la fois sociale et médicale. Le plus souvent, ces deux aspects de la prise en charge de la démence sont examinés séparément. La logique conceptuelle adoptée dans le présent document en propose une analyse globale et étudie leur interaction tout au long du continuum de soins. Il n’existe aucun traitement efficace permettant d’arrêter la progression de la démence ; c’est la raison pour laquelle l’entourage familial joue un rôle fondamental dans sa prise en charge, dont il fait partie intégrante. Le présent document montre que les programmes visant à alléger le fardeau des personnes s’occupant d’un proche atteint de ... Classification-JEL: I10; I18; I19 Creation-Date: 2004-07-28 Number: 13 Handle: RePEc:oec:elsaad:13-EN Template-type: ReDIF-Paper 1.0 Author-Name: Eddy van Doorslaer Author-Name: Cristina Masseria Title: Income-Related Inequality in the Use of Medical Care in 21 OECD Countries Abstract: This study updates and extends a previous study on equity in physician utilisation for a subset of the countries analyzed here (Van Doorslaer, Koolman and Puffer, 2002). It updates results to 2000 for 13 countries and adds new results for eight countries: Australia, Finland, France, Hungary, Mexico, Norway, Switzerland and Sweden. Both simple quintile distributions and concentration indices were used to assess horizontal equity, i.e. the extent to which adults in equal need for physician care appear to have equal rates of medical care utilisation. With respect to physician utilisation, need is more concentrated among the worse off, but after “standardizing out” these need differences, significant horizontal inequity favoring the better off is found in about half of the countries, both for the probability and the total number of visits. The degree of pro-rich inequity in doctor use is highest in the US, followed by Mexico, Finland, Portugal and Sweden. In the majority ...
Cette étude actualise et étend le champ d'investigation d'une étude antérieure sur l'équité de l'utilisation des services des médecins effectuée pour un sous-ensemble de pays analysés ici (Van Doorslaer, Koolman et Puffer, 2002). Elle actualise les résultats jusqu’à l’année 2000 pour treize pays et incorpore de nouveaux résultats pour huit autres pays de l'OCDE : l’Australie, la Finlande, la France, la Hongrie, le Mexique, la Norvège, la Suisse et la Suède. Elle utilise à la fois les distributions par quintile et les indices de concentration pour évaluer l'équité horizontale, c’est-à-dire dans quelle mesure des adultes ayant un égal besoin de soins médicaux ont apparemment des taux identiques d'utilisation de soins médicaux. Pour ce qui est de l'utilisation des médecins, les besoins en services médicaux ont tendance à être plus concentrés parmi les catégories défavorisées, mais après avoir pris en compte ces différences de besoins, on observe une iniquité horizontale positive ... Classification-JEL: I11; I18; I19 Creation-Date: 2004-05-11 Number: 14 Handle: RePEc:oec:elsaad:14-EN Template-type: ReDIF-Paper 1.0 Author-Name: Francesca Colombo Author-Name: Nicole Tapay Title: Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems Abstract: Governments often look to private health insurance (PHI) as a possible means of addressing some health system challenges. For example, they may consider enhancing its role as an alternative source of health financing and a way to increase system capacity, or promoting it as a tool to further additional health policy goals, such as enhanced individual responsibility. In some countries policy makers regard PHI as a key element of their health coverage systems While private health insurance represents, on average, only a small share of total health funding across the OECD area, it plays a significant role in health financing in some OECD countries and it covers at least 30% of the population in a third of the OECD members. It also plays a variety of roles, ranging from primary coverage for particular population groups to a supporting role for public systems. This paper assesses evidence on the effects of PHI in different national contexts and draws conclusions about its ...
Certains gouvernements voient dans l’assurance maladie privée un moyen de relever quelquesuns des défis liés aux systèmes de santé. Par exemple, certains envisagent de promouvoir son rôle de source de financement de substitution, de l’utiliser pour accroître les capacités du système, ou encore de la faire contribuer à la réalisation d’autres objectifs de la politique de santé, tels que le renforcement de la responsabilité individuelle. Dans certains pays, les décideurs considèrent l’assurance maladie privée comme un élément fondamental du système de couverture maladie. Bien que l’assurance maladie privée ne représente en moyenne qu’une petite fraction du financement total des dépenses de santé dans la zone OCDE, elle constitue dans quelques pays Membres un mode de financement important des soins et couvre au moins 30 pour cent de la population dans un tiers des pays de l’OCDE. Elle joue par ailleurs des rôles multiples, allant de l’octroi d’une couverture primaire à des ... Creation-Date: 2004-01-01 Number: 15 Handle: RePEc:oec:elsaad:15-EN Template-type: ReDIF-Paper 1.0 Author-Name: Eva Orosz Author-Name: David Morgan Title: SHA-Based National Health Accounts in Thirteen OECD Countries: A Comparative Analysis Abstract: The purpose of the System of Health Accounts Changes in health systems and concomitant health policy questions have been challenging the traditional system of health expenditure statistics over the last couple of decades. What are the major factors accounting for health expenditure growth? What factors explain the differences between countries in expenditure growth? How to ensure sustainable financing? What are the major factors accounting for the differences in the structure of health spending? How are the changes in health spending structure and the performance of health systems related? In order to answer such questions, reliable, comparable and appropriately detailed health expenditure data are required. The System of Health Accounts intends to provide the foundation for health statistics that are able to meet these challenges. Box 1What is the System of Health Accounts?The System of Health Accounts (SHA) proposes an integrated system of comprehensive and internationally ... Classification-JEL: H51; I10 Creation-Date: 2004-08-06 Number: 16 Handle: RePEc:oec:elsaad:16-EN Template-type: ReDIF-Paper 1.0 Author-Name: James Buchan Author-Name: Lynn Calman Title: Skill-Mix and Policy Change in the Health Workforce: Nurses in Advanced Roles Abstract: An important potential contribution to the efficient use of the health workforce, is the possibility of ‘skill mix’ changes. ‘Skill mix’ is a relatively broad term which can refer to the mix of staff in the workforce or the demarcation of roles and activities among different categories of staff. Most of the policy attention on using skill-mix changes to improve health system performance has been on the mix between physicians and nurses. Skill-mix changes may involve a variety of developments including enhancement of skills among a particular group of staff, substitution1 between different groups, delegation up and down a unidiscipliniary ladder, and innovation in roles. Such changes may be driven by a variety of motives including service innovation, shortages of particular categories of worker (especially in inner cities or rural areas), quality improvement, and a desire to improve the cost- effectiveness of service delivery. There are large differences in reported physician/nurse ...
Il existe un moyen susceptible de contribuer de manière importante à l’utilisation rationnelle des personnels de santé, à savoir la modification de « l’éventail des qualifications ». « L’éventail des qualifications » est un concept relativement vaste qui renvoie soit à l’éventail des personnels qualifiés, soit à la séparation des rôles et des activités réservés aux différentes catégories de personnel. Parmi les pistes envisagées dans l’utilisation des modifications de l’éventail des qualifications pour améliorer les performances des systèmes de santé, c’est la substitution du personnel infirmier aux médecins qui a le plus retenu l’attention. Les modifications de l’éventail des qualifications peuvent se traduire par des résultats divers, tels que le relèvement des qualifications au sein d’un groupe professionnel donné, une substitution2 entre différents groupes, une délégation des actes vers le haut et vers le haut au sein de la hiérarchie d’une même discipline ou des innovations au ... Creation-Date: 2005-02-24 Number: 17 Handle: RePEc:oec:elsaad:17-EN Template-type: ReDIF-Paper 1.0 Author-Name: Nicole Tapay Author-Name: Francesca Colombo Title: Private Health Insurance in the Netherlands: A Case Study Abstract: Private health insurance (PHI) is the sole source of primary health coverage for a third of the Netherlands’ population earning above a set income threshold. Social insurance (together with limited public (tax-based financing) is the main source of health coverage for the majority of the population. Most socially insured also purchase supplementary private health coverage. All citizens are eligible for a system of coverage for long-term care and care for the chronically ill. Thus, in the Netherlands, the source of health financing is determined according to the category of health risk, type of illness, as well as income level. Decisions have been made allocating the cost of more expensive long-term care and coverage of high-risk individuals and persons earning below a set level, to social or public insurance, or to PHI subsidised by a broader pool. From an equity perspective, the Dutch public/private financing mix appears to do well, although challenges remain. There appear to be ...
Pour les Néerlandais situés dans le tiers supérieur de l’échelle des revenus, l’assurance maladie privée constitue l’unique source de couverture maladie primaire. L’assurance sociale (et, dans une mesure restreinte, certains financements publics d’origine fiscale) représente pour sa part la principale source de couverture maladie pour la majorité de la population. La plupart des affiliés au régime social sont également titulaires d’une couverture maladie privée supplémentarité. Tous les citoyens sont admissibles à une couverture pour soins de longue durée, et les soins aux malades chroniques sont également couverts. Aux Pays-Bas, la source de financement des soins de santé est donc déterminée selon la catégorie de risque de santé, le type de maladie ainsi que le niveau de revenu. La décision a été prise d’allouer les coûts induits par les soins de longue durée (plus onéreux), les personnes à haut risque et les personnes gagnant moins d’un certain revenu à l’assurance sociale ou ... Classification-JEL: I11; I18; I19 Creation-Date: 2004-12-16 Number: 18 Handle: RePEc:oec:elsaad:18-EN Template-type: ReDIF-Paper 1.0 Author-Name: Steven Simoens Author-Name: Mike Villeneuve Author-Name: Jeremy Hurst Title: Tackling Nurse Shortages in OECD Countries Abstract: There are reports of current nurse shortages in all but a few OECD countries. With further increases in demand for nurses expected and nurse workforce ageing predicted to reduce the supply of nurses, shortages are likely to persist or even increase in the future, unless action is taken to increase flows into and reduce flows out of the workforce or to raise the productivity of nurses. This paper analyses shortages of nurses in OECD countries. It defines and describes evidence on current nurse shortages, and analyses international variability in nurse employment. Additionally, a number of demand and supply factors that are likely to influence the existence and extent of any future nurse shortages are examined. In order to resolve nurse shortages, the paper compares and evaluates policy levers that decision makers can use to increase flows of nurses into the workforce, reduce flows out of the workforce, and improve nurse retention rates. Although delayed market response may have been ...
Tous les pays de l’OCDE, à l’exception de quelques-uns, font état d’une pénurie d’infirmières. Etant donné que la demande d’infirmières va vraisemblablement augmenter encore et que l’offre devrait diminuer sous l’effet du vieillissement de cette population, la pénurie est susceptible de persister, voire de s’aggraver dans l’avenir si des mesures ne sont pas prises pour accroître les flux d’entrées dans la profession et réduire le nombre de sorties, ou pour augmenter la productivité des infirmières. Ce document présente une analyse de la pénurie d’infirmières que connaissent actuellement les pays de l’OCDE. Il rend compte des données disponibles sur ce phénomène et examine les différences entre pays dans le domaine de l’emploi infirmier. Il passe également en revue un certain nombre de facteurs qui agissent du côté de la demande et de l’offre et pourraient déterminer l’existence de futures pénuries d’infirmières et l’ampleur qu’elles auront. Afin d’apporter une solution à ce ... Creation-Date: 2005-01-01 Number: 19 Handle: RePEc:oec:elsaad:19-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jens Lundsgaard Title: Consumer Direction and Choice in Long-Term Care for Older Persons, Including Payments for Informal Care: How Can it Help Improve Care Outcomes, Employment and Fiscal Sustainability? Abstract: As the number of older persons in need of long-term care increases, efforts to support older persons remaining in their home are intensified in most OECD countries. In this context of ageing in place, there is a movement towards allowing more individual choice for older persons receiving publicly funded long-term care at home. Having more flexibility in terms of how to receive care can increase the older person’s self-determination and that of his/her informal care givers. Having a choice among alternative care providers can empower older persons as consumers and may help strengthen the role of households in the care-management process. Choice can also help address quality aspects that are difficult to quantify but easy to experience for users, such as the personal interaction between the older person and the care giver.
Le nombre de personnes âgées en perte d’autonomie augmentant, les efforts à leur intention destinés à leur permettre de continuer à vivre chez elles s’intensifient, dans la plupart des pays de l’OCDE. Dans cette logique du maintien à domicile, la tendance est à donner une liberté de choix de plus en plus grande aux personnes âgées qui bénéficient, chez elles, d’une aide et de services financés sur fonds publics. En acceptant plus de flexibilité dans les modalités de déploiement de la prestation on peut renforcer la capacité de décision de la personne âgée et des aidants informels. Le fait de donner à la personne âgée la liberté de choix entre différents prestataires peut lui conférer un certain poids en tant que consommateur, et cela peut contribuer à renforcer le rôle des ménages dans le processus de gestion de la prise en charge. La faculté de choisir peut aussi aider à prendre en compte les aspects qualitatifs, qui sont difficiles à mesurer mais très importants pour l’utilisateur, comme la qualité des échanges entre la personne âgée et la personne qui s’occupe d’elle. Classification-JEL: D10; I38; J22; L33; M50 Creation-Date: 2005-05-11 Number: 20 Handle: RePEc:oec:elsaad:20-EN Template-type: ReDIF-Paper 1.0 Author-Name: Steven Simoens Author-Name: Jeremy Hurst Title: The Supply of Physician Services in OECD Countries Abstract: The delivery of an appropriate quantity and quality of health care in an efficient way requires, among other things, matching the supply with the demand for the services of physicians, over time. Such matching has led to very different levels of physicians per million population across OECD countries – because of variations, among other things, in: morbidity and mortality, health expenditure as a share of GDP and the design of health systems. In addition, there are signs that a higher density of physicians is found in countries which have left the supply of physicians mainly to the market whereas lower density is found in countries which have planned the intake to medical schools centrally over many years...
Pour qu'un système de santé puisse assurer de façon efficace un niveau de soins satisfaisant, en quantité comme en qualité, il faut, entre autres choses, que l'offre et la demande de médecins parviennent à s'équilibrer. De ce point de vue, et si l'on en juge d'après le nombre de médecins par million d'habitants, les pays de l'OCDE affichent une grande diversité, pour des raisons qui tiennent notamment à des différences dans les taux de morbidité et de mortalité, les dépenses de santé en proportion du PIB et la conception des systèmes de santé. En outre, il semble que la densité médicale soit plus élevée dans les pays qui ont pour l'essentiel laissé au marché le soin de réguler l'offre de médecins, et moins élevée dans ceux où l'accès aux études de médecine a longtemps été encadré à l'échelon national... Creation-Date: 2006-01-16 Number: 21 Handle: RePEc:oec:elsaad:21-EN Template-type: ReDIF-Paper 1.0 Author-Name: Soeren Mattke Author-Name: Edward Kelley Author-Name: Peter Scherer Author-Name: Jeremy Hurst Author-Name: Maria Luisa Gil Lapetra Author-Name: HCQI Expert Group Members Title: Health Care Quality Indicators Project: Initial Indicators Report Abstract: The OECD Health Care Quality Indicator (HCQI) Project was started in 2001. The long-term objective of the HCQI Project is to develop a set of indicators that can be used to raise questions for further investigation concerning quality of health care across countries. It was envisioned that the indicators that were finally recommended for inclusion in the HCQI measure set would be scientifically sound, important at a clinical and policy level and feasible to collect in that data would be available and could be made comparable across countries. It was also envisioned that the indicators would not enable any judgement to be made on the overall performance of whole health systems. In essence, they should be used as the basis for investigation to understand why differences exist and what can be done to reduce those differences and improve care in all countries.
Le projet de l’OCDE sur les indicateurs de la qualité des soins de santé (HCQI) a été lancé en 2001. Son objectif à long terme est d’élaborer un ensemble d’indicateurs qui puissent être utilisés pour déterminer de nouvelles pistes de recherche sur la qualité des soins dans les pays de l’OCDE. Les indicateurs devant finalement être recommandés pour faire partie de cet ensemble d’indicateurs doivent en principe être pertinents du point de vue scientifique et importants sur le plan clinique et stratégique, et leur collecte réalisable dans la pratique au sens où les données y afférentes doivent être disponibles et comparables à l’échelon international. Ces indicateurs ne sont pas non plus censés permettre de porter un jugement sur la performance globale des systèmes de santé dans leur intégralité. Ils devraient essentiellement être utilisés comme point de départ pour comprendre pourquoi des différences existent et par quels moyens les réduire et améliorer les soins de santé dans tous les pays. Creation-Date: 2006-03-09 Number: 22 Handle: RePEc:oec:elsaad:22-EN Template-type: ReDIF-Paper 1.0 Author-Name: Edward Kelley Author-Name: Jeremy Hurst Title: Health Care Quality Indicators Project: Conceptual Framework Paper Abstract: This paper represents an attempt to set out a conceptual framework for the OECD’s Health Care Quality Indicator (HCQI) Project. Two main issues are tackled: what concepts, or dimensions, of quality of health care should be measured and how, in principle, should they be measured. The need for a conceptual framework for the Project was expressed by a large group of participating countries. In interviews by the OECD Secretariat with member countries in April and May 2005, country experts and delegates to the Group on Health reiterated the need for a framework for the OECD’s health care quality work. Countries stated that the framework should be: a) based on country experience and b) could be used to guide both current and future work by the OECD in health care quality measurement and monitoring.
Ce document a pour objet de présenter le cadre conceptuel du projet de l’OCDE sur les indicateurs de la qualité des soins de santé (projet HCQI). Deux grandes questions y sont traitées : quels concepts, ou aspects, de la qualité des soins convient-il d’évaluer et comment ceux-ci doivent-ils en théorie être évalués. La nécessité d’élaborer un cadre conceptuel pour le projet a été exprimée par un grand nombre de pays participants. Lors des entretiens menés par le Secrétariat de l’OCDE avec les pays membres en avril et mai 2005, les experts et délégués nationaux auprès du Groupe sur la santé ont réaffirmé la nécessité d’élaborer un cadre pour les travaux de l’OCDE sur la qualité des soins de santé. Les pays ont indiqué que ce cadre devait a) être fondé sur l’expérience des pays et b) pouvoir être utilisé pour éclairer les travaux actuels et futurs de l’OCDE dans le domaine de l’évaluation et du suivi de la qualité des soins de santé. Creation-Date: 2006-03-09 Number: 23 Handle: RePEc:oec:elsaad:23-EN Template-type: ReDIF-Paper 1.0 Author-Name: Valérie Paris Author-Name: Elizabeth Docteur Title: Pharmaceutical Pricing and Reimbursement Policies in Canada Abstract: This paper describes and assesses pharmaceutical pricing and reimbursement policies in Canada, considering them in the context of the broader policy and market environment in which they operate, and investigating their role in contributing to Canada’s achievements in meeting a range of objectives relating to the pharmaceutical policy. The federal government regulates prices of patented pharmaceutical products with the objective of protecting consumers against excessive prices. Regulation has very likely been responsible for bringing Canada’s prices for patented medicines roughly in line with European comparators. Prices of generic products, which are not regulated, are relatively high although high...
Ce document décrit et évalue les politiques de prix et de remboursement des médicaments au Canada, en les situant dans le contexte politique et l’environnement de marché dans lesquels elles s’inscrivent ; et en observant leur rôle dans l’atteinte des objectifs relatifs à la politique pharmaceutique canadienne. Le gouvernement fédéral régule les prix des médicaments brevetés dans le but de protéger les consommateurs de prix excessifs. Cette régulation a très probablement eu pour effet d’amener les prix des médicaments brevetés canadiens au niveau des prix des pays européens auxquels le Canada se compare. Les prix des médicaments génériques, qui ne sont pas régulés, sont relativement élevés malgré une forte pénétration des... Classification-JEL: I11; I18 Keywords: Canada, Canada, marché pharmaceutique, pharmaceutical market, pharmaceutical policy, politique pharmaceutique, pricing and reimbursement, prix et remboursement Creation-Date: 2006-12-22 Number: 24 Handle: RePEc:oec:elsaad:24-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pierre Moïse Author-Name: Elizabeth Docteur Title: Pharmaceutical Pricing and Reimbursement Policies in Mexico Abstract: This paper examines aspects of the policy environment and market characteristics of Mexico's pharmaceutical sector, and assesses the degree to which Mexico has achieved certain policy goals. This paper questions the effectiveness of the maximum price regulation. It notes that retail prices for pharmaceuticals are relatively high, although proximity to the United States may have some influence. Although not wholly successful in containing overall drug expenditures, the federal government can claim some measure of success for the public sector market. A high reliance on out-of-pocket spending brings into question the sustainability of financing pharmaceuticals in Mexico. It also contributes to greater inequality, although a new health insurance scheme, the Seguro Popular, is addressing the latter with some success as it endeavours to provide coverage for the half of Mexico's population without health insurance. Finally, the paper acknowledges the government.s efforts in improving efficiency of expenditures and quality of care through new bioequivalency requirements for generics. However, an unintended side-effect of the loss of low cost, non-bioequivalent drugs may be higher average prices for pharmaceuticals.
Le présent document examine certains aspects touchant l'environnement politique et les caractéristiques du marché du secteur pharmaceutique du Mexique, et évalue la mesure dans laquelle le Mexique a atteint certains objectifs politiques. Il met en doute l'efficacité de la réglementation sur les prix maximums et fait observer que les prix de détail des produits pharmaceutiques sont relativement élevés, mais que cette situation est peut-être due en partie à la proximité des États-Unis. Bien que le gouvernement fédéral n'ait pas totalement réussi à maîtriser les dépenses globales de médicaments, il peut revendiquer d'un certain succès en ce qui concerne le marché du secteur public. Un large recours aux versements directs amène à s'interroger sur la viabilité du financement des produits pharmaceutiques au Mexique. Un tel recours contribue également à un accroissement des inégalités, bien qu'un nouveau dispositif d'assurance maladie, le Seguro Popular, remédie dans une certaine mesure à ce problème en s'efforçant d'offrir une couverture maladie à la moitié de la population du Mexique qui n'est pas assurée. Enfin, le document fait état des efforts déployés par le gouvernement pour rationaliser les dépenses et améliorer la qualité des soins moyennant l'adoption de nouvelles dispositions en matière de bioéquivalence des médicaments génériques. Cela étant, la disparition des médicaments peu coûteux non bioéquivalents risque d'avoir pour effet involontaire une augmentation des prix moyens des produits pharmaceutiques. Classification-JEL: I11; I18 Keywords: fixation des prix, marché, market, Mexico, Mexique, pharmaceutical policy, politique du médicament, pricing, reimbursement, remboursement Creation-Date: 2007-02-13 Number: 25 Handle: RePEc:oec:elsaad:25-EN Template-type: ReDIF-Paper 1.0 Author-Name: Gaétan Lafortune Author-Name: Gaëlle Balestat Title: Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications Abstract: As the number and share of the population aged 65 and over will continue to grow steadily in OECD countries over the next decades, improvements in the functional status of elderly people could help mitigate the rise in the demand for, and hence expenditure on, long-term care. This paper assesses the most recent evidence on trends in disability among the population aged 65 and over in 12 OECD countries: Australia, Belgium, Canada, Denmark, Finland, France, Italy, Japan, the Netherlands, Sweden, the United Kingdom and the United States. The focus is on reviewing trends in severe disability (or dependency), defined where possible as one or more limitations in basic activities of daily living (ADLs, such as eating, washing/bathing, dressing, and getting in and out of bed), given that such severe limitations tend to be closely related to demands for long-term care. One of the principal findings from this review is that there is clear evidence of a decline in disability among elderly people in only five of the twelve countries studied (Denmark, Finland, Italy, the Netherlands and the United States). Three countries (Belgium, Japan and Sweden) report an increasing rate of severe disability among people aged 65 and over during the past five to ten years, and two countries (Australia, Canada) report a stable rate. In France and the United Kingdom, data from different surveys show different trends in ADL disability rates among elderly people, making it impossible to reach any definitive conclusion on the direction of the trend. One of the main policy implications that can be drawn from the findings of this study is that it would not be prudent for policymakers to count on future reductions in the prevalence of severe disability among elderly people to offset completely the rising demand for long-term care that will result from population ageing. Even though disability prevalence rates have declined to some extent in some countries, the ageing of the population and the greater longevity of individuals can be expected to lead to increasing numbers of people at older ages with a severe disability and in need of long-term care. The results of the projection exercise to 2030 for all countries, regardless of different trends in disability prevalence, confirm this important finding.
Alors que le nombre et la proportion de personnes âgées de 65 ans et plus vont continuer de s'accroître dans les pays de l'OCDE au cours des prochaines décennies, une amélioration de l'état fonctionnel des personnes âgées pourrait contribuer à ralentir l'augmentation de la demande et des dépenses pour les soins de longue durée. Cette étude examine les tendances les plus récentes concernant l'évolution de l'incapacité parmi la population âgée de 65 ans et plus dans 12 pays de l'OCDE : Australie, Belgique, Canada, Danemark, Finlande, France, Italie, Japon, Pays-Bas, Suède, Royaume-Uni et États- Unis. L'étude se concentre sur l'incapacité sévère (ou la dépendance), définie dans la mesure du possible comme une ou plusieurs limitations dans les activités de la vie quotidienne (AVQ, comme la capacité de se nourrir, de faire sa toilette, de s'habiller et de sortir du lit), étant donné que ce sont de telles limitations qui tendent à être associées à des demandes pour des soins de longue durée. Un des principaux résultats de cette revue est qu'il y a eu une diminution claire de la prévalence de l'incapacité sévère parmi la population âgée dans seulement cinq des douze pays étudiés (Danemark, Finlande, Italie, Pays-Bas et États-Unis). Par ailleurs, dans trois pays (Belgique, Japon, Suède), on observe une augmentation de la prévalence de l'incapacité sévère parmi les personnes âgées au cours des cinq ou dix dernières années, alors que les taux ont été stables dans deux pays (Australie, Canada). Enfin, en France et au Royaume- Uni, il n'est pas possible pour l'instant de tirer des conclusions définitives, parce que les résultats des analyses de tendance divergent selon les sources (enquêtes) utilisées. Une des principales implications politiques de ces résultats est qu'il ne serait pas prudent de la part des décideurs politiques de compter sur une réduction à venir de la prévalence de l'incapacité sévère chez les personnes âgées pour compenser l'augmentation de la demande de soins de longue durée qui résultera du vieillissement de la population. Même si la prévalence de l'incapacité sévère a diminué dans une certaine mesure dans certains pays, il est à prévoir que le vieillissement de la population et l'allongement de l'espérance de vie vont contribuer à l'augmentation du nombre de personnes âgées dépendantes. Les résultats de l'exercice de projections jusqu'en 2030 pour tous les pays, quelles que soient les tendances passées de la prévalence de l'incapacité, viennent appuyer cette conclusion. Classification-JEL: J11; J14 Keywords: disability, OECD countries Creation-Date: 2007-03-30 Number: 26 Handle: RePEc:oec:elsaad:26-EN Template-type: ReDIF-Paper 1.0 Author-Name: Valérie Paris Author-Name: Elizabeth Docteur Title: Pharmaceutical Pricing and Reimbursement Policies in Switzerland Abstract: This paper examines aspects of the policy environment and market characteristics of the Swiss pharmaceutical sector, and assesses the degree to which Switzerland has achieved certain policy goals. In Switzerland, pharmaceutical spending has not been growing faster than health expenditure as a whole, as has been the case in many other OECD countries. Swiss pharmaceutical spending per capita and as a share of GDP is modest by OECD standards. This in part reflects relatively low levels of pharmaceutical consumption, given that public prices are among the highest in Europe and the Swiss tend to be early adopters of new pharmaceutical products. Switzerland’s regulation of prices for reimbursed drugs, based on referencing across countries and within the therapeutic class for products with comparators, appears to result in prices lower than what would be obtained absent regulation. Although ex-manufacturer prices are somewhat high relative to other European countries, recent reforms have reduced the differential. While costs are under control, Switzerland has scope to improve the cost-effectiveness of its expenditures in the pharmaceutical area. Generic penetration of the market is increasing but falls short of what has been achieved elsewhere and the prices of generic products are higher than what is found in other countries. Relatively high mark-ups over ex-factory prices suggest that the distribution chain is a source of further potential efficiencies, although high costs could also reflect characteristics of the Swiss economy...
Ce document passe en revue différents aspects des politiques et des caractéristiques de marché du secteur pharmaceutique en Suisse et évalue l’atteinte des objectifs relatifs à la politique pharmaceutique suisse. En Suisse, les dépenses pharmaceutiques n’ont pas augmenté plus vite que l’ensemble des dépenses de santé, contrairement ce qui s’est passé dans de nombreux autres pays de l’OCDE. Les dépenses de médicaments par habitant, et en proportion du PIB, restent modérées par rapport à la moyenne des pays de l’OCDE. Cela tient en partie au niveau relativement faible de la consommation pharmaceutique, puisque les prix publics sont parmi les plus élevés en Europe et les Suisses enclins à adopter rapidement les nouveaux produits. La régulation des prix des prix des médicaments remboursés, basée sur des comparaisons internationales et, le cas échéant, sur les prix des comparateurs au sein d’une même classe thérapeutique, semble conduire à des niveaux de prix moins élevés que ce qu’ils seraient sans régulation. Même si les prix fabricants sont relativement élevés par rapport à ce qu’ils sont dans d’autres pays européens, les récentes réformes ont réduit l’écart. Les coûts sont certes maîtrisés mais la Suisse pourrait aller encore plus loin pour améliorer l’efficience de ses dépenses pharmaceutiques. Le taux de pénétration des génériques sur le marché s’améliore mais reste inférieur à ce qu’il est ailleurs et les prix des génériques sont plus élevés que dans d’autres pays. Les marges relativement élevées appliquées sur les prix fabricants donnent à penser que les circuits de distribution pourraient être rationalisés, même si les coûts élevés peuvent aussi refléter certaines caractéristiques de l’économie suisse... Classification-JEL: I11; I18 Keywords: marché pharmaceutique, pharmaceutical market, pharmaceutical policy, politique pharmaceutique, pricing and reimbursement, Suisse, Switzerland, tarification et remboursement Creation-Date: 2007-06-27 Number: 27 Handle: RePEc:oec:elsaad:27-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pierre Moïse Author-Workplace-Name: OECD Author-Name: Elizabeth Docteur Author-Workplace-Name: OECD Title: Pharmaceutical Pricing and Reimbursement Policies in Sweden Abstract: This paper examines aspects of the policy environment and market characteristics of the Swedish pharmaceutical sector, assesses the degree to which Sweden has achieved certain policy goals, and puts forth some key findings and conclusions. Thanks to low mark-ups in the distribution chain and no VAT for prescribed medicines, Sweden's public prices for pharmaceuticals are relatively low, in contrast to average prices received by manufacturers, which are among the highest in Europe. Recent reforms have helped to restrain pharmaceutical expenditure growth, following a period of double digit growth in the 1990s. Pharmaceutical expenditure per capita in Sweden is lower than the OECD average. Only five OECD countries devote less of their national income to pharmaceuticals. What limited evidence exists tends to suggest that relatively low pharmaceutical expenditures in Sweden are due to its low public prices, rather than to low levels of consumption. Sweden introduced a new pricing and reimbursement scheme in 2002. Its main features are the use of cost-effectiveness analysis for determining the reimbursement status of new pharmaceuticals and mandatory substitution of the lowest-cost generic alternative. The use of cost-effectiveness analysis in reimbursement decisions helps to relate the reimbursement price paid to the social value of the product, but does not necessarily result in the lowest possible price.The generic substitution policy has enabled Sweden to achieve fairly high penetration of generic drugs into the market in terms of volume, with a considerably low share of the total value of the market. However, the requirement to substitute only the lowest-priced listed drug risks undermining the competitiveness of the generic drug industry...
Le présent document passe en revue les différents aspects des politiques et des caractéristiques du marché du secteur pharmaceutique suédois, évalue l'atteinte des objectifs relatifs à la politique pharmaceutique suédoise et formule un certain nombre de constats et de conclusions. Grâce à la faiblesse des marges de distribution et à l'absence de TVA sur les médicaments prescrits sur ordonnance, les prix publics des produits pharmaceutiques sont relativement bas, alors que les prix moyens perçus par les fabricants se situent parmi les plus élevés d'Europe. Les récentes réformes ont contribué à freiner la croissance des dépenses pharmaceutiques, qui avait dépassé 10 % par an durant les années 1990. En Suède, les dépenses de médicaments par habitant sont inférieures à la moyenne des pays de l'OCDE. Seuls cinq pays de l'OCDE y consacrent une part plus faible de leur revenu national. Les éléments d'appréciation peu nombreux disponibles tendent à laisser penser que le niveau relativement peu élevé des dépenses de médicaments en Suède s'explique par le niveau peu élevé des prix publics, plutôt que par la faiblesse de la consommation. La Suède a institué en 2002 un nouveau système de prix et de remboursement qui se caractérise essentiellement par le recours à l'analyse coût-efficacité pour la détermination du niveau de remboursement des nouveautés pharmaceutiques et le remplacement systématique par les génériques les moins onéreux. Le recours à l'analyse coût-efficacité pour l'adoption des décisions en matière de remboursement aide à relier le prix de remboursement à la valeur sociale du produit, mais ne garantit pas que le prix soit le plus bas possible. La politique de substitution des génériques a permis à la Suède d'assurer un taux relativement élevé de pénétration en volume de ces produits sur le marché, alors qu'en valeur, ils ne représentent qu'une part extrêmement réduite du total. Toutefois, l'obligation de remplacer un médicament prescrit par le produit substituable le moins cher risque de compromettre la compétitivité de l'industrie des génériques... Classification-JEL: I11; I18 Keywords: marché pharmaceutique, pharmaceutical market, pharmaceutical policy, politique pharmaceutique, pricing and reimbursement, Suède, Sweden, tarification et remboursement Creation-Date: 2007-07-26 Number: 28 Handle: RePEc:oec:elsaad:28-EN Template-type: ReDIF-Paper 1.0 Author-Name: Sandra Garcia Armesto Author-Name: Maria Luisa Gil Lapetra Author-Name: Lihan Wei Author-Name: Edward Kelley Title: Health Care Quality Indicators Project 2006 Data Collection Update Report Abstract: This report is an update to the OECD Health Working Paper No. 22, Health Care Quality Indicators Project: Initial Indicators Report that was based on data collected between 2003 and 2005 and released in 2006. That report presented the OECD’s initial work on developing a set of health care quality indicators that could be used to raise questions about differences in quality of care across countries. The 2006 report covered 21 “initial indicators” with data provided by 24 countries. It identified 17 of these indicators as being fit for international comparisons of which 4 were identified as needing further work. Following the release of that report in March 2006, the OECD undertook a second round of data collection on the initial indicator set and also gathered data for the first time on new indicators in a questionnaire sent to participating HCQI countries. This paper reports on the results of that second round of data collection. Data is presented here on an augmented indicator set considered fit for the purpose of making international comparisons on quality of health care. The data is comprised of 19 indicators (17 initial indicators plus 2 new ones). The paper also presents the data provided on 7 other indicators that are not yet considered fit for international comparison. In this round of data collection, data were reported by 32 countries...
Le présent rapport est une version actualisée du Document de travail de l’OCDE sur la santé n 22 intitulé Health Care Quality Indicators Project : Initial Indicators Report, établi sur la base des données rassemblées en 2003/2005 et publié en 2006. Ce rapport présentait les travaux initiaux de l’OCDE concernant l’élaboration d’une série d’indicateurs sur la qualité des soins de santé qui pourraient être utilisés pour tenter d’expliquer les différences en matière de qualité de soins entre les pays. Le rapport 2006 portait sur 21 « indicateurs initiaux » pour lesquels 24 pays avaient communiqué des données ; il a été estimé que 17 de ces indicateurs se prêtaient à des comparaisons internationales et que quatre d’entre eux nécessitaient des travaux approfondis. A la suite de la publication du rapport en mars 2006, l’OCDE a entamé un deuxième cycle de collecte de données relatives à la série initiale d’indicateurs et a entrepris de recueillir pour la première fois des données sur de nouveaux indicateurs par le biais d’un questionnaire adressé aux pays participants au projet HCQI. Le présent rapport fait état des résultats du deuxième cycle de collecte de données. Il contient des données sur la série élargie d’indicateurs considérés comme se prêtant à des comparaisons internationales, soit des données portant sur 19 indicateurs (17 indicateurs existants et 2 nouveaux). Il présente également les données fournies en ce qui concerne 7 autres indicateurs dont on estime qu’ils ne se prêtent pas encore à des comparaisons internationales. Les données communiquées émanent cette fois de 32 pays (des pays de l’UE qui ne sont pas membres de l’OCDE ont été invités à participer au projet)... Creation-Date: 2007-10-11 Number: 29 Handle: RePEc:oec:elsaad:29-EN Template-type: ReDIF-Paper 1.0 Author-Name: Maria M. Hofmarcher Author-Name: Howard Oxley Author-Workplace-Name: OECD Author-Name: Elena Rusticelli Author-Workplace-Name: OECD Title: Improved Health System Performance through better Care Coordination Abstract: This report attempts to assess whether -- and to what degree - better care coordination can improve health system performance in terms of quality and cost-efficiency. Coordination of care refers to policies that help create patient-centred care that is more coherent both within and across care settings and over time. Broadly speaking, it means making health-care systems more attentive to the needs of individual patients and ensuring they get the appropriate care for acute episodes as well as care aimed at stabilising their health over long periods in less costly environments. These issues are of particular interest to patients with chronic conditions and the elderly who may find it difficult to "navigate" fragmented health-care systems that are often found in OECD countries. Interest in coordination of care issues is increasing Growing interest in these issues has reflected a shift in the demands placed on health-care services. Chronic conditions have become progressively more important and are absorbing a growing share of health-care budgets. Since most of the chronically ill are elderly, this share can be expected to rise as populations age over coming decades. At the same time, many reports suggest that the quality of care that the chronically ill receive may need improvement. With these developments occurring in a context of tight public finance, some countries have been attempting to improve both the quality of care provided to the chronically ill and reduce cost pressures via changes to the architecture of health-care systems that encourage greater care coordination...
L'objet de ce rapport est de tenter d'apprécier si - et, le cas échéant, dans quelle mesure - une meilleure coordination des soins est susceptible d'améliorer la performance des systèmes de santé en termes de qualité et d'efficience au regard du coût. Par coordination des soins on entend les mesures de nature à aider à instaurer une prise en charge centrée sur le patient qui soit plus cohérente aussi bien à l'intérieur d'un même cadre de soins qu'entre différents cadres de soins, et dans le temps. Plus généralement, il s'agit de faire en sorte que les systèmes de santé soient plus attentifs aux besoins individuels des patients et de faire en sorte que ceux-ci reçoivent les soins appropriés à l'occasion d'épisodes aigus, ainsi que des soins destinés à stabiliser leur état de santé, dans une perspective à long terme, dans un environnement moins coûteux. Ces questions revêtent une importance toute particulière pour les malades chroniques et pour les personnes âgées qui trouveront sans doute difficile de « naviguer » à l'intérieur de systèmes de santé fragmentés comme c'est souvent le cas dans les pays de l'OCDE. On s'intéresse de plus en plus à la problématique de la coordination des soins L'intérêt croissant pour cette question reflète un déplacement des attentes à l'égard des services de santé. Les maladies chroniques sont de plus en plus fréquentes et absorbent une part croissante des budgets de santé. Les maladies chroniques concernant, le plus souvent, les personnes âgées, on peut penser, la population vieillissant, que c'est un aspect des systèmes de santé qui prendra de plus en plus d?importance au cours des décennies à venir. Dans le même temps, de nombreux rapports signalent que la qualité des soins dispensés aux malades chroniques pourrait sans doute être améliorée. Ces évolutions intervenant dans un contexte difficile pour les finances publiques, certains pays s'efforcent d'améliorer la qualité des soins dispensés aux malades chroniques et de réduire la pression sur les coûts en repensant complètement l'architecture de leur système de santé, de façon à encourager une plus grande coordination des soins... Creation-Date: 2007-12-12 Number: 30 Handle: RePEc:oec:elsaad:30-EN Template-type: ReDIF-Paper 1.0 Author-Name: Zoltán Kaló Author-Workplace-Name: Eotvos Lorand University, Budapest Author-Name: Elizabeth Docteur Author-Workplace-Name: OECD Author-Name: Pierre Moïse Author-Workplace-Name: OECD Title: Pharmaceutical Pricing and Reimbursement Policies in Slovakia Abstract: This paper examines aspects of the policy environment and market characteristics of Slovakia's pharmaceutical sector, and assesses the degree to which Slovakia has achieved certain policy goals. Pharmaceutical expenditure in Slovakia accounts for a higher share of total health expenditure than it does in any other OECD country, and the share of national income going to pharmaceuticals is exceeded only in Hungary. Although its relatively low national income is a partial explanation for Slovakia's status in this respect, this review finds that Slovakia has scope to reduce its expenditures and the rapid rate of growth in its pharmaceutical spending. Financing of pharmaceutical expenditure in Slovakia rests more heavily on the public sector than is typical in the OECD, with out-of-pocket spending accounting for just a quarter of total expenditure. The effectiveness of international price referencing in limiting Slovak prices for on-patent pharmaceutical products is questionable. For products that have gone off-patent and for those with similar chemical structure, a reference-pricing scheme and competition among generic alternatives results in effective price control, although incentives for generic substitution are weak (for patients) and misaligned (for pharmacists). When deciding whether a drug will be reimbursed through the social insurance scheme, the cost-effectiveness of new pharmaceuticals is not assessed. On the other hand, certain policy goals have been achieved. The accessibility and availability of medicines--including the most innovative products--is good; affordability is supported by relatively low average co-payment levels. While more expensive drugs usually have higher cost-sharing, drugs are not excluded from coverage on affordability grounds.
Le présent document examine les différents aspects des politiques et des caractéristiques du marché du secteur pharmaceutique slovaque, et évalue les objectifs atteints. La part des dépenses pharmaceutiques dans l'ensemble des dépenses de santé est plus élevée en République slovaque que dans tout autre pays de l'OCDE, et la proportion du revenu national consacrée aux produits pharmaceutiques n'est plus forte qu'en Hongrie. Si la modestie relative du revenu national explique en partie cette situation, le présent examen indique que la République slovaque dispose d'une certaine marge de manœuvre pour réduire ses dépenses pharmaceutiques et ralentir la croissance rapide de ceux-ci. En République slovaque, le financement des dépenses pharmaceutiques dépend davantage du secteur public que dans les autres pays membres de l'OCDE : la participation aux coûts des ménages n'en supporte que le quart. Le recours aux prix de référence externes n'a pas fait la preuve de modérer les prix slovaques des produits pharmaceutiques qui sont encore protégés par un brevet. S'agissant des produits tombés dans le domaine public et des produits ayant une structure chimique comparable, un dispositif de prix de référence et la concurrence avec les génériques permettent une maîtrise effective des prix, même si les incitations à la substitution par des produits génériques sont faibles pour les patients et ne sont pas aligné pour les pharmaciens. Par ailleurs, le processus de décision de remboursement d'un médicament par l'assurance sociale ne donne pas lieu à une évaluation du coût-efficacité des nouveaux produits pharmaceutiques. D'un autre côté, certains objectifs des politiques pharmaceutiques ont été atteints. La facilité d'accès et la disponibilité des médicaments - y compris les plus innovants - sont satisfaisantes ; l'accessibilité financière aux médicaments est soutenue par la relative modération de la participation aux coûts de l'assuré. Si les médicaments chers sont en général synonymes pour l'assuré d'une participation financière supérieure, le critère de l'accessibilité financière n'est pas un motif d'exclusion de la liste des médicaments remboursés. Classification-JEL: I11; I18 Keywords: marché pharmaceutique, pharmaceutical market, pharmaceutical policy, politique pharmaceutique, pricing, reimbursement, République slovaque, Slovakia, tarification et remboursement Creation-Date: 2008-02-25 Number: 31 Handle: RePEc:oec:elsaad:31-EN Template-type: ReDIF-Paper 1.0 Author-Name: Franco Sassi Author-Workplace-Name: OECD Author-Name: Jeremy Hurst Author-Workplace-Name: OECD Title: The Prevention of Lifestyle-Related Chronic Diseases: an Economic Framework Abstract: This paper provides an economic perspective on the prevention of chronic diseases, focusing in particular on diseases linked to lifestyle choices. The proposed economic framework is centred on the hypothesis that the prevention of chronic diseases may provide the means for increasing social welfare, enhancing health equity, or both, relative to a situation in which chronic diseases are simply treated once they emerge. Testing this hypothesis requires the completion of several conceptual and methodological steps. The pathways through which chronic diseases are generated must be identified as well as the levers that could modify those pathways. Justification for action must be sought by examining whether the determinants of chronic diseases are simply the outcome of efficient market dynamics, or the effect of market and rationality failures preventing individuals from achieving the best possible outcomes. Where failures exist, possible preventive interventions must be conceived, whose expected impact on individual choices should be commensurate to the extent of those failures and to the severity of the outcomes arising from them. A positive impact of such interventions on social welfare and health equity should be assessed empirically through a comprehensive evaluation before interventions are implemented.
Le présent rapport appréhende dans une optique économique la question de la prévention des maladies chroniques, en mettant tout particulièrement l'accent sur celles qui sont associées au mode de vie. Le cadre économique proposé repose essentiellement sur l'hypothèse selon laquelle la prévention des maladies chroniques peut permettre d'améliorer le bien-être social ou d'accroître l'équité face à la santé, ou les deux, par rapport à une situation dans laquelle ces maladies sont simplement traitées lorsqu'elles se déclarent. Pour vérifier cette hypothèse, il faut accomplir plusieurs tâches d'ordre conceptuel et méthodologique. Il est nécessaire de cerner le processus qui aboutit à l'apparition des maladies chroniques, ainsi que les moyens susceptibles d'infléchir ce processus. Pour définir l'action à mener dans ce sens, il faut examiner si les déterminants de ces maladies sont simplement issus de la dynamique d'un marché efficient ou s'ils découlent d'une défaillance du marché et d'un défaut de rationalité qui empêchent les individus d'obtenir les meilleurs résultats possibles. Lorsqu'il y a défaillance, il est nécessaire de définir les mesures préventives qui pourraient être prises, mesures dont l'impact attendu sur les choix individuels doit être proportionnel à l'ampleur de cette défaillance et à la gravité des effets qu'elle produit. Il conviendrait d'examiner si ces mesures auront une incidence positive sur le bien-être social et l'équité face à la santé en effectuant une évaluation approfondie à l'aide de données concrètes avant leur application. Classification-JEL: H23; H51; I12; I18 Keywords: analyse coût-efficacité, analyse coûts-avantages, choice, choix, cost-benefit analysis, cost-effectiveness analysis, défaillances de marché, déterminants de la santé, health determinants, health equity, maladies non transmissibles, market failure, non-communicable diseases, prevention, prévention, rationality, rationalité, équité face à la santé Creation-Date: 2008-03-25 Number: 32 Handle: RePEc:oec:elsaad:32-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pascal Zurn Author-Workplace-Name: OECD Author-Name: Jean-Christophe Dumont Author-Workplace-Name: OECD Title: Health Workforce and International Migration: Can New Zealand Compete? Abstract: This paper examines health workforce and migration policies in New Zealand, with a special focus on the international recruitment of doctors and nurses. 2. The health workforce in New Zealand, as in all OECD countries, plays a central role in the health system. Nonetheless, maybe more than for any other OECD country, the health workforce in New Zealand cannot be considered without taking into account its international dimension. 3. New Zealand has the highest proportion of migrant doctors among OECD countries, and one of the highest for nurses. There is no specific immigration policy for health professionals, although the permanent and temporary routes make it relatively easy for doctors and nurses who can get their qualification recognised to immigrate in New Zealand. At the same time, New Zealand also has high emigration rates of health workers, mainly to other OECD countries. International migration is thus at the same time an opportunity and a challenge for the management of the human resources for health (HRH) in New Zealand. 4. Increasing international competition for highly skilled workers raises important issues such as sustainability and ability to compete in a global market. In this context, new approaches to improve the international recruitment of health workers, as well as developing alternative policies, may need to be considered. As for international recruitment, better coordination and stronger collaboration between main stakeholders could contribute to more effective and pertinent international recruitment.
5. Ce document examine les effectifs de professionnels de la santé et les politiques migratoires de la Nouvelle-Zélande, en se concentrant plus particulièrement sur le recrutement international de médecins et d'infirmières. 6. En Nouvelle-Zélande comme dans tous les pays de l'OCDE, ces professionnels jouent un rôle crucial dans le système de santé. Dans ce pays, pourtant, peut-être plus que dans tout autre pays de l'OCDE, on ne saurait étudier les travailleurs de la santé sans prendre en compte la dimension internationale de cette population. 7. La Nouvelle-Zélande compte la proportion de médecins immigrés la plus élevée de tous les pays de l'OCDE, celle des infirmières immigrées comptant aussi parmi les plus fortes. Le pays ne s'est pas doté d'une politique d'immigration particulière concernant ces professions même si Les filières d'immigration permanente ou temporaire font qu'il est relativement facile pour les médecins et les infirmières qui parviennent à faire reconnaître leurs diplômes d'aller s'installer en Nouvelle-Zélande. En parallèle, le pays présente également des taux élevés d'émigration de travailleurs de la santé (principalement vers les autres pays de l'OCDE). En matière de gestion des ressources humaines de la santé, les migrations internationales représentent donc à la fois une chance et une difficulté pour la Nouvelle-Zélande. 8. La concurrence internationale croissante pour attirer des travailleurs hautement qualifiés soulève des problèmes importants comme la soutenabilité et la capacité à affronter cette concurrence sur un marché mondialisé. Dans ce contexte, il faudrait peut-être réfléchir à de nouvelles stratégies pour améliorer le recrutement international de travailleurs de la santé et élaborer d'autres mesures possibles. Quant à ce recrutement, l'amélioration de la coordination et le renforcement de la collaboration entre les principales parties prenantes pourraient contribuer à le rendre plus effectif et plus approprié. Classification-JEL: F22; I10; J12 Creation-Date: 2008-05-22 Number: 33 Handle: RePEc:oec:elsaad:33-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jonathan Chaloff Author-Workplace-Name: OECD Title: Mismatches in the Formal Sector, Expansion of the Informal Sector: Immigration of Health Professionals to Italy Abstract: Italy has an aging population which is placing a strain on the public health system and on families. At the same time, it has a distorted market of supply of health professionals. Past over enrolment in medical faculties has produced a current glut of doctors, although shortages will appear as this cohort retires. It is difficult for foreign-trained doctors, and Italian-trained foreigners, to practice medicine in Italy. In nursing, the situation is more critical, with far fewer graduates of nursing schools than necessary even to meet replacement needs. Care for the aged, which was traditionally borne by families, has increasingly been delegated to informal immigrant workers. In the absence of major changes in the care industry, recruitment efforts for nurses and other health technicians has expanded to include other source countries. Obstacles to international recruitment of nurses have been reduced, both by simplifying recognition of foreign qualifications and by exempting nurses from limits on labour migration to Italy. However, a ban on permanent employment in the public sector has relegated foreign nurses largely to private sector and shorter-term contract work. National and local health authorities have also become involved in supporting international recruitment of nurses, often through private agencies. In the home-care sector, families have been granted more opportunities to hire care workers from abroad legally, and many local authorities are attempting to integrate this spontaneous private care into their eldercare system through skill upgrades and support. Nonetheless, international migration will not be sufficient to solve Italy’s health care professional needs.
Le vieillissement de la population en Italie pèse lourdement sur le système de santé public et les familles. Parallèlement, l’offre de professionnels de la santé sur le marché du travail est déséquilibré. Dans le passé, le nombre excessif d’inscriptions dans les facultés de médecine a entrainé une surabondance de médecins, mais des pénuries apparaîtront au fur et à mesure qu’ils partiront à la retraite. Il est difficile pour les médecins ayant étudié à l’étranger et les immigrés qui se sont qualifiés en Italie d’exercer la médecine dans ce pays. En ce qui concerne les infirmières, la situation est plus critique, avec un trop petit nombre de diplômés des écoles d’infirmières, même pour satisfaire uniquement les besoins de remplacement. Les soins aux personnes âgées, incombant traditionnellement aux familles, ont été de plus en plus délégués aux immigrés du secteur informel. En l’absence de changements majeurs dans les politiques de la santé, des efforts ont été faits pour recruter des infirmières et personnels de santé dans d’autres pays d’origine. La simplification de la reconnaissance des qualifications acquises à l’étranger et l’exemption de quotas d’infirmières étrangères sur le marché du travail en Italie ont réduit les obstacles au recrutement international d’infirmières. Cependant, l’interdiction de les employer de façon permanente dans le secteur public a relégué la majorité des infirmières étrangères dans le secteur privé et dans les contrats de travail à court terme. L’administration sanitaire nationale et locale a aussi contribué au recrutement international des infirmières souvent par le biais d’agences privées. Dans le secteur des soins à domicile, les familles se sont vu octroyer plus d’opportunités pour recruter légalement à l’étranger du personnel de soins à domicile. Beaucoup d’autorités locales s’efforcent d’intégrer ce type de soins privés dans leurs systèmes de soins aux personnes âgées en assistant les personnels soignants privés et en renforçant leurs compétences. Néanmoins, les migrations internationales ne seront pas suffisantes pour répondre aux besoins de l’Italie en professionnels de la santé. Classification-JEL: I19; J61 Creation-Date: 2008-10-01 Number: 34 Handle: RePEc:oec:elsaad:34-EN Template-type: ReDIF-Paper 1.0 Author-Name: Linda H. Aiken Author-Name: Robyn Cheung Title: Nurse Workforce Challenges in the United States: Implications for Policy Abstract: The United States has the largest professional nurse workforce in the world numbering close to 3 million but does not produce enough nurses to meet its growing demand. A shortage of close to a million professional nurses is projected to evolve by 2020. An emerging physician shortage will further exacerbate the nurse shortage as the boundaries in scope of practice necessarily overlap. Nurse immigration has been growing since 1990 and the U.S. is now the world’s major importer of nurses. While nurse immigration is expected to continue to grow, the shortage is too large to be solved by recruitment of nurses educated abroad without dramatically depleting the world’s nurse resources. Moreover, the domestic applicant pool for nursing education is very strong with tens of thousands of qualified applicants turned away annually because of faculty shortages and capacity limitations. The national shortage could be largely addressed by investments in expanding nursing school capacity to increase graduations by 25 percent annually and the domestic applicant pool appears sufficient to support such an increase. A shortage of faculty and limited capacity for expansion of baccalaureate and graduate nurse education require public policy interventions. Specifically public subsidies to increase production of baccalaureate nurses are required to enlarge the size of the pool from which nurse faculty, advanced practice nurses in clinical care roles, and managers are all recruited. Retention of nurses in the workforce is critical and will require substantial improvements in human resource policies, the development of satisfying professional work environments, and technological innovations to ease the physical burdens of caregiving. Because of the reliance of the U.S. on nurses educated abroad as well as the benefits to the U.S. of improving global health, the nation should invest in nursing education as part of its global agenda.
Les États-Unis comptent le plus grand nombre d’infirmiers(ères) diplômés au monde – près de 3 millions – mais ils n’en forment pas suffisamment pour répondre à une demande en augmentation. Il devrait manquer près d’un million d’infirmiers(ières) diplômés, aux États-Unis, d’ici 2020. Et le déficit de médecins qui commence d’apparaître ne fera qu’exacerber le problème car les deux pratiques professionnelles sont nécessairement interdépendantes. L’immigration d’infirmiers(ères) n’a cessé d’augmenter depuis 1990 et les États-Unis sont désormais le premier pays d’accueil d’infirmiers(ères) étrangers au monde. Cette vague d’immigration devrait se poursuivre mais la pénurie est trop importante pour pouvoir être résorbée par des recrutements à l’étranger sans que cela ponctionne gravement les ressources en personnel infirmier au niveau mondial. Par ailleurs, les personnes désireuses de suivre une formation d’infirmier(ère) dans le pays sont nombreuses mais des dizaines de milliers de postulants qualifiés sont refusés chaque année en raison du manque de personnel enseignant et de l’insuffisance des capacités d’accueil dans les écoles d’infirmiers(ères). On pourrait largement pallier ces insuffisances en intensifiant les investissements consacrés aux écoles d’infirmiers(ières) de façon à accroître de 25 % par an le nombre des diplômés, ce qui paraît réaliste au regard du nombre actuel de candidats. Le manque de personnel enseignant et l’insuffisance des capacités de formation appellent l’intervention des pouvoirs publics. Précisément, des subventions publiques doivent aider à accroître le nombre d’infirmiers(ières) diplômés, ce qui élargira l’effectif au sein duquel on pourra recruter du personnel enseignant, des infirmiers(ères) cliniciens de haut niveau et des gestionnaires. Inciter les infirmiers(ères) à rester dans la profession est fondamental et cela nécessitera une amélioration significative des politiques de gestion des ressources humaines, la garantie d’un environnement de travail satisfaisant et des innovations technologiques pour alléger la charge physique que représente l’activité de soins. Compte tenu de l’importance des personnels infirmiers formés à l’étranger pour les États-Unis et des avantages qui résulteraient d’une amélioration générale de la santé publique, le pays devrait faire de l’investissement dans la formation d’infirmiers(ères) un des objectifs de l’action publique. Creation-Date: 2008-10-01 Number: 35 Handle: RePEc:oec:elsaad:35-EN Template-type: ReDIF-Paper 1.0 Author-Name: OCDE Title: Projet OCDE sur la migration des professionnels de santé : Le cas de la France Abstract: Ce document examine la démographie des professionnels de la santé en France ainsi que les évolutions récentes des politiques migratoire relatives aux professionnels de la santé. Il traite également de la planification des effectifs et du rôle possible du recrutement du personnel de la santé étranger dans les années à venir. L’évolution des effectifs au cours des années 90 a été marquée par des restrictions concernant la formation de médecins et d’infirmières. Depuis lors, les capacités de formation ont été fortement accrues, et la France se situe ainsi au niveau de la moyenne européenne et au dessus de l’ensemble des pays de l’OCDE en termes de densité de médecin. Les chiffres disponibles montrent qu’en France, le recrutement international de professionnels de santé ne joue pas un rôle prépondérant. Une proportion importante de ceux qui sont formés à l’étranger sont originaires de pays membres de l’Union Européenne, notamment en raison des dispositions législatives européennes, qui vise à faciliter la reconnaissance de diplôme des ressortissants de l’UE pour la plupart des professions de la santé. Pour ce qui est des diplômés hors Union Européenne, ils doivent répondre à des mesures plus restrictives, mises en place par la législation française, qui limite l’accès à la profession. Les médecins et infirmiers formés à l’étranger sont principalement employés en milieu hospitalier....
This report examines health workforce demographics in France, together with recent trends in migration policies regarding health professionals. It also analyses workforce planning and the possible role of the recruitment of foreign health workers in coming years. Workforce trends in the 1990s were marked by restrictions governing the training of doctors and nurses. Since then, training capacities have expanded significantly, and France is now on a par with the European average and above the OECD-wide average in terms of density of doctors. The available figures show that the international recruitment of health professionals does not play a decisive role in France. A large share of foreign-trained health workers come from EU countries, in particular because of the European legislation aimed at facilitating recognition of diplomas of EU nationals for most health professions. Non-EU diplomas, however, are subject to tighter restrictions laid down by French legislation, which limits access to the profession. Foreign-trained doctors and nurses are primarily employed in hospitals.... Creation-Date: 2008-10-01 Number: 36 Handle: RePEc:oec:elsaad:36-FR Template-type: ReDIF-Paper 1.0 Author-Name: Richard Cooper Title: The US Physician Workforce: Where Do We Stand? Abstract: This review surveys trends in physician supply in the United States from 1980 to the present with particular attention to the participation of International Medical Graduates. It discussed the composition of the physician workforce with regards to the number of family practitioners, specialists, women physicians and the aging of the workforce. Changes in the inflows and outflows of the physician workforce are discussed and, in particular, how international migration, retirement, part-time practice and alternative employment have impacted the physician workforce.
La présente étude consistait à observer l’évolution de l’offre de médecins aux États-Unis de 1980 à nos jours, en accordant une attention particulière aux médecins diplômés étrangers. On y examine la composition du corps médical, dont le nombre de médecins de famille, de spécialistes, de femmes médecins, ainsi que la question de son vieillissement. On y réfléchit sur l’évolution des flux d’entrées et de sorties de médecins en activité et, en particulier, sur la manière dont les migrations internationales, les départs à la retraite, l’exercice à temps partiel et la possibilité d’exercer un autre emploi ont influé sur cette population. Classification-JEL: I19; J61 Keywords: absolute poverty Creation-Date: 2008-10-13 Number: 37 Handle: RePEc:oec:elsaad:37-EN Template-type: ReDIF-Paper 1.0 Author-Name: James Buchan Author-Name: Susanna Baldwin Author-Name: Miranda Munro Title: Migration of Health Workers: The UK Perspective to 2006 Abstract: The UK has a population of 56 million, and most healthcare is delivered through the National Health Service (NHS). The NHS employs more than one million staff. In the late 1990s shortages of skilled staff were a main obstacle to improving services in the NHS. The response by government was to “grow” the NHS workforce. There are four main policy options to “grow” the workforce- increase home based training; improve retention rates of current staff (to reduce need to recruit additional staff); improve “return” of staff currently not practising; and internationally recruit health professionals. International recruitment was used to achieve rapid growth in the NHS workforce. It was facilitated by fast tracking work permits for health professionals, by targeting recruits in specified countries, using specialist recruitment agencies, and by co-ordinating local level recruitment within the NHS (...)
Le Royaume-Uni compte 56 millions d’habitants, et en matière de santé, la plupart des prestations y sont fournies par le biais du National Health Service (NHS). Le NHS emploie plus d’un million d’agents. A la fin des années 90, un des principaux obstacles à l’amélioration du NHS était la pénurie de personnel qualifié. La réponse du gouvernement a consisté à « étoffer » les effectifs du NHS. Pour ce faire, les pouvoirs publics disposent de quatre grands moyens d’action possibles : développer la formation dispensée dans le pays même, améliorer le taux de maintien des agents en poste (ce qui permet de diminuer les besoins en recrutement de nouveaux agents), convaincre les agents ayant cessé d’exercer pour le moment de « reprendre du service », et recruter des professionnels de la santé à l’international. Soucieux d’étoffer rapidement ses effectifs, le NHS a eu recours au recrutement à l’international. L’opération a été facilitée par l’application de la procédure de traitement accéléré des demandes de permis de travail pour les professionnels de la santé, par le ciblage des personnes à recruter dans des pays précis (en faisant appel à des agences de recrutement spécialisées), et par la coordination du recrutement au niveau local au sein du NHS (...) Creation-Date: 2008-10-13 Number: 38 Handle: RePEc:oec:elsaad:38-EN Template-type: ReDIF-Paper 1.0 Author-Name: Valérie Paris Author-Workplace-Name: OECD Author-Name: Elizabeth Docteur Author-Workplace-Name: OECD Title: Pharmaceutical Pricing and Reimbursement Policies in Germany Abstract: This paper describes pharmaceutical pricing and reimbursement policies in Germany, considering them in the broader environment in which they operate, and assesses their impact on the achievement of a number of policy goals. Pharmaceutical coverage is comprehensive, with a high level of public funding, and ensures access to treatments. However, recent increases in out-of-pocket payments may impair affordability for the poorest part of the population. Germany does not regulate ex-manufacturer prices of pharmaceuticals at market entry (though distribution margins are regulated for reimbursed drugs). On the other hand, maximum reimbursement amounts (known as reference prices) are set for products which can be clustered in groups of equivalent (generic) or comparable products (...)
Ce document décrit les politiques de prix et de remboursement des médicaments en Allemagne, en les replaçant dans le contexte plus large dans lequel elles s’insèrent, et évalue leur impact sur l’atteinte de plusieurs objectifs. La couverture des médicaments par l’assurance maladie est bonne, caractérisée par un haut niveau de prise en charge publique, et permet un bon accès aux traitements. Cependant, les augmentations récentes des paiements à la charge des usagers pourraient entraver l’accessibilité financière pour les populations les plus modestes. L’Allemagne ne régule pas les prix fabricant des médicaments à leur entrée sur le marché, mais seulement les marges des distributeurs pour les médicaments pris en charge par l’assurance maladie. D’un autre côté, des montants maximum de remboursement (souvent nommés “prix de référence ") sont fixés pour les produits qui peuvent être rassemblés au sein de groupes de produits équivalents (génériques) ou comparables. Classification-JEL: I11; I18 Creation-Date: 2008-10-21 Number: 39 Handle: RePEc:oec:elsaad:39-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jean-Christophe Dumont Author-Name: Pascal Zurn Author-Name: Jody Church Author-Name: Christine LeThi Title: International Mobility of Health Professionals and Health Workforce Management in Canada: Myths and Realities Abstract: This report examines the role played by immigrant health workers in the Canadian health workforce but also the interactions between migration policies and education and health workforce management policies. Migrant health worker makes a significant contribution to the Canadian health workforce. Around 2005-06, more than 22% of the doctors were foreign-trained and 37% were foreign-born. The corresponding figures for nurses are close to 7.7% and 20%, respectively. Foreign-trained doctors play an important role in rural areas as they contribute to filling the gaps. In most rural areas, on average, 30% of the physicians were foreign-trained in 2004. Over past decades the evolution of the health workforce in Canada has been characterised notably by a sharp decline in the density of nurses and a stable density of doctors, which is in contrast with the trends observed in other OECD countries. This evolution is largely the result of measures were adopted at the end of the 1980s and early 1990s in order to address a perceived health workforce surplus.
Ce rapport examine le rôle joué par la migration de personnel de santé dans les effectifs de santé au Canada mais aussi les interactions entre les politiques migratoires, la formation et les politiques de gestion de ressources humaines. Le personnel de santé recruté à l’étranger contribue de façon significative aux effectifs de santé au Canada. En 2005-06, plus de 22 % des médecins au Canada sont formés à l’étranger et 37 % d’entre eux sont nés à l’étranger. Respectivement pour les infirmières, la part des personnes formées à l’étranger est de 7.7 % et celle des personnes nées à l’étranger de 20%. Les médecins formés à l’étranger jouent un rôle important dans des zones rurales ayant contribué à réduire au manque d’effectif dans les zones rurales. En 2004, dans la plupart des zones rurales, en moyenne 30 % des médecins sont formés à l’étranger. Au cours des dernières décennies, l’évolution des effectifs de santé au Canada a été marquée notamment par un net déclin de la densité des infirmières et par une densité stable des médecins, ce qui contraste avec les tendances observées dans les pays de l’OCDE. Cette évolution est largement due aux mesures adoptées à la fin des années 80 et au début des années 90 afin de répondre au surplus perçu d’effectif de personnel de santé. Creation-Date: 2008-10-16 Number: 40 Handle: RePEc:oec:elsaad:40-EN Template-type: ReDIF-Paper 1.0 Author-Name: Rie Fujisawa Author-Workplace-Name: OECD Author-Name: Gaétan Lafortune Author-Workplace-Name: OECD Title: The Remuneration of General Practitioners and Specialists in 14 OECD Countries: What are the Factors Influencing Variations across Countries? Abstract: This paper provides a descriptive analysis of the remuneration of doctors in 14 OECD countries for which reasonably comparable data were available in OECD Health Data 2007 (Austria, Canada, the Czech Republic, Denmark, Finland, France, Germany, Hungary, Iceland, Luxembourg, Netherlands, Switzerland, the United Kingdom and the United States). Data are presented for general practitioners (GPs) and medical specialists separately, comparing remuneration levels across countries both on the basis of a common currency (US dollar, adjusted for purchasing power parity) and in relation to the average wage of all workers in each country.
Ce document de travail présente une analyse descriptive de la rémunération des médecins dans 14 pays de l’OCDE pour lesquels on trouve des données raisonnablement comparables dans Eco-santé OCDE 2007 (Allemagne, Autriche, Canada, Danemark, États-Unis, Finlande, France, Hongrie, Islande, Luxembourg, Pays-Bas, République tchèque, Royaume-Uni et Suisse). Les données sont présentées séparément pour les généralistes (omnipraticiens) et les spécialistes. La comparaison des niveaux de rémunération entre pays est faite sur la base d’une monnaie commune (le dollar américain, ajusté pour la parité des pouvoirs d’achat), ainsi qu’en rapport avec le salaire moyen de l’ensemble des travailleurs dans chacun des pays. Creation-Date: 2008-12-18 Number: 41 Handle: RePEc:oec:elsaad:41-EN Template-type: ReDIF-Paper 1.0 Author-Name: Howard Oxley Author-Workplace-Name: OECD Title: Policies for Healthy Ageing: An Overview Abstract: This paper reviews policies in the area of healthy ageing. With the ageing of OECD countries’ population over coming decades, maintaining health in old age will become increasingly important. Successful policies in this area can increase the potential labour force and the supply of non-market services to others. They can also delay the need for longer-term care for the elderly. A first section briefly defines what is meant by healthy ageing and discusses similar concepts – such as “active ageing”. The paper then groups policies into four different types and within each, it describes the range of individual types of programmes that can be brought to bear to enhance improved health of the elderly. A key policy issue in this area concerns whether such programmes have a positive effect on health outcomes and whether they are costeffective.
Ce document de travail examine les politiques relatives au vieillissement en bonne santé. Compte tenu du vieillissement démographique annoncé dans les pays de l’OCDE au cours des prochaines décennies, préserver la bonne santé des personnes âgées deviendra de plus en plus important. Des politiques réussies dans ce domaine peuvent augmenter la main-d’oeuvre potentielle ainsi que l’offre de services non marchands. Elles peuvent aussi retarder le besoin de soins de longue durée pour les personnes âgées. Une première partie définit brièvement ce que l’on entend par « vieillir en bonne santé » et analyse des concepts similaires – tels que le « vieillissement actif ». Le rapport présente ensuite quatre groupes de politiques et, pour chacun, les différents programmes mobilisables afin d’améliorer l’état de santé des personnes âgées. Une question importante sur l’action publique dans ce domaine consiste à savoir si ces programmes ont un effet positif sur les résultats de santé et s’ils sont coût-efficaces. Classification-JEL: I18 Creation-Date: 2009-02-16 Number: 42 Handle: RePEc:oec:elsaad:42-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michael de Looper Author-Workplace-Name: OECD Author-Name: Gaétan Lafortune Author-Workplace-Name: OECD Title: Measuring Disparities in Health Status and in Access and Use of Health Care in OECD Countries Abstract: Most OECD countries have endorsed as major policy objectives the reduction of inequalities in health status and the principle of adequate or equal access to health care based on need. These policy objectives require an evidence-based approach to measure progress. This paper assesses the availability and comparability of selected indicators of inequality in health status and in health care access and use across OECD countries, focussing on disparities among socioeconomic groups. These indicators are illustrated using national or cross-national data sources to stratify populations by income, education or occupation level. In each case, people in lower socioeconomic groups tend to have a higher rate of disease, disability and death, use less preventive and specialist health services than expected on the basis of their need, and for certain goods and services may be required to pay a proportionately higher share of their income to do so.
Les politiques de santé dans la plupart des pays de l’OCDE ont comme objectifs majeurs la réduction des inégalités en matière de santé et le respect du principe d’un accès adéquat ou égal aux soins basé sur les besoins. Des données robustes et fiables sont nécessaires pour mesurer l’atteinte de ces objectifs politiques. Ce document de travail évalue la disponibilité et la comparabilité de certains indicateurs de l’inégalité de l’état de santé et de l’accès et de l’utilisation des soins dans les pays de l’OCDE, en se concentrant sur les disparités selon les groupes socio-économiques. Ces indicateurs sont illustrés à partir de sources de données nationales ou internationales qui permettent de distinguer les populations par niveau de revenu, d’éducation et d’emploi. Dans tous les cas, les personnes appartenant à des groupes socio-économiques désavantagés ont tendance à avoir des taux de morbidité, d’incapacité et de mortalité plus élevés, à utiliser moins de services préventifs et de soins spécialisés que ce à quoi on pourrait s’attendre sur la base de leurs besoins, et à payer une plus large part de leur revenu pour se procurer certains biens et services de santé. Classification-JEL: I10; I18; J10 Creation-Date: 2009-03-09 Number: 43 Handle: RePEc:oec:elsaad:43-EN Template-type: ReDIF-Paper 1.0 Author-Name: Rie Fujisawa Author-Workplace-Name: OECD Author-Name: Francesca Colombo Author-Workplace-Name: OECD Title: The Long-Term Care Workforce: Overview and Strategies to Adapt Supply to a Growing Demand Abstract: This working paper offers an overview of the LTC workforce and reviews country responses to a growing demand for LTC workers. In the context of ageing societies, the importance of long-term care is growing in all OECD countries. In 2005, long-term care expenditure accounted for slightly over 1% of GDP across OECD countries (OECD Health Data 2008), but this is projected to reach between 2% and 4% of GDP by 2050 (Oliveira Martins et al., 2006). Spending on long-term care as a share of GDP rises with the share of the population that is over 80 years old, which is expected to triple from 4 per cent to 11-12 per cent between 2005 and 2050. In addition to ageing, there are other factors likely to affect future spending. Trends in severe disability among elderly populations across 12 OECD countries for which data are available do not show a consistent sign of decline (Lafortune and Balestat, 2007), while the number of elderly that need assistance in carrying out activities of daily living is also growing. Meanwhile, societal changes – notably possible reductions in the importance of informal care due to rising labour market participation by women and declining family size, as well as growing expectations for more responsive, quality health and social-care systems – are creating pressures to improve value for money in long-term care systems. These factors add pressures on the workforce of this highly labour-intensive sector. Adding to this are the difficulties in attracting and retaining caregivers to a physically and mentally gruelling profession.

Soins de longue durée: l'accroissement de la demande de travailleurs du secteur
Ce document de travail présente une vue d’ensemble sur les travailleurs du secteur des soins de longue durée (SLD) et passe en revue les réponses des pays à l'accroissement de la demande de travailleurs des SLD. Dans le contexte du vieillissement des sociétés, l’importance des soins de longue durée va se développer dans tous les pays de l’OCDE. En 2005, les dépenses de SLD ne représentaient guère plus de 1 % du PIB dans ces différents pays (Éco-Santé OCDE 2008), mais d’après les projections, cette proportion pourrait atteindre entre 2 et 4 % du PIB à l’horizon 2050 (Oliveira Martins et al., 2006). La part des dépenses de SLD exprimées en pourcentage du PIB augmente en même temps que s’accroît la part de la population âgée de plus de 80 ans. Or, cette part devrait tripler entre 2005 et 2050 et passer de 4 % à 11 ou 12 % sur cette période. Outre le vieillissement, d’autres facteurs pouvant affecter les dépenses futures sont impliqués. Dans 12 pays de l’OCDE pour lesquels on dispose de données, la tendance à l’incapacité sévère chez les personnes âgées ne diminue pas de manière régulière (Lafortune et Balestat, 2007), tandis que le nombre de personnes âgées ayant besoin d’aide pour accomplir les activités élémentaires de la vie quotidienne est en augmentation. En même temps, l’évolution de la société (notamment, la possible diminution d’importance qui devrait être accordée aux soins informels du fait de l’accroissement du taux d’activité des femmes et de la diminution de la taille des familles, mais aussi les attentes croissantes face à des systèmes de soins de santé et de protection sociale que l’on voudrait plus réactifs et de meilleure qualité) accroît la nécessité d’une utilisation plus efficiente des ressources des systèmes de SLD. Ces facteurs renforcent la pression qui s’exerce sur les travailleurs de ce secteur à très forte intensité de main-d’oeuvre. S’y ajoutent les difficultés rencontrées pour attirer des soignants vers un métier pénible à la fois physiquement et psychologiquement et pour les retenir. Classification-JEL: I1; I10; I12; J1; J10; J14; J20; J61 Creation-Date: 2009-03-17 Number: 44 Handle: RePEc:oec:elsaad:44-EN Template-type: ReDIF-Paper 1.0 Author-Name: Franco Sassi Author-Workplace-Name: OECD Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Michele Cecchini Author-Workplace-Name: OECD Author-Name: Elena Rusticelli Author-Workplace-Name: OECD Title: The Obesity Epidemic: Analysis of Past and Projected Future Trends in Selected OECD Countries Abstract: This paper provides an overview of past and projected future trends in adult overweight and obesity in OECD countries. Using individual-level data from repeated cross-sectional national surveys, some of the main determinants and pathways underlying the current obesity epidemic are explored, and possible policy levers for tackling the negative health effect of these trends are identified. First, projected future trends show a tendency towards a progressive stabilisation or slight shrinkage of pre-obesity rates, with a projected continued increase in obesity rates. Second, results suggest that diverging forces are at play, which have been pushing overweight and obesity rates into opposite directions. On one hand, the powerful influences of obesogenic environments (aspects of physical, social and economic environments that favour obesity) have been consolidating over the course of the past 20-30 years. On the other hand, the long term influences of changing education and socio-economic conditions have made successive generations increasingly aware of the health risks associated with lifestyle choices, and sometimes more able to handle environmental pressures. Third, the distribution of overweight and obesity in OECD countries consistently shows pronounced disparities by education and socio-economic condition in women (with more educated and higher socio-economic status women displaying substantially lower rates), while mixed patterns are observed in men. Fourth, the findings highlight the spread of overweight and obesity within households, suggesting that health-related behaviours, particularly those concerning diet and physical activity, are likely to play a larger role than genetic factors in determining the convergence of BMI levels within households.

Obésité : Analyses des tendances dans les pays de l'OCDE
Ce document fournit une vue d’ensemble des tendances passées et futures des taux de surpoids et d’obésité dans les pays de l’OCDE. L’utilisation de données individuelles issues d’enquêtes transversales nationales a permis d’explorer les déterminants principaux et les cheminements sous-jacents à l’épidémie d’obésité, et d’identifier de possibles leviers politiques pour contrer les effets négatifs de ces tendances sur la santé. Premièrement, les projections futures confirment la tendance vers une stabilisation progressive voire une faible baisse des taux de pré-obésité, accompagnée d’une augmentation continuelle des taux d’obésité. Deuxièmement, les résultats suggèrent que des forces divergentes sont en jeu, poussant les taux de surpoids et d’obésité dans deux directions opposées. D’une part, la forte influence d’un environnement obésogène (les aspects de l’environnement physique, social et économique qui favorisent l’obésité) a été confirmée au cours des 20-30 dernières années. D’autre part, l’influence sur le long terme de l’évolution de l’éducation et des conditions socio-économiques a rendu les générations successives de plus en plus conscientes des risques pour la santé liés aux choix de vie, et parfois plus aptes à gérer la pression de l’environnement. Troisièmement, les distributions des taux de surpoids et d’obésité dans les pays de l’OCDE montrent de façon cohérente des disparités marquées selon l’éducation et les conditions socio-économiques chez les femmes (plus éduquées et ayant un statut socio-économique plus élevé, les femmes ont des taux considérablement plus faibles), alors que des résultats variés sont observés chez les hommes. Quatrièmement, les résultats soulignent l’étendu du surpoids et de l’obésité au sein des ménages, et suggèrent que les comportements liés à la santé en particulier ceux concernant l’alimentation et l’activité physique, jouent probablement un rôle plus important que les facteurs génétiques dans la détermination du niveau de l’IMC au sein des ménages. Classification-JEL: D12; I12; I32 Keywords: household, obesity, obesogenic environment, socio-economic inequality Creation-Date: 2009-03-20 Number: 45 Handle: RePEc:oec:elsaad:45-EN Template-type: ReDIF-Paper 1.0 Author-Name: Franco Sassi Author-Workplace-Name: OECD Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Jody Church Author-Workplace-Name: OECD Author-Name: Michele Cecchini Author-Workplace-Name: OECD Author-Name: Francesca Borgonovi Author-Workplace-Name: OECD Title: Education and Obesity in Four OECD Countries Abstract: An epidemic of obesity has been developing in virtually all OECD countries over the last 30 years. Existing evidence provides strong suggestions that such epidemic has affected certain social groups more than others. In particular, education appears to be associated with a lower likelihood of obesity, especially among women. A range of analyses of health survey data from Australia, Canada, England and Korea were undertaken with the aim of exploring the relationship between education and obesity. The findings of these analyses show a broadly linear relationship between the number of years spent in full-time education and the probability of obesity, with most educated individuals displaying lower rates of the condition (the only exception being men in Korea). This suggests that marginal returns to education, in terms of reduction in obesity rates, are approximately constant throughout the education spectrum. The findings obtained confirm that the education gradient in obesity is stronger in women than in men. Differences between genders are minor in Australia and Canada, more pronounced in England and major in Korea. The causal nature of the link between education and obesity has not yet been proven with certainty; however, using data from France we were able to ascertain that the direction of causality appears to run mostly from education to obesity, as the strength of the association is only minimally affected when accounting for reduced educational opportunities for those who are obese in young age. Most of the effect of education on obesity is direct. Small components of the overall effect of education on obesity are mediated by an improved socio-economic status linked to higher levels of education, and by a higher level of education of other family members, associated with an individual’s own level of education. The positive effect of education on obesity is likely to be determined by at least three factors: (a) greater access to health-related information and improved ability to handle such information; (b) clearer perception of the risks associated with lifestyle choices; and, (c) improved self-control and consistency of preferences over time. However, it is not just the absolute level of education achieved by an individual that matters, but also how such level of education compares with that of the individual’s peers. The higher the individual’s education relative to his or her peers’, the lower is the probability of the individual being obese.

Éducation et obésité dans quatre pays de l'OCDE
Une épidémie d’obésité est en train de s’étendre dans presque tous les pays de l’OCDE depuis les 30 dernières années. Les preuves existantes suggèrent fortement qu’une telle épidémie a davantage affecté certains groupes sociaux que d’autres. En particulier, l’éducation paraît être associée à une plus faible probabilité d’obésité, notamment chez les femmes. Une série d’analyses de données d’enquête de santé concernant l’Australie, le Canada, l’Angleterre et la Corée a été menée dans le but d’explorer la relation entre l’éducation et l’obésité. Les résultats de ces analyses montrent une relation généralement linéaire entre le nombre d’années d’éducation à plein temps et la probabilité d’obésité, les individus les plus éduqués ayant de plus bas taux d’obésité (la seule exception étant les hommes en Corée). Ceci suggère que les rendements marginaux de l’éducation, en termes de réduction des taux d’obésité, sont approximativement constants quelque soit le nombre d’années d’éducation. Les résultats obtenus confirment que le gradient d’obésité selon le niveau d’éducation est plus fort chez les femmes que chez les hommes. Les différences entre les genres sont faibles en Australie et au Canada, plus prononcées en Angleterre et importantes en Corée. La nature causale du lien entre l’éducation et l’obésité n’a pas encore été prouvée avec certitude ; cependant, en utilisant des données françaises, nous avons pu établir que le sens de la causalité semble aller de l’éducation vers l’obésité, puisque la force de l’association est faiblement affectée quand on tient compte d’une moindre éducation pour ceux qui sont obèses aux jeunes âges. La plupart des effets de l’éducation sur l’obésité sont directs. De petites composantes de l’effet total de l’éducation sur l’obésité sont médiées par un meilleur statut socio-économique lié à des niveaux d’éducation plus élevés, et par un meilleur niveau d’éducation des autres membres de la famille, associé au niveau d’éducation propre à l’individu. Il est probable que l’effet positif de l’éducation sur l’obésité soit déterminé par au moins trois facteurs : (a) un meilleur accès à l’information liée à la santé et une meilleure capacité à utiliser une telle information ; (b) une perception plus claire des risques associés aux choix de vie ; et, (c) un meilleur contrôle de soi et une cohérence des préférences dans le temps. Cependant, ce n’est pas seulement le niveau absolu de l’éducation acquis par un individu qui importe, mais aussi comment un tel niveau d’éducation se place par rapport à celui de l’entourage de l’individu. Plus le niveau d’éducation relatif à son entourage est élevé, plus faible est la probabilité que l’individu soit obèse. Classification-JEL: I12; I21 Keywords: education, obesity, obésité, éducation Creation-Date: 2009-06-15 Number: 46 Handle: RePEc:oec:elsaad:46-EN Template-type: ReDIF-Paper 1.0 Author-Name: Saskia Drösler Author-Workplace-Name: Niederrhein University of Applied Sciences Author-Name: Patrick Romano Author-Workplace-Name: University of California Author-Name: Lihan Wei Author-Workplace-Name: OECD Title: Health Care Quality Indicators Project: Patient Safety Indicators Report 2009 Abstract: This paper reports on the progress in the research and development of the set of patient safety indicators developed by the Health Care Quality Indicators project. The indicators presented here have been recommended by an expert group for further consideration in international reporting on the quality of care on the key dimension of safety. The indicators have been selected by expert consensus, undergone validity testing and have been tested for comparability. While concern remains related to differences in coding and reporting from administrative hospital databases, the rigour with which the indicator work has been undertaken has resulted in the improved ability of countries to report on the quality of care. The work on the development of the patient safety indicators highlights the technical progress made in constructing measures and the ongoing need for methodological improvements. The indicators reported here should not be considered as making inferences on the state of patient safety in countries, but are intended to raise questions towards improving understanding of the reported differences.
Ce document présente l’état d’avancement de la recherche et du développement d’un ensemble d’indicateurs en matière de sécurité des patients dans le cadre du projet sur les indicateurs de la qualité des soins (HCQI). Un groupe d’experts a recommandé l’utilisation des indicateurs présentés ici pour les comparaisons internationales sur une dimension clé de la qualité des soins : la sécurité. Les indicateurs ont été sélectionnés par un consensus d’experts, leur validité et leur comparabilité ont été testées. Bien qu’il reste quelques problèmes quant aux différences de codage et de déclaration venant des bases de données administratives hospitalières, la rigueur du travail sur les indicateurs a permis d’améliorer la capacité des pays à rendre compte de la qualité des soins. Le développement des indicateurs de la sécurité des patients met l’accent sur les progrès techniques réalisés dans la construction de mesures et le besoin récurrent d’améliorer la méthodologie. Les indicateurs présentés ici ne doivent pas donner lieu à des conclusions quant à la situation de la sécurité des patients dans les pays, mais visent plutôt à poser des questions pour une meilleure compréhension des différences observées. Classification-JEL: I19 Creation-Date: 2009-11-23 Number: 47 Handle: RePEc:oec:elsaad:47-EN Template-type: ReDIF-Paper 1.0 Author-Name: Franco Sassi Author-Workplace-Name: OECD Author-Name: Michele Cecchini Author-Workplace-Name: OECD Author-Name: Jeremy Lauer Author-Workplace-Name: World Health Organization Author-Name: Dan Chisholm Author-Workplace-Name: World Health Organization Title: Improving Lifestyles, Tackling Obesity: The Health and Economic Impact of Prevention Strategies Abstract: Overweight and obesity rates have been increasing relentlessly over recent decades in all industrialised countries, as well as in many lower income countries. OECD analyses of trends over time support the grim picture drawn in the international literature and so do projections of overweight and obesity rates over the next ten years. The circumstances in which people have been leading their lives over the past 20-30 years, including physical, social and economic environments, have exerted powerful influences on their overall calorie intake, on the composition of their diets and on the frequency and intensity of physical activity at work, at home and during leisure time. Many countries have been concerned not only about the pace of the increase in overweight and obesity, but also about inequalities in their distribution across social groups, particularly by socio-economic status and by ethnic background.
Les taux de surpoids et d’obésité ne cessent d’augmenter depuis plusieurs décennies dans tous les pays industrialisés, ainsi que dans beaucoup de pays ayant un revenu plus faible. Les analyses consacrées par l’OCDE aux tendances structurelles confirment le sombre tableau qui a été brossé dans les publications internationales, tout comme le font les prévisions établies sur les taux de surpoids et d’obésité pour les dix prochaines années. Les conditions dans lesquelles vivent les individus depuis vingt ou trente ans, notamment sur le plan matériel, social et économique, ont très fortement influé sur leur ration calorique globale, la composition de leur alimentation, ainsi que la fréquence et l’intensité de leur activité physique au travail, à la maison et pendant les loisirs. Beaucoup de pays sont préoccupés non seulement par le rythme auquel progressent le surpoids et l’obésité, mais aussi par le caractère inégal de leur répartition entre les catégories sociales, en particulier selon la situation socioéconomique et l’origine ethnique. Classification-JEL: D61; D63; H51; I12; I18 Creation-Date: 2009-11-20 Number: 48 Handle: RePEc:oec:elsaad:48-EN Template-type: ReDIF-Paper 1.0 Author-Name: Peter Scherer Author-Workplace-Name: OECD Author-Name: Marion Devaux Author-Workplace-Name: OECD Title: The Challenge of Financing Health Care in the Current Crisis: An Analysis Based on the OECD Data Abstract: The ratio of health expenditure to GDP, which in macroeconomic terms is an indicator which summarises the financing needs of a national health system, is likely to rise in countries for which the GDP falls. Over the past four decades, health expenditure has risen in most countries at a faster rate than GDP, leading to a rise in the expenditure ratio. Fluctuations in this ratio can come about through fluctuations in either of its components. In some cases, notably the USA, GDP variation is the main origin of changes in the ratio, but in the majority of countries health expenditure variation is more important. The experience of countries which did reduce health expenditure after previous recessions suggests that such reductions are short-lived, and demand for health services results over time in a revival of health expenditure growth.
La proportion des dépenses de santé par rapport au PIB, qui en termes macro-économiques est un indicateur récapitulant les besoins de financement d'un système de santé national, va probablement monter dans des pays où le PIB chute. Pendant les quatre dernières décennies, les dépenses de santé ont augmenté dans la plupart des pays plus rapidement que le PIB, menant à une hausse de la proportion des dépenses. Des fluctuations dans cette proportion peuvent survenir à la suite de variations dans l’une ou l’autre de ses composantes. Dans quelques cas, notamment aux États-Unis, la variation du PIB est à l'origine même de la différence du ratio, mais dans la majorité des pays, les variations de dépense de santé sont plus importantes. L'expérience des pays qui ont vraiment réduit leurs dépenses de santé après des récessions laisse à penser que de telles réductions sont de courte durée et que la demande de résultats en matière de services de la santé signifie à la longue une reprise de la croissance des dépenses de santé. Classification-JEL: H51; I18; N00 Creation-Date: 2010-05-21 Number: 49 Handle: RePEc:oec:elsaad:49-EN Template-type: ReDIF-Paper 1.0 Author-Name: Valérie Paris Author-Workplace-Name: OECD Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Lihan Wei Author-Workplace-Name: OECD Title: Health Systems Institutional Characteristics: A Survey of 29 OECD Countries Abstract: In 2008, the OECD launched a survey to collect information on the health systems characteristics of member countries. This paper presents the informaton provided by 29 of these countries in 2009. It describes country-specific arrangements to organise the population coverage against health risks and the financing of health spending. It depicts the organisation of health care delivery, focusing on the public/private mix of health care provision, provider payment schemes, user choice and competition among providers, as well as the regulation of heallth care suppply and prices. Finally, this document provides information on governnance and resource allocation in health systems (decentralisation in decisionmaking, nature of budget constraints and priority setting).
En 2008, l’OCDE a lancé une enquête auprès de ses pays membres pour recueillir une information sur les caractéristiques des systèmes de santé. Ce document présente l’information fournie par 29 pays en 2009. Il décrit comment chaque pays organise la couverture de la population contre les risques liés à la santé et le financement des dépenses de santé. Il dépeint l’organisation des soins, à travers le caractère public/privé de l’offre de soins, les modes de paiement des prestataires, le choix de l’usager et la concurrence entre prestataires, ainsi que la régulation de l’offre et des prix. Finalement, il donne une information sur la gouvernance et l’allocation des ressources dans les systèmes de santé (décentralisation, nature de la contrainte budgétaire et établissement des priorités). Classification-JEL: I1; I10; I18 Creation-Date: 2010-04-28 Number: 50 Handle: RePEc:oec:elsaad:50-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jeremy Hurst Title: Effective Ways to Realise Policy Reforms in Health Systems Abstract: Sometimes it is argued that the content of a reform is less important in determining whether or not it receives public and legislative approval than the timing of the proposal; the way in which the reform is presented; the discussions with stakeholders; and a multitude of other factors. The OECD has a crosscutting project on these issues, entitled Making Reform Happen. A number of OECD directorates are considering the factors lying behind successful implementation of reforms in their different policy areas, including tax, environment, agriculture, trade, competition, education, health, pensions, product markets and labour markets.
D’aucuns arguent parfois que le contenu d’une réforme est moins important pour déterminer son acceptation par le public et par le législateur que le timing de la proposition, la manière dont la réforme est présentée, les discussions avec les parties prenantes et une multitude d’autres facteurs. L’OCDE a lancé un projet transversal sur ces questions sous le titre Making Reform Happen. Un certain nombre de Directions à l’OCDE étudient les facteurs qui sous-tendent le succès des réformes dans leurs différents domaines, notamment la fiscalité, l’environnement, l’agriculture, le commerce, la concurrence et l’éducation, la santé, les réformes des retraites, des marchés de produits et des marchés du travail. Classification-JEL: D72; D78; I18 Creation-Date: 2010-03-29 Number: 51 Handle: RePEc:oec:elsaad:51-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ravi P. Rannan-Eliya Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Title: Guidelines for Improving the Comparability and Availability of Private Health Expenditures Under the System of Health Accounts Framework Abstract: This paper reports on a project to improve the comparability and availability of private health expenditure under the joint health accounts questionnaire (JHAQ) data collection. The JHAQ is a framework for joint data collection in the area of health expenditure data developed by OECD, Eurostat, and WHO. In particular, the study questions were: How to overcome the inherent tendency for much private health care financing to occur without the generation of linked, reliable, and comprehensive routine data? How to tackle the issue of private providers likely to operate without reporting of routine data to statistical agencies? Classification-JEL: C81; I10; N41 Creation-Date: 2010-05-26 Number: 52 Handle: RePEc:oec:elsaad:52-EN Template-type: ReDIF-Paper 1.0 Author-Name: Francette Koechlin Author-Workplace-Name: OECD Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Paul Schreyer Author-Workplace-Name: OECD Title: Comparing Price Levels of Hospital Services Across Countries: Results of Pilot Study Abstract: Health services account for a large and increasing share of production and expenditure in OECD countries but there are also noticeable differences between countries in expenditure per capita. Whether such differences are due to more services consumed in some countries than in others or whether they reflect differences in the price of services is a question of significant policy relevance. Yet, cross-country comparisons of the price of health services are rare and fraught with measurement issues. This paper presents a new set of comparative prices for hospital services in a selection of OECD countries. The data is novel in that it reflects quasi-prices (negotiated or administrative prices or tariffs) of the output of hospital services. Traditionally, prices of outputs have been compared by comparing prices of inputs such as wage rates of medical personnel. The new methodology moves away from the input perspective towards an output perspective. This should allow productivity differences between countries to be captured and paves the way for more meaningful comparisons of the volume of health services provided to consumers in the different countries. One of the key findings of the pilot study is that the price level of hospital services in the United States is more than 60 % above that of the average price level of 12 countries included in the study. Price levels turn out to be significantly below average in Korea, Israel and Slovenia.
Les services de santé représentent une part importante et croissante de la production et des dépenses dans les pays de l’OCDE mais avec des différences notables entre pays dans les dépenses par habitant. Savoir si de telles différences sont dues aux quantités de services consommés dans tel ou tel pays ou reflètent des différences dans les prix des services est une question fondamentale pour mener une politique pertinente. Jusqu’à présent, les comparaisons entre pays du prix des services de santé sont rares et rendues difficiles par les problèmes de mesure. Cet article présente un ensemble de prix comparatifs pour les services hospitaliers dans une sélection de pays de l'OCDE. Ces données sont inédites car elles reflètent « les quasi-prix » (prix négociés ou réglementés ou tarifs) de la production de services hospitaliers. Traditionnellement, les prix de ces produits étaient comparés en utilisant les prix des « input » (approche par les coûts) tels que les taux de salaire du personnel médical. La nouvelle méthodologie s’écarte de cette approche pour tendre vers une approche « output ». Cela devrait permettre de saisir les différences de productivité entre les pays et d’ouvrir la voie à des comparaisons plus significatives du volume des services de santé fournis aux consommateurs dans les différents pays. Un des résultats clés de cette étude pilote est que le niveau de prix des services hospitaliers aux États -Unis est de plus de 60% supérieur au niveau de prix moyen des 12 pays inclus dans l’étude. En revanche, les niveaux de prix sont significativement plus bas en Corée, en Israël et en Slovénie. Classification-JEL: C43; I10; M41 Creation-Date: 2010-07-08 Number: 53 Handle: RePEc:oec:elsaad:53-EN Template-type: ReDIF-Paper 1.0 Author-Name: Marie-Laure Delamaire Author-Name: Gaétan Lafortune Author-Workplace-Name: OCDE Title: Les pratiques infirmières avancées : Une description et évaluation des expériences dans 12 pays développés Abstract: Beaucoup de pays cherchent à améliorer la prestation des soins de santé en examinant les rôles des différents corps professionnels, y compris les infirmières. Le développement de nouveaux rôles infirmiers plus avancés peut contribuer à améliorer l’accès aux soins dans un contexte d’offre de médecins limitée voire en diminution. Cela pourrait aussi permettre de contenir les coûts en délégants certaines tâches d’une main-d’oeuvre médicale onéreuse aux infirmières. Cette étude analyse le développement des pratiques infirmières avancées dans 12 pays (Australie, Belgique, Canada, Chypre, États-Unis, Finlande, France, Irlande, Japon, Pologne, République Tchèque, Royaume-Uni), en se concentrant notamment sur leurs rôles dans les soins primaires. Elle analyse aussi les évaluations des impacts sur les soins des patients et les coûts… Classification-JEL: I10; I18; J2 Keywords: infirmières, infirmières cliniciennes, infirmières praticiennes, pays membres de l'OCDE, rôles avancés, soins primaires Creation-Date: 2010-08-31 Number: 54 Handle: RePEc:oec:elsaad:54-FR Template-type: ReDIF-Paper 1.0 Author-Name: Marie-Laure Delamaire Author-Name: Gaétan Lafortune Author-Workplace-Name: OECD Title: Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries Abstract: Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors. It might also contain costs by delegating tasks away from more expensive doctors. This paper reviews the development of advanced practice nurses in 12 countries (Australia, Belgium, Canada, Cyprus, Czech Republic, Finland, France, Ireland, Japan, Poland, United Kingdom and United States), with a particular focus on their roles in primary care. It also reviews the evaluations of impacts on patient care and cost. The development of new nursing roles varies greatly. The United States and Canada established “nurse practitioners” in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. Although development in Australia and Ireland is more recent, these two countries have been very active in establishing higher education programmes and posts for advanced practice nurses in recent years. In other countries, the formal recognition of advanced practice nurses is still in its infancy, although unofficial advanced practices may already exist in reality. Evaluations show that using advanced practice nurses can improve access to services and reduce waiting times. Advanced practice nurses are able to deliver the same quality of care as doctors for a range of patients, including those with minor illnesses and those requiring routine follow-up. Most evaluations find a high patient satisfaction rate, mainly because nurses tend to spend more time with patients, and provide information and counselling. Some evaluations have tried to estimate the impact of advanced practice nursing on cost. When new roles involve substitution of tasks, the impact is either cost reducing or cost neutral. The savings on nurses’ salaries – as opposed to doctors – can be offset by longer consultation times, higher patient referrals, and sometimes the ordering of more tests. When new roles involve supplementary tasks, some studies report that the impact is cost increasing. Classification-JEL: I10; I18; J2 Keywords: advanced roles, clinical nurse specialists, nurse practitioners, nurses, OECD countries, primary care, skills Creation-Date: 2010-07-08 Number: 54 Handle: RePEc:oec:elsaad:54-EN Template-type: ReDIF-Paper 1.0 Author-Name: Juan G. Gay Author-Name: Valérie Paris Author-Workplace-Name: OECD Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Michael de Looper Author-Workplace-Name: OECD Title: Mortality Amenable to Health Care in 31 OECD Countries: Estimates and Methodological Issues Abstract: This study assesses the potential of the concept of “mortality amenable to health care” as an indicator of outcome for health care systems. It presents estimates of the mortality amenable to health care in 31 OECD countries for the period 1997-2007. It measures the sensitivity of this indicator to the list of death causes considered to be “amenable to care” by comparing results obtained from two leading lists. It then presents the advantages of this indicator over indicators of general mortality, as well as its limitations.
Cette étude évalue dans quelle mesure l’indicateur de « mortalité évitable grâce au système de soins » peut être utilisé comme indicateur de résultat du système de soins. Elle présente des estimations de cette mortalité évitable par les soins pour 31 pays de l’OECD et pour la période 1997-2007. Elle mesure la sensibilité de l’indicateur à la liste de causes de décès considérées comme évitables par les soins en comparant les résultats obtenus à partir de deux listes alternatives. Puis, elle présente les avantages de cet indicateur sur les indicateurs de mortalité générale, ainsi que ses limites. Classification-JEL: I10; I12 Creation-Date: 2011-01-31 Number: 55 Handle: RePEc:oec:elsaad:55-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Mark Pearson Author-Workplace-Name: OECD Title: Description of Alternative Approaches to Measure and Place a Value on Hospital Products in Seven OECD Countries Abstract: This paper provides a description of the classification systems used to measure hospital services in selected OECD countries: Australia, Canada, France, Germany, Norway, United Kingdom (England), and the United States. Three classifications are relevant: those on diagnoses; on procedures; and on products. In addition, methods used to measure the cost of hospital services are reviewed. Classification-JEL: H51; I12; I19 Creation-Date: 2011-04-14 Number: 56 Handle: RePEc:oec:elsaad:56-EN Template-type: ReDIF-Paper 1.0 Author-Name: James Buchan Author-Workplace-Name: Queen Margaret University Author-Name: Steven Black Title: The Impact of Pay Increases on Nurses' Labour Market: A Review of Evidence from Four OECD Countries Abstract: Nurses are usually the most numerous professionals in the healthcare workforce, and their contribution is a core component in attaining the policy objectives of improved productivity, quality of care and effectiveness in the health sector. The recent global economic crisis, and its related impacts on health sector funding and health labour market dynamics, has reinforced these policy priorities. This report reviews the impact of pay increases on nurses’ labour market indicators. It presents background data on trends in the numbers of nurses and the remuneration of nurses in OECD countries; summarises the limited evidence base on pay and labour market behaviour; reports on four case study countries where a significant pay raise was awarded to at least some categories of nurses in recent years in response to perceived labour market challenges – the United Kingdom (UK), New Zealand, Finland and the Czech Republic – using a variety of indicators to illustrate impact; and concludes with key points for policy makers. There has been variable growth in nurses’ employment levels in OECD countries in recent years, and nurses’ pay rates, in comparison to other earnings in national economies, vary markedly across OECD countries. The country case studies in this report highlight that there were several main drivers for the implementation of a pay rise for nurses, and also identified a range of possible indicators that can be used to assess the impact of changes to nurses’ pay. The main impetus for a pay increase came from: labour market concerns (geographic or specialty shortages), which were reported in all four countries; pay equity issues (New Zealand and the UK); structural changes in the pay systems (e.g., increased flexibility) (Finland, New Zealand and the UK); attempts to improve organizational productivity and the quality of care (UK); and improving international pay competitiveness (Czech Republic after EU accession). The review concludes by arguing that how nurses are paid - as well as how much they are paid – is an issue worthy of more detailed examination. While the same policy drivers exist in most OECD countries, nurses’ pay systems are very different. The findings suggest that, in the short term at least, the pay increases in the four countries contributed to an increase in the potential “new” supply of entrants to nurse education; the effect on those already in work is more difficult to assess, as their behaviour is also impacted by the complex interaction of other aspects, such as working environment and working conditions, career possibilities, and individuals' priorities.
Le personnel infirmier est habituellement la catégorie la plus nombreuse des professionnels de santé, et leur contribution joue un rôle essentiel dans l’atteinte des objectifs d’amélioration de la productivité, de la qualité des soins et de l’efficacité dans le secteur de la santé. La crise économique mondiale récente, et ses impacts sur le financement des dépenses de santé et sur la dynamique du marché du travail dans ce secteur, est venue renforcer ces objectifs. Ce rapport examine l’impact des augmentations de salaire sur les indicateurs du marché du travail du personnel infirmier. Il présente des données de base sur les tendances concernant le nombre d’infirmières et leur rémunération dans les pays de l’OCDE ; résume les résultats des travaux de recherche disponibles sur les liens entre la rémunération des infirmières et les comportements sur le marché du travail ; présente de façon plus détaillée quatre études de cas de pays (Royaume-Uni, Nouvelle-Zélande, Finlande et République tchèque) où des augmentations significatives de salaire ont été octroyées à au moins certaines catégories d’infirmières et analyse l’impact de ces augmentations en utilisant différents indicateurs ; et conclut par quelques points clés à l’attention des décideurs politiques. La croissance de l’emploi du personnel infirmier a été variable au cours des dernières années dans les pays de l’OCDE, et les salaires des infirmières, en comparaison avec le salaire moyen dans chacun des pays, varient fortement d’un pays à l’autre, Les études de cas présentées dans ce rapport mettent en évidence plusieurs facteurs ayant entraîné une augmentation significative des salaires des infirmières dans les quatre pays en question, et identifient une série d’indicateurs susceptibles d’être utilisés pour mesurer l’impact de ces augmentations. Les principaux moteurs de ces augmentations de salaire sont venus : d’inquiétudes concernant le marché du travail dans les quatre pays (des pénuries sur le plan géographique ou au niveau de certaines spécialités) ; de questions entourant l’équité salariale (Nouvelle-Zélande et Royaume-Uni) ; des changements structurels dans les systèmes de paiements, notamment la mise en place d’une plus grande flexibilité (Finlande, Nouvelle- Zélande et Royaume-Uni) ; de tentatives d’amélioration de la productivité et de la qualité des soins (Royaume-Uni) ; et de l’amélioration de la compétitivité internationale des salaires (République tchèque après son entrée dans l’UE). Une des conclusions de ce rapport est que non seulement le niveau moyen de rémunération des infirmières mais aussi les méthodes de paiement mériteraient des études plus approfondies. Ces méthodes de paiement varient fortement d’un pays à l’autre alors que les mêmes défis se posent dans la plupart des pays. Les résultats des études de cas suggèrent qu’au moins à court terme, les augmentations de salaire des infirmières dans les quatre pays ont contribué à accroitre le nombre de personnes intéressées à étudier et travailler dans ce domaine. Il est toutefois difficile d’évaluer l’impact que ces augmentations ont eu sur les infirmières déjà sur le marché du travail, étant donné que leur comportement est aussi affecté par de nombreux facteurs tel que l’environnement et les conditions de travail ainsi que les priorités individuelles. Classification-JEL: I10; I18; J2 Creation-Date: 2011-08-30 Number: 57 Handle: RePEc:oec:elsaad:57-EN Template-type: ReDIF-Paper 1.0 Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Michael de Looper Author-Workplace-Name: OECD Title: Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-2009 Abstract: This Working Paper examines income-related inequalities in health care service utilisation in OECD countries. It extends a previous analysis (Van Doorslaer and Masseria, 2004) to 2008-2009 for 13 countries, and adds new results for 6 countries, for doctor and dentist visits, and cancer screening. Quintile distributions and concentration indices were used to assess inequalities. For doctor visits, horizontal equity was assessed, i.e. the extent to which adults in equal need of physician care appear to have equal rates of utilisation. The paper considers the evolution of inequalities over time by comparing results with the previous study, as data permit. Health system financing arrangements are examined to see how these might affect inequalities in health service use.
Ce document de travail examine les inégalités liées aux revenus dans l’utilisation des services de santé dans les pays de l’OCDE. Il met à jour une étude précédente (Van Doorslaer and Masseria, 2004) pour 13 pays, et inclut 6 nouveaux pays, utilisant des données de 2008-2009, portant sur les consultations de médecins et dentistes, et le dépistage du cancer. Les inégalités sont mesurées à l’aide de distributions par quintile et d’indices de concentration. Cette étude s’intéresse à l’équité horizontale pour les consultations de médecins, i.e. dans quelle mesure des adultes ayant un besoin égal de soins médicaux ont apparemment des taux identiques d’utilisation de soins. Elle examine l’évolution des inégalités en comparant les résultats avec l’étude précédente lorsque les données le permettent. Le cadre d’analyse s’intéresse aux caractéristiques de financement des systèmes de santé et à leurs possibles influences sur les inégalités d’utilisation des services de santé. Classification-JEL: I14; I18 Keywords: health care, inequality, private health insurance Creation-Date: 2012-07-10 Number: 58 Handle: RePEc:oec:elsaad:58-EN Template-type: ReDIF-Paper 1.0 Author-Name: Roberto Astolfi Author-Workplace-Name: OECD Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Jillian Oderkirk Author-Workplace-Name: OECD Title: A Comparative Analysis of Health Forecasting Methods Abstract: Concerns about health expenditure growth and its long-term sustainability have stimulated the development of health expenditure forecasting models in many OECD countries. This comparative analysis reviewed 25 models that were developed by, or used for, policy analysis by OECD member countries and other international organisations... Classification-JEL: H51; I12; J11 Creation-Date: 2012-10-31 Number: 59 Handle: RePEc:oec:elsaad:59-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Roberto Astolfi Author-Workplace-Name: OECD Title: Health Spending Growth at Zero: Which Countries, Which Sectors Are Most Affected? Abstract: Health spending slowed markedly or fell in many OECD countries recently after years of continuous growth, according to OECD Health Data 2012. As a result of the global economic crisis which began in 2008, a zero rate of growth in health expenditure was recorded on average in 2010, and preliminary estimates for 2011 suggest that low or negative growth in health spending continued in many of the countries for which data are available.
Il ressort de l’édition 2012 de la Base de données de l’OCDE sur la santé qu’après des années de progression constante, récemment les dépenses de santé se sont nettement ralenties, voire ont reculé, dans de nombreux pays de l'OCDE. Suite à la crise économique mondiale qui a commencé en 2008, un taux de progression nul des dépenses de santé a été enregistré en moyenne en 2010, et les premières estimations pour 2011 semblent indiquer une progression faible et même négative dans nombre des pays pour lesquels on dispose de données. Classification-JEL: H51; I12; I18 Creation-Date: 2013-01-29 Number: 60 Handle: RePEc:oec:elsaad:60-EN Template-type: ReDIF-Paper 1.0 Author-Name: Klim McPherson Author-Workplace-Name: University of Oxford Author-Name: Giorgia Gon Author-Name: Maggie Scott Title: International Variations in a Selected Number of Surgical Procedures Abstract: This paper summarises recent international data on rates of five surgical procedures (i.e. caesarean, hysterectomy, prostatectomy, hip replacement and appendectomy) across OECD countries. It examines trends over time and compares age- and sex-specific rates for a recent year, for a sub-set of countries for which data are available. The report shows substantial international variations for most procedures, but also striking similarities between countries; some procedures show universal trends, with trends in rates by sex and age behaving in very similar ways. A full understanding of the reasons for and consequences of different utilisation rates demands a detailed understanding of patterns of illness and patient preferences, incentives embedded within health systems, and above all mechanisms to link activity to outcomes. While recognising the many limitations of the data that exist, the analyses reported here paint a picture of widespread differences in the rates at which certain procedures are performed (e.g. hysterectomy and prostatectomy) yet, for others (e.g. appendectomy), they indicate the emergence of growing international convergence. It is important to recognise that these findings are simply a stimulus to further enquiry into health services. Where variation is observed, there is no way, using these data alone, of knowing which rate is the “right” one in any country. It is not even possible to say that the presence of variation is a sign of important health service delivery problems. Classification-JEL: I10; I12 Creation-Date: 2013-03-25 Number: 61 Handle: RePEc:oec:elsaad:61-EN Template-type: ReDIF-Paper 1.0 Author-Name: Tomoko Ono Author-Workplace-Name: OECD Author-Name: Gaétan Lafortune Author-Workplace-Name: OECD Author-Name: Michael Schoenstein Author-Workplace-Name: OECD Title: Health Workforce Planning in OECD Countries: A Review of 26 Projection Models from 18 Countries Abstract: Health workforce planning aims to achieve a proper balance between the supply and demand for different categories of health workers, in both the short and longer-term. Workforce planning in the health sector is particularly important, given the time and cost involved in training new doctors and other health professionals. In a context of tight budget constraints, proper health workforce planning is needed not only to guide policy decisions on entry into medical and nursing education programmes, but also to assess the impact of possible re-organisations in health service delivery to better respond to changing health care needs...
La planification de la main-d'oeuvre dans le domaine de la santé vise à atteindre un juste équilibre entre l'offre et la demande pour les différentes catégories de professionnels de santé, à court et à long terme. La planification de la main-d'oeuvre dans le secteur de la santé s'avère particulièrement importante compte tenu du temps et des coûts investis dans la formation de nouveaux médecins et autres professionnels. Dans un contexte de fortes contraintes budgétaires, une planification appropriée du personnel de santé est nécessaire non seulement pour guider les décisions en matière d'admission aux études de formation médicale et infirmière, mais aussi pour évaluer l'impact d'éventuelles ré-organisations dans la prestation des services de santé afin de mieux répondre aux nouveaux besoins... Classification-JEL: I10; I11; I12; I18; J11 Creation-Date: 2013-06-26 Number: 62 Handle: RePEc:oec:elsaad:62-EN Template-type: ReDIF-Paper 1.0 Author-Name: Valérie Paris Author-Workplace-Name: OECD Author-Name: Annalisa Belloni Author-Workplace-Name: OECD Title: Value in Pharmaceutical Pricing Abstract: This study analyses how 14 OECD Countries refer to “value” when making decisions on reimbursement and prices of new medicines. It details the type of outcomes considered, the perspective and methods adopted for economic evaluation when used; and the consideration of budget impact. It describes which dimensions are taken into account in the assessment of “innovativeness” and the consequences of this assessment on prices; it confirms that treatments for severe and/or rare diseases are often more valued than others and shows how countries use product-specific agreements in an attempt to better align value and price.
Cette étude analyse comment 14 pays de l’OCDE prennent en compte la “valeur” dans leurs décisions concernant le remboursement et le prix des nouveaux médicaments. Elle décrit le type de « résultats » pris en compte, la perspective et les méthodes adoptées pour l’évaluation économique là où elle est utilisée, ainsi que la prise en compte de l’impact budgétaire. Elle décrit quelles dimensions sont prises en compte pour évaluer le caractère innovant et les conséquences de cette évaluation en termes de prix ; elle confirme que les pays accordent souvent une valeur plus élevée aux traitements pour les maladies sévères et/ou rares et montre comment les pays utilisent les accords « par produit » pour tenter de mieux adapter le prix à la valeur. Classification-JEL: I18 Creation-Date: 2013-07-11 Number: 63 Handle: RePEc:oec:elsaad:63-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ankit Kumar Author-Workplace-Name: OECD Author-Name: Michael Schoenstein Author-Workplace-Name: OECD Title: Managing Hospital Volumes: Germany and Experiences from OECD Countries Abstract: To help inform a conference organised by the Germany Ministry of Health (BMG) and the OECD on ‘Managing Hospital Volumes’ on the 11th April 2013, the OECD Secretariat produced this paper giving an international perspective on Germany’s situation and the current policy debate. It provides a number of observations about the structure and financing of hospitals in Germany. It begins by arguing that Germany has a more open-ended approach to the financing of hospital services and weaker controls over the hospital budget than in many other OECD countries. In large part this reflects that DRGs in Germany are almost strictly used for pricing, whereas other countries use DRGs as one of many tools they have to influence hospital budgets. This is compounded by a situation where State governments do not have an incentive to rationalise hospital capacity where this may be desirable. Finally, the paper argues that the vast array of quality information available in Germany ought to be used to better direct financing.
Afin d’apporter des informations à l’appui de la conférence organisée le 11 avril 2013 par le ministère allemand de la Santé (BMG) et l’OCDE sur le thème de la « Gestion des volumes d’activité des hôpitaux », le Secrétariat de l’OCDE a élaboré ce document, qui permet d’aborder la situation de l’Allemagne et le débat en cours selon une perspective internationale. Ce texte livre un certain nombre d’observations concernant la structure et le financement des hôpitaux allemands. Il montre dans un premier temps que l’Allemagne a du financement des services hospitaliers une approche plus ouverte que de nombreux autres pays de l’OCDE, et que le budget des hôpitaux y est plus faiblement contrôlé. Cela tient en grande partie au fait que la tarification des services hospitaliers repose en Allemagne presque exclusivement sur les groupes homogènes de malades (GHM), alors que d’autres pays s’en servent plutôt – avec un grand nombre d’autres outils – pour contrôler le budget des hôpitaux. Cette situation est renforcée par le fait que les autorités des Länder ne sont pas incitées à rationaliser la capacité du secteur hospitalier, alors que cela pourrait être souhaitable. Enfin, le document fait valoir que les nombreuses informations disponibles en Allemagne sur la qualité des soins devraient contribuer à une meilleure affectation des financements. Classification-JEL: I11; I12; I13; I18 Creation-Date: 2013-10-11 Number: 64 Handle: RePEc:oec:elsaad:64-EN Template-type: ReDIF-Paper 1.0 Author-Name: Franco Sassi Author-Workplace-Name: OECD Author-Name: Annalisa Belloni Author-Workplace-Name: OECD Author-Name: Chiara Capobianco Author-Workplace-Name: OECD Title: The Role of Fiscal Policies in Health Promotion Abstract: Taxes and other fiscal measures on health-related commodities are in widespread use. Alcoholic beverages and tobacco products have been subjected to taxation for a long time in most countries. Several OECD governments have passed legislation to increase existing taxes or to introduce new taxes on foods high in salt, sugar or fat in the past few years. Traditionally, commodity taxes have been primarily seen as a source of fiscal revenues and a way to address consumption externalities. More recently, an increased emphasis has been placed on the potential health benefits of commodity taxation, as evidence emerged of the adverse public health, social and economic consequences of the consumption of a range of commodities. This paper provides a review of the theoretical arguments and empirical evidence on the key factors that governments must address when considering the adoption of fiscal measures for health promotion, highlighting the strengths, as well as the limitations and pitfalls, of specific measures. The main focus of this paper is on taxes on health-related commodities, although a range of other fiscal measures may potentially be used in health promotion. Existing evidence of effects on consumption and health outcomes points to the conclusion that taxes on healthrelated commodities can be a powerful tool for health promotion, although the variety and complexity of the effects they generate require careful consideration by policy makers who intend to adopt new taxes or reform existing ones. The arguments in support of taxes being used to attain public health objectives are strong for tobacco products and alcoholic beverages, but less clear-cut for foods, in which case the value of using taxes is highly dependent on their design and on the context in which they would be applied. Classification-JEL: H2; I18; I31; Q18 Creation-Date: 2013-12-11 Number: 66 Handle: RePEc:oec:elsaad:66-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luigi Siciliani Author-Workplace-Name: University of York Author-Name: Valerie Moran Author-Workplace-Name: University of York Author-Name: Michael Borowitz Author-Workplace-Name: Gobal Fund Title: Measuring and Comparing Health Care Waiting Times in OECD Countries Abstract: Waiting times for elective (non-emergency) treatments are a key health policy concern in several OECD countries. This study describes common measures on waiting times across OECD countries from administrative data. It focuses on common elective procedures, like hip and knee replacement, and cataract surgery, where waiting times are notoriously long. It provides comparative data on waiting times across twelve OECD countries and presents trends in waiting times in the last decade. Waiting times appear to be low in the Netherlands and Denmark. In the last decade the United Kingdom (in particular England), Finland and the Netherlands have witnessed large reductions in waiting times which can be attributed to a range of policy initiatives, including higher spending, waiting-times target schemes, and incentive mechanisms which reward higher levels of activity. The negative trend in these countries has however halted in recent years and in some cases reverted. The analysis also emphasizes systematic differences across different waiting-time measures, in particular between the distribution of waiting times of patients treated versus the one of patients on the list. For example, the mean waiting time of patients on the list is generally higher than the mean waiting time of patients treated though we can find examples of the opposite. Mean waiting times are systematically higher than median waiting times and the difference can be quantitatively large.
Les délais d'attente pour les traitements électifs (non urgents) constituent un problème majeur de la politique de santé dans plusieurs pays de l'OCDE. Cette étude fondée sur des données administratives décrit les mesures courantes pour réduire les temps d'attente dans les pays de l'OCDE. Elle se concentre sur les interventions non urgentes pratiquées dans les pays, comme le remplacement de la hanche et du genou ainsi que la chirurgie de la cataracte, pour lesquels les délais d'attente sont connus pour être longs. Elle fournit des données comparatives sur les délais d’attente dans douze pays de l'OCDE et montre comment ils ont évolué ces dix dernières années. Ainsi, ils paraissent être courts aux Pays-Bas et au Danemark. Ces dix dernières années, le Royaume-Uni (en particulier l’Angleterre), la Finlande et les Pays-Bas ont vu leurs délais d’attente se réduire considérablement, ceci pouvant être attribué à une série d'initiatives stratégiques, comme une hausse des dépenses, la mise en place de systèmes d’objectif des délais d’attente et des mécanismes d'incitation récompensant des niveaux d'activité plus élevés. La réduction des délais d’attente dans ces pays s’est toutefois interrompue depuis quelques années et, dans certains cas, ils sont même revenus à la hausse. L'analyse souligne également des différences systématiques entre les différentes mesures relatives aux délais d'attente, en particulier entre la répartition des délais d’attente des patients traités et celle des personnes inscrites sur des listes d'attente. Par exemple, le délai d’attente moyen des patients sur une liste est généralement plus élevé que celui des patients traités, bien qu’il existe des contreexemples. Les délais d’attente moyens sont systématiquement plus élevés que les délais d’attente médians et la différence peut être quantitativement importante. Classification-JEL: I10; I18 Creation-Date: 2013-11-18 Number: 67 Handle: RePEc:oec:elsaad:67-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Roberto Astolfi Author-Workplace-Name: OECD Title: Health Spending Continues to Stagnate in Many OECD Countries Abstract: The global economic crisis which began in 2008 has had a dramatic effect on health spending across OECD countries. Estimates of expenditure on health released back in 2012 showed that, for the first time, health spending had slowed markedly or fallen across many OECD countries after years of continuous growth. As a result, close to zero growth in health expenditure was recorded on average in 2010. Preliminary estimates suggested that the low or negative growth in health spending was set to continue in many OECD countries in following years...
La crise économique mondiale qui a débuté en 2008 a profondément modifié l'évolution des dépenses de santé des pays de l’OCDE. Les estimations publiées en 2012 ont montré que, pour la première fois après des années de croissance ininterrompue, les dépenses de santé avaient sensiblement ralenti, voire diminué, dans de nombreux pays. Ainsi, leur taux de croissance moyen s’établissait autour de zéro en 2010 et, d’après les premières estimations, il serait resté faible ou négatif dans de nombreux pays en 2011... Classification-JEL: H51; I12; I18 Creation-Date: 2014-04-03 Number: 68 Handle: RePEc:oec:elsaad:68-EN Template-type: ReDIF-Paper 1.0 Author-Name: Tomoko Ono Author-Workplace-Name: OECD Author-Name: Michael Schoenstein Author-Workplace-Name: OECD Author-Name: James Buchan Author-Workplace-Name: Queen Margaret University Title: Geographic Imbalances in Doctor Supply and Policy Responses Abstract: Doctors are distributed unequally across different regions in virtually all OECD countries, and this causes concern about how to continue to ensure access to health services everywhere. In particular access to services in rural regions is the focus of attention of policymakers, although in some countries, poor urban and sub-urban regions pose a challenge as well. Despite numerous efforts this mal-distribution of physician supply persists. This working paper first examines the drivers of the location choice of physicians, and second, it examines policy responses in a number of OECD countries...
La répartition des médecins entre les régions est inégale dans pratiquement tous les pays de l’OCDE, et cela pose la question de savoir comment continuer de garantir l’accès aux services de santé partout. L’accès aux services dans les régions rurales préoccupe tout particulièrement les responsables publics, même si, dans certains pays, les régions urbaines et suburbaines pauvres posent aussi un problème. En dépit d’importants efforts, les inégalités dans la répartition des effectifs médicaux persistent. Le présent document de travail examine, dans un premier temps, les critères déterminants, pour les médecins, dans le choix de leur lieu d’exercice et, dans un second temps, les réponses apportées par les pouvoirs publics dans un certain nombre de pays de l’OCDE... Classification-JEL: I18 Creation-Date: 2014-04-03 Number: 69 Handle: RePEc:oec:elsaad:69-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ankit Kumar Author-Workplace-Name: OECD Author-Name: Grégoire de Lagasnerie Author-Name: Frederica Maiorano Author-Name: Alessia Forti Title: Pricing and competition in Specialist Medical Services: An Overview for South Africa Abstract: Major disparities in the cost of health care have made the pricing of specialist and hospital services a contentious issue in South Africa, particularly in the private sector. To help inform policy debate, this paper profiles selected experiences on the pricing of health services, competition policy and models of buying specialist health care services from the private sector across the OECD. Firstly, South Africa is compared to OECD countries to identify countries where voluntary private health insurance – the major source of financing for private hospitals – plays a similar role. Second, this paper provides an overview of price setting across OECD health care systems. It then covers the economic rationale and the institutional arrangements which OECD countries have established to set prices, before moving to an overview of competition policy considerations surrounding these arrangements. Finally, the paper highlights a few models of buying services from the private sector for public patients, with a particular focus on Mexico and Turkey. It is argued that South Africa should separate the task of establishing a schedule of medical services from negotiations over overall payments to medical professionals.
La tarification des services spécialisés et hospitaliers est devenue en Afrique du Sud, en particulier dans le secteur privé, une question controversée suite à d'importantes disparités dans le coût des soins de santé. Pour éclairer le débat politique, ce document décrit différents exemples de tarification des services de santé, de politique de concurrence et des modèles d'achat de services de soins spécialisés au secteur privé dans la zone OCDE. Dans un premier temps, l’étude compare l'Afrique du Sud à d'autres pays de l'OCDE pour identifier les pays où l'assurance-maladie volontaire privée - la principale source de financement pour les hôpitaux privés en Afrique du Sud - joue un rôle similaire. Il donne ensuite un aperçu de la fixation des prix dans les systèmes de santé de l'OCDE. Puis, il aborde la logique économique et les dispositifs institutionnels mis en place par les pays de l’OCDE pour fixer les prix, avant de présenter une vue d'ensemble de la réflexion concernant la politique de la concurrence autour de ces arrangements. Enfin, le document expose quelques modèles d'achat de services au secteur privé pour les patients du secteur public, en développant plus particulièrement les exemples du Mexique et de la Turquie. Il apparaît que l'Afrique du Sud devrait séparer d’un côté l’élaboration d’une liste de services médicaux et de l’autre les négociations faites sur l'ensemble des paiements des professionnels de santé. Classification-JEL: I1; I11; I18 Creation-Date: 2014-06-12 Number: 70 Handle: RePEc:oec:elsaad:70-EN Template-type: ReDIF-Paper 1.0 Author-Name: Alessia Forti Author-Workplace-Name: OECD Title: Mental Health Analysis Profiles (MhAPs): Italy Abstract: As part of a wider project on mental health in OECD countries, a series of descriptive profiles have been prepared, intended to provide descriptive, easily comprehensible, highly informative accounts of the mental health systems of OECD countries. These profiles, entitled ‘Mental Health Analysis Profiles’ (MHAPs), will be able to inform discussion and reflection and provide an introduction to and a synthesised account of mental health in a given country. Each MHAP follows the same template, and whilst the MHAPs are stand-alone profiles, loose cross-country comparison using the MHAPs is possible and encouraged. The recent history of mental health in Italy has been one of de-institutionalisation. The significant overhaul undertaken with regards to mental health over the last years is an example of this process: as it moved away from the century-long tradition of restrictive mental health asylums (manicomi) from the late 1970s with the recent process of closures of judicial psychiatric hospitals (Ospedali Psichiatrici Giudiziari – OPG), Italy progressively managed to integrate mental health services within community-based facilities. Focus was no longer on security and on isolating citizens suffering from mental disorders, but rather on patients’ needs and moving towards social integration and rehabilitation.
Lancée dans le cadre d’un projet plus vaste consacré à la santé mentale dans les pays de l'OCDE, la série de profils « Santé mentale : profils d’analyse » (Mental Health Analysis Profiles - MHAP) vise à décrire de manière simple et détaillée les systèmes de santé mentale des pays de l'OCDE. Ces profils, qui étayeront les examens et les réflexions qui seront menés, feront le point sur la situation d’un pays donné dans le domaine de la santé mentale. Les profils MHAP sont indépendants les uns des autres mais suivent le même modèle : il est donc possible, et recommandé, de les utiliser pour procéder à des comparaisons entre pays. L'histoire récente de la santé mentale en Italie a été marquée par la désinstitutionalisation, comme en témoignent les réformes importantes entreprises au cours des dernières années : en abandonnant peu à peu le placement traditionnel en hôpital psychiatrique (manicomi) à partir de la fin des années 1970 et en procédant depuis peu à la fermeture des hôpitaux psychiatriques judiciaires (Ospedali Psichiatrici Giudiziari - OPG), l'Italie est parvenue progressivement à intégrer des services de santé mentale dans les services de proximité. La priorité n’est plus accordée à la sécurité et à l'isolement des patients souffrant de troubles mentaux, mais plutôt aux besoins des patients, à leur insertion sociale et à leur réadaptation. Classification-JEL: I1 Creation-Date: 2014-07-07 Number: 71 Handle: RePEc:oec:elsaad:71-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pauliina Patana Author-Workplace-Name: OECD Title: Mental Health Analysis Profiles (MhAPs): Finland Abstract: As part of a wider project on mental health in OECD countries, a series of descriptive profiles have been prepared, intended to provide descriptive, easily comprehensible, highly informative accounts of the mental health systems of OECD countries. These profiles, entitled ‘Mental Health Analysis Profiles’ (MHAPs), will be able to inform discussion and reflection and provide an introduction to and a synthesised account of mental health in a given country. Each MHAP follows the same template, and whilst the MHAPs are stand-alone profiles, loose cross-country comparison using the MHAPs is possible and encouraged. Mental health disorders comprise one of the highest burdens of disease in Finland. The share of disability pensions granted due to mental disorders is high and while the rates of suicide have decreased in recent years, they are still above the OECD average. Consequently, tackling mental ill health is a government priority for Finland. The mental health system has undergone a number of reforms in recent years, and several innovative initiatives have been introduced. Whilst a number of challenges remain, the evolution of the mental health system has been promising, and holds lessons for other OECD countries.
Lancée dans le cadre d’un projet plus vaste consacré à la santé mentale dans les pays de l'OCDE, la série de profils « Santé mentale : profils d’analyse » (Mental Health Analysis Profiles - MHAP) vise à décrire de manière simple et détaillée les systèmes de santé mentale des pays de l'OCDE. Ces profils, qui étayeront les examens et les réflexions qui seront menés, feront le point sur la situation d’un pays donné dans le domaine de la santé mentale. Les profils MHAP sont indépendants les uns des autres mais suivent le même modèle : il est donc possible, et recommandé, de les utiliser pour procéder à des comparaisons entre pays. En Finlande, les troubles de la santé mentale représentent l’une des charges les plus lourdes pour le système de santé. La proportion de pensions d’invalidité versées au titre de troubles mentaux est élevée et bien qu’il ait diminué ces dernières années, le taux de suicide reste supérieur à la moyenne de l'OCDE. C’est pourquoi les pouvoirs publics finlandais ont fait de la santé mentale une priorité. Plusieurs réformes ont été menées dans le système de santé mentale au cours des dernières années, avec le lancement de plusieurs initiatives novatrices. Des problèmes persistent mais l’évolution du système de santé mentale est encourageante et pourrait inspirer d’autres pays de l'OCDE. Classification-JEL: I1 Creation-Date: 2014-07-10 Number: 72 Handle: RePEc:oec:elsaad:72-EN Template-type: ReDIF-Paper 1.0 Author-Name: Alessia Forti Author-Workplace-Name: OECD Author-Name: Chris Nas Author-Workplace-Name: Dutch Association of Mental Health and Addiction Care Author-Name: Alex van Geldrop Author-Workplace-Name: Dutch Association of Mental Health and Addiction Care Author-Name: Gerdien Franx Author-Workplace-Name: Trimbos Institute, Netherlands Institution of Mental Health and Addiction Author-Name: Ionela Petrea Author-Workplace-Name: Trimbos Institute, Netherlands Institution of Mental Health and Addiction Author-Name: Ype van Strien Author-Workplace-Name: Ministry of Health, Welfare and Sport, The Netherlands Author-Name: Patrick Jeurissen Author-Workplace-Name: Radboud University Medical Center Title: Mental Health Analysis Profiles (MhAPs): Netherlands Abstract: As part of a wider project on mental health in OECD countries, a series of descriptive profiles have been prepared, intended to provide descriptive, easily comprehensible, highly informative accounts of the mental health systems of OECD countries. These profiles, entitled ‘Mental Health Analysis Profiles’ (MHAPs), will be able to inform discussion and reflection and provide an introduction to and a synthesised account of mental health in a given country. Each MHAP follows the same template, and whilst the MhAPs are stand-alone profiles, loose cross-country comparison using the MhAPs is possible and encouraged. The Dutch mental health system is highly institutionalised and has a large number of psychiatric beds compared to other OECD countries. Nonetheless, government reforms have aimed at shifting the axis of the system from bed-based hospital services to more integrated mental health services and community-based services. Structural changes to the Dutch mental health system, together with recent government policies that aim to improve access to mental health services, have led to decreasing the treatment gap for mental disorders but also to increasing the expenditures associated with mental health care up until 2011.
Lancée dans le cadre d’un projet plus vaste consacré à la santé mentale dans les pays de l'OCDE, la série de profils « Santé mentale : profils d’analyse » (Mental Health Analysis Profiles - MHAP) vise à décrire de manière simple et détaillée les systèmes de santé mentale des pays de l'OCDE. Ces profils, qui étayeront les examens et les réflexions qui seront menés, feront le point sur la situation d’un pays donné dans le domaine de la santé mentale. Les profils MHAP sont indépendants les uns des autres mais suivent le même modèle : il est donc possible, et recommandé, de les utiliser pour procéder à des comparaisons entre pays. Le système de santé mentale néerlandais s’appuie en grande partie sur les soins en établissement et compte un grand nombre de lits de psychiatrie par rapport à d'autres pays de l'OCDE. Néanmoins, les réformes entreprises par le gouvernement visent à réorienter le système de santé mentale des services hospitaliers vers des services spécialisés et des services de proximité plus intégrés. Les réformes structurelles qui ont été menées, ainsi que les récentes mesures visant à améliorer l'accès aux services de santé mentale, ont permis de réduire les lacunes en matière de traitement des troubles mentaux, mais elles ont aussi fait augmenter les dépenses liées aux soins de santé mentale jusqu'en 2011. Classification-JEL: I1 Creation-Date: 2014-08-25 Number: 73 Handle: RePEc:oec:elsaad:73-EN Template-type: ReDIF-Paper 1.0 Author-Name: Alessia Forti Author-Workplace-Name: OECD Title: Mental Health Analysis Profiles (MhAPs): Scotland Abstract: As part of a wider project on mental health in OECD countries, a series of descriptive profiles have been prepared, intended to provide descriptive, easily comprehensible, highly informative accounts of the mental health systems of OECD countries. These profiles, entitled ‘Mental Health Analysis Profiles’ (MHAPs), will be able to inform discussion and reflection and provide an introduction to and a synthesised account of mental health in a given country. Each MHAP follows the same template, and whilst the MHAPs are stand-alone profiles, loose cross-country comparison using the MHAPs is possible and encouraged. Mental health is a priority area within the Scottish health care agenda. In the Scottish mental health system significant focus is given to recovery, service user involvement, anti-stigma initiatives, and suicide reduction strategies. Amongst the peculiarities, and strengths, of the Scottish mental health system are its focus on data collection, monitoring and evaluation, with a strong focus on improvement and delivery, as data collection and mental health indicators are turned into a management tool for policy makers. However, better indicators could be developed to monitor specialist mental health services delivered in the community.
Lancée dans le cadre d’un projet plus vaste consacré à la santé mentale dans les pays de l'OCDE, la série de profils « Santé mentale : profils d’analyse » (Mental Health Analysis Profiles - MHAP) vise à décrire de manière simple et détaillée les systèmes de santé mentale des pays de l'OCDE. Ces profils, qui étayeront les examens et les réflexions qui seront menés, feront le point sur la situation d’un pays donné dans le domaine de la santé mentale. Les profils MHAP sont indépendants les uns des autres mais suivent le même modèle : il est donc possible, et recommandé, de les utiliser pour procéder à des comparaisons entre pays. La santé mentale est un domaine prioritaire du programme de l’Écosse en matière de soins de santé. Le système de santé mentale écossais met l’accent sur la guérison, l’implication des patients, les initiatives de lutte contre la stigmatisation et les plans d’action contre le suicide. Le système de santé mentale de l’Écosse se distingue par certaines spécificités et plusieurs points forts, notamment la priorité accordée à la collecte de données, au suivi et à l'évaluation, avec un fort accent sur l'amélioration et la diffusion, la collecte de données et les indicateurs de la santé mentale étant convertis en outils de gestion à l’intention des décideurs. Toutefois, de meilleurs indicateurs pourraient être développés pour le suivi des services de santé mentale de proximité. Classification-JEL: I1 Creation-Date: 2014-07-07 Number: 74 Handle: RePEc:oec:elsaad:74-EN Template-type: ReDIF-Paper 1.0 Author-Name: Francette Koechlin Author-Workplace-Name: OECD Author-Name: Paul Konijn Author-Workplace-Name: Eurostat Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Paul Schreyer Author-Workplace-Name: OECD Title: Comparing Hospital and Health Prices and Volumes Internationally: Results of a Eurostat/OECD Project Abstract: Health services account for a large and increasing share of production and expenditure in OECD and Eurostat countries but there are also noticeable differences between countries in expenditure per capita. Whether such differences are due to more services being consumed or whether they reflect differences in the price of services is a question of significant policy relevance. Yet, cross-country comparisons of health services have typically not disentangled these effects. This paper presents the results of a joint effort between OECD and Eurostat in developing price comparisons for health goods and services. The main novel feature is the collection of comparable and output-based prices for hospital services that can then be applied to matching national accounts expenditure data so as to derive consistent price and volume comparisons of health products. The data is novel in that it reflects “quasi prices” (negotiated or administrative prices or tariffs) of the output of hospital services, instead of prices of inputs such as wages of medical personnel. The new methodology moves away from the traditional input perspective, thereby relaxing the assumption that hospital productivity is the same across countries...
Les services de santé représentent une part importante et croissante de la production et des dépenses dans les pays de l'OCDE et d'Eurostat, mais des différences notables apparaissent au regard des dépenses par habitant. Savoir si de telles différences sont dues aux quantités des services consommés ou si celles-ci reflètent des différences dans le prix des services est une question fondamentale pour mener des politiques pertinentes. Jusqu’à présent, les comparaisons internationales des services de santé n’ont pourtant pas permis de distinguer ces effets. Ce document présente les résultats d'un effort conjoint entre l'OCDE et Eurostat dans le développement de comparaisons de prix pour les biens et services de santé. Le caractère novateur de cette étude est la collecte de prix comparables pour les services hospitaliers, prix qui peuvent être ensuite appliqués aux dépenses de comptabilité nationale correspondantes pour obtenir des comparaisons cohérentes de prix et de volume des produits de santé. Les données sont inédites car elles reflètent les "quasi-prix" (prix négociés ou réglementés ou tarifs) de la production des services hospitaliers, au lieu des prix des facteurs de production (« input ») tels que les salaires du personnel médical. La nouvelle méthodologie s'écarte de la perspective traditionnelle basée sur les facteurs de production, s’éloignant ainsi de l'hypothèse que la productivité des hôpitaux est la même dans tous les pays... Classification-JEL: C43; I10; M41 Creation-Date: 2014-08-26 Number: 75 Handle: RePEc:oec:elsaad:75-EN Template-type: ReDIF-Paper 1.0 Author-Name: Kees van Gool Author-Workplace-Name: OECD Author-Name: Mark Pearson Author-Workplace-Name: OECD Title: Health, Austerity and Economic Crisis: Assessing the Short-term Impact in OECD countries Abstract: The economic crisis that started in 2008 has had a profound impact on the lives of citizens. Millions of people lost their job, saw their life-savings disappear and experienced prolonged financial hardship. The economic crisis has also led a number of OECD governments to introduce austerity measures to reduce public deficits. The health sector, like many other social welfare programmes, has witnessed extensive spending cuts and has also been the subject of substantial reforms. The combined effects of economic crisis, austerity and reforms have led many OECD health systems into unchartered territory.This paper looks at the impact of economic crisis on health and health care. It summarises findings from the published literature on the effects of economic crisis that took place over the past few decades and also describes recent health policy reforms, focusing on those countries where the economic crisis has hit hardest. Finally, this paper analyses the empirical relationship between unemployment and health care use, quality and health outcomes, using data from OECD Health Statistics. In doing so, it investigates whether the effects of unemployment on health outcomes have been extenuated by austerity measures...
La crise économique qui a débuté en 2008 a eu d’importantes répercussions pour des millions de personnes, qui ont perdu leur travail ou l’épargne de toute leur vie et se trouvent confrontées à des difficultés financières de longue durée. La crise a également conduit plusieurs pays de l’OCDE à adopter des mesures d’austérité pour réduire leur déficit public. Le secteur de la santé, comme beaucoup d’autres programmes de protection sociale, a ainsi été soumis à d’importantes restrictions budgétaires et a fait l’objet de réformes de grande ampleur. Suite à l’effet conjugué de la crise économique, des mesures d’austérité et des réformes, les systèmes de santé de nombre de pays de l’OCDE doivent aujourd’hui se réinventer.Ce document passe en revue les retombées de la crise économique sur la santé et les soins de santé. Il fait la synthèse des résultats de diverses publications sur les effets des crises économiques des dernières décennies et décrit les récentes réformes des politiques de santé, en s’intéressant plus particulièrement aux pays les plus touchés. Enfin, il analyse, à partir des Statistiques de l’OCDE sur la santé, les relations empiriques qui existent entre le chômage et l’utilisation, la qualité et l’efficacité des soins de santé. Dans cette optique, il s’interroge sur la question de savoir si les mesures d’austérité ont contribué à atténuer les effets du chômage sur les résultats en matière de santé... Classification-JEL: C23; H51; I10; I18 Creation-Date: 2014-09-01 Number: 76 Handle: RePEc:oec:elsaad:76-EN Template-type: ReDIF-Paper 1.0 Author-Name: James Buchan Author-Workplace-Name: Queen Margaret University Author-Name: Ankit Kumar Author-Workplace-Name: OECD Author-Name: Michael Schoenstein Author-Workplace-Name: OECD Title: Wage-setting in the Hospital Sector Abstract: This paper examines wage setting mechanisms for health workers in hospitals across eight different OECD countries. It describes similarities and differences and how fixed or fluid these approaches have been in recent years through health system reforms, labour market dynamics and economic pressures. Based on a review of grey literature and expert interviews with officials from the covered countries, it finds that prior to the economic downturn, several countries had signalled a shift to more local and flexible wage setting in the hospital sector but this ambition does not seem to have been realised in full for public sector hospitals in most OECD countries. Fiscal pressures have led to some “recentralisation” of wage setting, particularly in France, Portugal and the United Kingdom. While the extent of centralisation has been a question of considerable debate, the countries covered in this paper suggest that the benefits of centralised and/ or co-ordinated wage setting generally appear to have been given more attention by policy makers. The current research base on the effectiveness of different wage setting approaches is limited. Policy-making would benefit from developing a better understanding of the impact of wage setting on improved hospital performance and quality.
Ce document analyse les mécanismes de détermination des salaires des agents hospitaliers dans huit pays de l’OCDE. Il décrit les similitudes et les différences entre ces mécanismes et évalue la capacité d’adaptation dont ils ont fait preuve ces dernières années face aux réformes des systèmes de santé, à la dynamique du marché du travail et aux pressions économiques. Il ressort d’un examen de la documentation parallèle et d’entretiens menés avec des experts des pays concernés que si, avant la crise économique, plusieurs pays de l’OCDE avaient annoncé que la détermination des salaires dans le secteur hospitalier allait être plus locale et flexible, la plupart d’entre eux semblent ne pas avoir complètement atteint ces objectifs dans les hôpitaux du secteur public. Les difficultés budgétaires ont en effet contraint à une « recentralisation », notamment en France, au Portugal et au Royaume-Uni. L’intérêt de la centralisation fait l’objet d’un large débat, mais dans les pays couverts dans ce document, il semblerait que les décideurs mettent généralement en avant les avantages de la centralisation et/ou de l’harmonisation de la détermination des salaires. La base de recherches sur l’efficacité des différentes approches est actuellement limitée et le processus décisionnel gagnerait à meilleur compréhension des effets de la détermination des salaires sur l’amélioration de la performance et de la qualité des hôpitaux. Classification-JEL: I11; J45; J50 Creation-Date: 2014-09-05 Number: 77 Handle: RePEc:oec:elsaad:77-EN Template-type: ReDIF-Paper 1.0 Author-Name: Grégoire de Lagasnerie Author-Name: Valérie Paris Author-Name: Michael Mueller Author-Workplace-Name: OECD Author-Name: Ankit Kumar Author-Workplace-Name: OECD Title: Tapering payments in hospitals: Experiences in OECD countries Abstract: This study covers “tapering scale” mechanism in hospital payments, i.e. mechanisms linking unit prices to the volume of services produced. This paper begins with an overview of hospital services and hospital payment methods in OECD countries, focusing more specifically on DRG-based payment. It then reviews studies published on economies of scales in hospitals, which is the economic rationale justifying tapering payments. Thereafter, four case studies from Germany, the US State of Maryland, the Czech Republic and Israel offer a detailed insight into the practicalities of introducing this method of controlling hospital volumes and the impacts it has had.
Ce rapport porte sur les politiques de dégressivité tarifaire appliquées au paiement des hôpitaux, c’est-à-dire les mécanismes liant les prix unitaires des services hospitaliers au volume de soins produits. Ce document de travail dresse tout d’abord un panorama de l’offre hospitalière et des modes de paiement des hôpitaux au sein des pays de l’OCDE en étudiant plus spécifiquement le paiement à l’activité. Il présente ensuite une revue des études portant sur les économies d’échelle dans le secteur hospitalier, justification principale de la diminution des tarifs au-delà d’un seuil de production. Enfin, quatre études de cas en Allemagne, l’État du Maryland, la République tchèque et Israël sont présentées afin d’étudier finement les modalités d’instauration et l’impact de ce mécanisme de contrôle des volumes hospitaliers. Classification-JEL: D22; D24; H51; I18; L84; L88 Creation-Date: 2015-03-27 Number: 78 Handle: RePEc:oec:elsaad:78-EN Template-type: ReDIF-Paper 1.0 Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Franco Sassi Author-Workplace-Name: OECD Title: Alcohol consumption and harmful drinking: Trends and social disparities across OECD countries Abstract: Harmful alcohol consumption is one of the leading causes of ill health and premature mortality worldwide. This paper illustrates trends and social disparities in alcohol consumption and harmful drinking in 20 OECD countries. Analyses are based on individual-level data from national health and lifestyle surveys. Alcohol consumption, on average, remained relatively stable in OECD countries over the past 20 years, but with significant variations between countries. However, a closer look at trends and patterns of consumption in specific population groups reveals a more complex picture. Young people are increasingly taking up harmful drinking. Women with high education and high socio-economic status are more likely to engage in harmful drinking than their less educated and less well-off counterparts, while the opposite is observed in men. Levels and patterns of alcohol consumption have an impact on labour market. Heavy alcohol consumption is associated with less employment opportunities, high wage penalties, and lower productivity, whereas light and moderate consumption are associated with positive labour market outcomes. By shedding light on some of the dimensions of alcohol consumption in OECD countries, this paper aims at contributing to the design of appropriate health policies to prevent alcohol-related harms. The findings presented in the paper provide a basis for a quantitative assessment of the impacts of alternative policy options, and may contribute to a better targeting of such policies.
La consommation à risque d’alcool est l’une des principales causes de maladie et de mortalité prématurée dans le monde. Ce document de travail s’intéresse aux tendances et aux disparités sociales face à la consommation d’alcool et à la consommation à risque dans 20 pays de l’OCDE. Les analyses reposent sur des données individuelles d’enquêtes nationales de santé. La consommation d’alcool est restée en moyenne relativement stable dans les pays de l’OCDE lors des 20 dernières années, malgré de grandes variations entre pays. Une analyse approfondie des tendances et des modes de consommation dans certains groupes de population révèle cependant un schéma plus complexe. Les jeunes adultes adoptent de plus en plus des modes de consommation à risque. Les femmes les plus éduquées ou avec un statut socioéconomique élevé ont davantage une consommation à risque que celles moins éduquées ou avec un statut socioéconomique plus faible, alors que la relation inverse est observée chez les hommes. Les niveaux et les modes de consommation d’alcool ont un impact sur le marché du travail. Une consommation à risque est associée à de plus faibles opportunités d’emploi, des pénalités de salaires plus importantes, et une plus faible productivité, alors qu’une consommation légère et modérée est associée à des résultats positifs. Ce papier apporte un éclairage sur certaines dimensions de la consommation d’alcool dans les pays de l’OCDE, et aide ainsi à la définition de politiques de santé en matière de prévention des risques de la consommation d’alcool. Les résultats présentés dans ce document sont utiles à une évaluation quantitative de l’impact des politiques de prévention, et peuvent contribuer à un meilleur ciblage de ces politiques. Classification-JEL: I10; I12; I14 Creation-Date: 2015-05-01 Number: 79 Handle: RePEc:oec:elsaad:79-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michele Cecchini Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Franco Sassi Author-Workplace-Name: OECD Title: Assessing the impacts of alcohol policies: A microsimulation approach Abstract: Alcohol policies have significant potential to curb alcohol-related harms, improve health, increase productivity, reduce crime and violence, and cut government expenditure. The WHO Global Strategy to reduce the harmful use of alcohol provides a menu of policy options based on international consensus, which the OECD has used as a starting point in identifying a set of policies to be assessed in an economic analysis based on a computer simulation approach. This working paper provides a comprehensive illustration of the modelling approach, input data and underlying assumptions that have been used to carry out the analyses. The policies assessed in three country settings – Canada, the Czech Republic and Germany – include price policies, regulation and enforcement policies, education programmes and health care interventions. The results of the OECD analyses show that brief interventions in primary care, typically targeting high-risk drinkers, and tax increases, which affect all drinkers, have the potential to generate large health gains. The impacts of regulation and enforcement policies as well as other health care interventions are more dependent on the setting and mode of implementation, while school-based programmes show less promise. Alcohol policies have the potential to prevent alcohol-related disabilities and injuries in hundreds of thousands of working-age people in the countries examined, with major potential gains in their productivity. Most alcohol policies are estimated to cut health care expenditures to the extent that their implementation costs would be more than offset. Health care interventions and enforcement of drinking-and-driving restrictions are more expensive policies, but they still have very favourable cost-effectiveness profiles.
Les politiques de l’alcool peuvent jouer un rôle majeur dans la réduction des méfaits de l’alcool, l’amélioration de la santé, l’accroissement de la productivité, la réduction des délits et de la violence, et la diminution des dépenses publiques. La Stratégie mondiale de l’OMS visant à réduire l’usage nocif de l’alcool propose une liste d’options découlant d’un consensus international, que l’OCDE a utilisée comme point de départ pour mettre en lumière un ensemble d’actions à évaluer dans le cadre d’une analyse économique s’appuyant sur un modèle de micro-simulation. Ce document de travail offre une description complète du modèle, des données et des hypothèses sous-jacentes utilisées pour mener les analyses. Les actions évaluées dans trois pays – le Canada, la République tchèque et l’Allemagne – incluent des politiques de prix, des mesures de réglementation et d’application de la législation, des programmes d’éducation et des interventions sanitaires. Les résultats de l’analyse de l’OCDE montrent que l’on peut obtenir d’importants résultats en termes de santé grâce à des interventions brèves dans le cadre de soins primaires, qui ciblent généralement des consommateurs à haut risque, et à des hausses des taxes qui pénalisent tous les consommateurs. L’impact des mesures de réglementation et d’application de la législation, ainsi que d’autres interventions sanitaires, dépendent davantage du contexte et du mode d’application, tandis que les programmes en milieu scolaire semblent quant à eux moins prometteurs. Dans les pays étudiés, les politiques de l’alcool peuvent permettre à des centaines de milliers de personnes en âge de travailler d’éviter les incapacités et les blessures liées à l’alcool, ce qui améliorerait beaucoup leur productivité. On estime que la plupart des politiques de l’alcool pourraient contribuer à réduire les dépenses de santé dans la mesure où leurs coûts de mise en oeuvre seraient plus que compensés. Les interventions sanitaires et l’application de restrictions concernant l’alcool au volant constituent des mesures plus onéreuses, mais présentent quand même des rapports coût-efficacité très positifs. Classification-JEL: D61; D63; H51; I12; I18 Creation-Date: 2015-05-01 Number: 80 Handle: RePEc:oec:elsaad:80-EN Template-type: ReDIF-Paper 1.0 Author-Name: Emily Hewlett Author-Workplace-Name: OECD Author-Name: Kierran Horner Author-Workplace-Name: Department of Health Title: Mental Health Analysis Profiles (MhAPs): England Abstract: As part of a wider project on mental health in OECD countries, a series of descriptive profiles have been prepared, intended to provide descriptive, easily comprehensible, highly informative accounts of the mental health systems of OECD countries. These profiles, entitled ‘Mental Health Analysis Profiles’ (MHAPs), will be able to inform discussion and reflection and provide an introduction to and a synthesised account of mental health in a given country. Each MHAP follows the same template, and whilst the MHAPs are stand-alone profiles, loose cross-country comparison using the MHAPs is possible and encouraged. The English mental health care system can be regarded as one of the clearest examples of a “community care” approach to mental illness, with relatively well established links and networks between mental health care providers and social care providers. Strong links between social support services, for example employment and housing services, and appropriate psychological and medical interventions, have been a priority. Recent developments in the system include the introduction of a programme of talking therapies, IAPT, rolled-out nation-wide, a commitment to introduce waiting times standards for mental health services, and early in 2014 a mental health action plan, Closing the gap: priorities for essential change, which sets out 25 areas for urgent action.
Lancée dans le cadre d’un projet plus vaste consacré à la santé mentale dans les pays de l'OCDE, la série de profils « Santé mentale : profils d’analyse » (Mental Health Analysis Profiles - MHAP) vise à décrire de manière simple et détaillée les systèmes de santé mentale des pays de l'OCDE. Ces profils, qui étayeront les examens et les réflexions qui seront menés, feront le point sur la situation d’un pays donné dans le domaine de la santé mentale. Les profils MHAP sont indépendants les uns des autres mais suivent le même modèle : il est donc possible, et recommandé, de les utiliser pour procéder à des comparaisons entre pays. Le système de santé mentale anglais peut être vu comme un des exemples typiques de système ayant une approche de "soins communautaires" en ce qui concerne les maladies mentales, avec des liens et réseaux relativement bien établis entre les intervenants de soins de santé mentale et les services sociaux. La priorité a été mise sur la nécessité d'avoir des liens étroits entre les services d'aide sociale, par exemple l'emploi et le logement, et les interventions médicales et psychologiques. De récentes évolutions dans ce système sont à noter, telles que l'introduction d'un programme de thérapie parlante, l'IAPT, déployé sur tout le territoire, un engagement pour l'introduction de limites de temps d'attente pour les services de santé mentale, et, au début de 2014, un plan d'action de santé mentale appelé en anglais Closing the gap: priorities for essential change, définissant 25 domaines d'action urgente. Creation-Date: 2015-07-08 Number: 81 Handle: RePEc:oec:elsaad:81-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pauliina Patana Author-Workplace-Name: OECD Title: Mental Health Analysis Profiles (MhAPs): Sweden Abstract: Mental ill-health is a significant issue in Sweden, with both mild-to-moderate and severe disorders representing a significant burden of ill health. Mild and moderate mental health problems constitute the greatest number of cases, and such disorders have been on the rise over the past several decades. However, mental ill-health is also recognised as a vital national issue by Swedish authorities. Accordingly, Sweden has a relatively comprehensive approach to mental health as part of its universal health plan. Sweden was also at the forefront of such trends as deinstitutionalisation and official suicide prevention programs. Country-specific initiatives designed to tackle the most pressing psychological problems in Sweden are in place, including suicide, societal stigma and rising levels of mental problems amongst Swedish youth and workers.
La santé mentale est un problème significatif en Suède avec à la fois des troubles légers à modérés et sévères qui représentent un fardeau considérable dans le domaine de la santé. Les problèmes de santé mentale légers à modérés constituent la majeure partie des cas, et ces troubles sont en augmentation depuis plusieurs décennies. Pour autant, les autorités suédoises reconnaissent la maladie mentale comme un sujet national primordial. C'est pourquoi la Suède adopte une approche relativement globale de la santé mentale dans le cadre de son plan universel de santé. La Suède a aussi été un pays précurseur dans la désinstitutionalisation et la mise en place de programmes officiels de prévention contre le suicide. Des initiatives nationales spécifiques existent pour lutter contre les problèmes psychologiques les plus urgents, tel que le suicide, la stigmatisation sociale et l’augmentation des problèmes mentaux chez les jeunes et les travailleurs suédois. Creation-Date: 2015-07-08 Number: 82 Handle: RePEc:oec:elsaad:82-EN Template-type: ReDIF-Paper 1.0 Author-Name: Caroline Berchet Author-Workplace-Name: OECD Title: Emergency Care Services: Trends, Drivers and Interventions to Manage the Demand Abstract: Emergency departments are the front line of health care systems and play a critical role in ensuring an efficient and high-quality response for patients in stress or crisis situations. A growing demand for emergency care might however reduce patients’ satisfaction (through waiting times), increase health provider workload and adversely affect quality of care. This working paper begins with an overview of the trends in the volume of emergency department visits across 21 OECD countries. It then explores the main drivers of emergency department visits in hospital settings, paying attention to both demand and supply side determinants. Thereafter, national approaches instituted by countries to reduce the demand for emergency care and to guarantee a more efficient use of emergency resources are presented. Classification-JEL: H51; I10; I18 Creation-Date: 2015-08-01 Number: 83 Handle: RePEc:oec:elsaad:83-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: David Morgan Author-Name: Yuki Murakami Author-Workplace-Name: OECD Author-Name: Chris James Author-Workplace-Name: OECD Title: Public Expenditure Projections for Health and Long-Term Care for China Until 2030 Abstract: In recent years, China has seen an unprecedented expansion of health insurance for its population in its quest to achieve universal health coverage. By 2011, 95% of the Chinese population was insured up from less than 50% in 2005 through public or employer-based insurance schemes. As part of this move, the structure of health care financing has shifted significantly, such that public sources in 2013 funded well over half of all health spending, compared with just over a third in the early 2000s. In that context, it is important to determine the main drivers of future growth in health spending in the medium term, to assess the possible impact on public budgets. Using a component-based health expenditure model developed at the OECD, future projections of public spending on health care and long-term care are made for OECD and key emerging economies, including China. The uniform cross-country framework allows for consistent international comparisons under different cost-pressure and cost-containment scenarios.
Ces dernières années, la Chine a connu une expansion sans précédent de la population couverte par l’assurance maladie dans sa quête pour une assurance maladie universelle. Dès 2011, 95% de la population chinoise était assurée contre moins de 50 % en 2005 par le biais de l’assurance maladie publique. Dans cette même mouvance, la structure du financement des soins de santé s'est déplacée de manière significative, au point que plus de la moitié des dépenses de santé est financée publiquement en 2013, contre un peu plus d'un tiers au début des années 2000. Dans ce contexte, il est important de déterminer les principaux moteurs de la croissance future des dépenses de santé à moyen terme, afin d'évaluer l'impact possible sur les budgets publics. En utilisant un modèle component-based des dépenses de santé développé à l'OCDE, des projections de la dépense publique en soins de santé et de longue durée, ont été réalisées pour les pays de l’OCDE et quelques pays émergents, incluant la Chine. L’utilisation d’une méthodologie unique pour l’ensemble des pays permet des comparaisons internationales cohérentes, avec différents scénarios de tension sur les coûts et de maitrise des coûts. Classification-JEL: H51; I12; J11 Creation-Date: 2015-10-12 Number: 84 Handle: RePEc:oec:elsaad:84-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Tomáš Roubal Author-Workplace-Name: World Health Organization Title: International Comparison of South African Private Hospital Price Levels Abstract: The health system in South Africa is unique in many ways. South Africa spends 41.8% of total health expenditures on private voluntary health insurance – more than any OECD country – but only 17% of the population – mostly high income citizens - can afford to purchase private insurance. Given the magnitude of private health expenditures, the activities in the private health care market have an important impact on the functioning of the health care system as a whole. Medical schemes (private health insurance) in South Africa mainly finance care that is predominantly delivered by private providers (i.e., private hospitals, specialists, general practitioners, pharmacies). Therefore, these schemes primarily finance an alternative to seeking care in the public sector and offer services that duplicate those available in the public sector.
Le système de santé sud-africain est unique à plusieurs égards. L'assurance maladie privée volontaire représente 41.8% des dépenses totales de santé sud-africaines - plus que tous les pays de l'OCDE - mais seul 17% de la population – surtout des citoyens à revenus élevés - peut souscrire à une assurance privée. Compte tenu de l'étendue des dépenses de santé privées, les activités du marché privé ont un impact important sur le fonctionnement du système de santé dans son ensemble. Les assurances maladie privées en Afrique du Sud financent principalement des soins fournis par des professionnels privés (hôpitaux privés, spécialistes, généralistes, pharmacies). Elles représentent par conséquent une alternative à la recherche de soins dans le secteur public et offrent les mêmes services que ce dernier. Classification-JEL: C43; D24; I13; M41 Creation-Date: 2016-02-17 Number: 85 Handle: RePEc:oec:elsaad:85-EN Template-type: ReDIF-Paper 1.0 Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Franco Sassi Author-Workplace-Name: OECD Title: The Labour Market Impacts of Obesity, Smoking, Alcohol Use and Related Chronic Diseases Abstract: This paper examines the labour market impacts of lifestyle risk factors and associated chronic diseases, in terms of employment opportunities, wages, productivity, sick leave, early retirement and receipt of disability benefits. It provides a review of the evidence of the labour market outcomes of key risk factors (obesity, smoking and hazardous drinking) and of a number of related chronic diseases, along with findings from new analyses conducted on data from a selection of OECD countries. Overall, the evidence suggests that chronic diseases and associated risk factors have potentially large detrimental labour market impacts, but with mixed findings in some areas. Obesity and smoking clearly impair employment prospects, wages and labour productivity. Cardiovascular diseases and diabetes have negative impacts on employment prospects and wages, and diabetes, cancer and arthritis lower labour productivity. Alcohol use, cancer, high blood pressure and arthritis have mixed effects on employment and wages, and are not always linked with increased sickness absence (e.g. cardiovascular diseases and high blood pressure). Finally, this paper stresses the importance of these findings for the economy at large, and supports the use of carefully designed chronic disease prevention strategies targeting people at higher risk of adverse labour market outcomes, which may lead to substantial gains in economic production through a healthier and more productive workforce.
Ce document examine les impacts sur le marché du travail des facteurs de risque liés aux modes de vie et des maladies chroniques associées, en termes d'opportunités d'emploi, de salaire, de productivité, de congés maladie, de retraite anticipée et de prestations d'invalidité. Il fournit une revue de la littérature des impacts sur le marché du travail des principaux facteurs de risque (obésité, tabagisme et consommation à risque d’alcool) ainsi que d'un certain nombre de maladies chroniques associées, et présente également les résultats de nouvelles analyses empiriques pour une sélection de pays de l’OCDE. Ce travail a révélé que généralement, les maladies chroniques et les facteurs de risques associés ont des impacts néfastes sur le marché du travail potentiellement importants, mais avec des effets mixtes dans certains cas. L’obésité et le tabagisme nuisent clairement à la probabilité d'emploi, aux salaires et la productivité du travail. Les maladies cardiovasculaires et le diabète ont des impacts négatifs sur la probabilité d'emploi et les salaires, et le diabète, le cancer et l'arthrite réduisent la productivité au travail. La consommation à risque d'alcool, les cancers, l'hypertension artérielle et l’arthrite ont des effets mixtes sur l'emploi et les salaires, et ne sont pas toujours liés à une augmentation de l'absentéisme (par exemple, les maladies cardiovasculaires et l'hypertension artérielle). Enfin, ce document souligne l'importance de ces résultats pour l'Économie au sens large, et soutient la mise en place de stratégies de prévention des maladies chroniques, soigneusement conçues, ciblant les personnes les plus vulnérables sur le marché du travail, qui peuvent conduire à des gains importants de production économique grâce à une main-d'oeuvre en meilleure santé et plus productive. Creation-Date: 2015-11-26 Number: 86 Handle: RePEc:oec:elsaad:86-EN Template-type: ReDIF-Paper 1.0 Author-Name: Annalisa Belloni Author-Workplace-Name: OECD Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Valérie Paris Author-Workplace-Name: OECD Title: Pharmaceutical Expenditure And Policies: Past Trends And Future Challenges Abstract: Across OECD countries, pharmaceutical spending reached around USD 800 billion in 2013, accounting for about 20% of total health spending on average when pharmaceutical consumption in hospital is added to the purchase of pharmaceutical drugs in the retail sector. This paper looks at recent trends in pharmaceutical spending across OECD countries. It examines the drivers of recent spending trends, highlighting differences across therapeutic classes. While the consumption of medicines continues to increase and to push pharmaceutical spending up, cost-containment policies and patent expiries of a number of top-selling products have exerted downward pressure on pharmaceutical expenditures in recent years. This resulted in a slower pace of growth over the past decade. The paper then looks at emerging challenges for policy makers in the management of pharmaceutical spending. The proliferation of high-cost specialty medicines will be a major driver of health spending growth in the coming years. While some of these medicines bring great benefits to patients, others provide only marginal improvements. This challenges the efficiency of pharmaceutical spending.
Les dépenses pharmaceutiques ont atteint environ 800 milliards USD en 2013 dans les pays de l’OCDE, soit environ 20 % en moyenne des dépenses de santé totales lorsque l’on ajoute la consommation hospitalière de produits pharmaceutiques à l’achat de médicaments au détail. Ce document examine les tendances récentes en matière de dépenses pharmaceutiques dans les pays de l’OCDE. Il examine les déterminants de l’évolution récente des dépenses, en soulignant les différences entre les classes de médicaments. Alors que la consommation de médicaments continue d’augmenter et de pousser à la hausse les dépenses pharmaceutiques, les politiques de maîtrise des coûts et l'expiration des brevets d'un certain nombre de produits les plus vendus ont exercé une pression à la baisse sur ces dépenses au cours des dernières années. Cela a entraîné un ralentissement de la croissance au cours de la dernière décennie. Le document se penche ensuite sur les défis émergents pour les décideurs politiques en ce qui concerne la gestion des dépenses pharmaceutiques. La prolifération de médicaments de spécialité à coût élevé sera un moteur important de la croissance des dépenses de santé dans les années à venir. Alors que certains de ces médicaments apportent de grands avantages aux patients, d'autres ne fournissent que des améliorations marginales. Cela remet en question l'efficacité des dépenses pharmaceutiques. Classification-JEL: I18 Keywords: dépenses pharmaceutiques, dépenses publiques de santé, health, pharmaceutical expenditure, pharmaceutical policy, politique pharmaceutique, public health, public health expenditures, santé Creation-Date: 2016-04-21 Number: 87 Handle: RePEc:oec:elsaad:87-EN Template-type: ReDIF-Paper 1.0 Author-Name: Valérie Paris Author-Name: Emily Hewlett Author-Workplace-Name: OECD Author-Name: Ane Auraaen Author-Workplace-Name: Organization of American States Author-Name: Jan Alexa Author-Workplace-Name: Organization of American States Author-Name: Lisa Simon Author-Workplace-Name: OECD Title: Health care coverage in OECD countries in 2012 Abstract: This paper provides a detailed description of health coverage in OECD countries in 2012. It includes information on the organisation of health coverage (residence-based vs contributory systems), on the range of benefits covered by basic health coverage and on cost-sharing requirements. It also describes policies implemented to ensure universal health coverage –in most countries- and to limit user charges for vulnerable populations or people exposed to high health spending. The paper then describes the role played by voluntary health insurance as a secondary source of coverage. Combining qualitative information collected through a survey of OECD countries on benefits covered and cost-sharing requirements with spending data collected through the system of health accounts for 2012, this paper provides valuable information on health care coverage in OECD countries at a time universal health coverage is high on the policy agenda of many countries.
Ce document fournit une description détaillée de la couverture santé dans les pays de l’OCDE en 2012. Il contient des informations sur l’organisation de la couverture santé (selon que les droits sont contributifs ou accordé à tout résident), sur l’étendue des services couverts par le régime de base et sur les contributions aux frais demandés aux usagers. Il décrit également les politiques introduites pour atteindre la couverture universelle- dans la plupart des pays ou pour les limiter les dépenses pour les usagers vulnérables ou exposés à des dépenses élevées. Ce document décrit ensuite le rôle joué par l’assurance privée volontaire en tant que source « secondaire » de couverture santé. Combinant l’information qualitative recueillie sur les services couverts et dépenses laissées à la charge des usagers lors d’une enquête menée auprès des pays de l’OCDE et les données sur les dépenses recueillies à travers les comptes de la santé, ce document fournit une information précieuse sur la couverture santé dans les pays de l’OCDE à un moment où la couverture santé universelle est une priorité politique dans de nombreux pays. Classification-JEL: I13; I18 Creation-Date: 2016-05-27 Number: 88 Handle: RePEc:oec:elsaad:88-EN Template-type: ReDIF-Paper 1.0 Author-Name: Caroline Berchet Author-Workplace-Name: OECD Author-Name: Carol Nader Author-Workplace-Name: OECD Title: The organisation of out-of-hours primary care in OECD countries Abstract: Out-of-hours (OOH) services provide urgent primary care when primary care physician (PCP) offices are closed, most often from 5pm on weekdays and all day on weekends and holidays. Based on a policy survey (covering 27 OECD countries) and the existing literature, the working paper describes the current challenges associated with the organisation of OOH primary care and reviews the existing models of delivering OOH primary care. The paper pays particular attention to policies which have been pursued to improve access and quality of OOH primary care. Findings of the paper show that most OECD health systems report key challenges to provide OOH primary care in an accessible and safe way. These challenges relate to (i) PCPs’ reluctance to practise due to high workload and insufficient remuneration; and (ii) geographical variations in access to OOH primary care within each health system. Together these challenges are leading sources of inappropriate hospital emergency department (ED) visits. Results also indicate that several models of OOH primary care exist alongside each other in the 27 OECD countries participating in the policy survey. Hospital EDs, rota groups and practice-based services remain the most common OOH arrangements, but there is a tendency to shift OOH primary care towards primary care centres and large-scale organisations known as general practice cooperatives (GPCs). A range of solutions have been implemented to improve access and quality of OOH primary care across OECD countries. These include providing organisational and financial support to PCPs; using other health care professionals (such as nurse practitioners), making OOH care participation compulsory, setting up a telephone triage system, using new technologies, and developing rich information systems. Classification-JEL: I18 Creation-Date: 2016-09-21 Number: 89 Handle: RePEc:oec:elsaad:89-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ane Auraaen Author-Workplace-Name: OECD Author-Name: Rie Fujisawa Author-Workplace-Name: OECD Author-Name: Grégoire de Lagasnerie Author-Workplace-Name: OECD Author-Name: Valérie Paris Author-Workplace-Name: OECD Title: How OECD health systems define the range of good and services to be financed collectively Abstract: Universal health coverage has been achieved in nearly all OECD countries, providing the population with access to a defined range of goods and services. This paper provides detailed descriptions of how countries delineate the range of benefits covered, including the role of health technology assessment and specific criteria to inform the decision-making process. Further, the paper examines the composition of assessment/appraisal and decision-making bodies across the different OECD health systems, highlighting the role of patients and public as well as transparency of decision-making processes. While the process of including new technologies to the range of benefits covered is structured and relies on a well-defined set of criteria, dynamic adjustments of the range of benefits covered are less structured. The paper then looks at the boundaries of health care coverage and presents a set of services for which coverage varies greatly across the OECD countries.
La quasi-totalité des pays de l’OCDE offrent à présent une couverture maladie universelle, donnant accès à leur population à un panier défini de biens et services de santé. Ce document décrit en détail la manière dont les pays définissent les contours de ce panier de soins, notamment le rôle de l’évaluation des technologies et des critères utilisés pour éclairer la prise de décision. Ce document examine également la composition des instances responsables d’évaluer les technologies et de prendre les décisions en matière de couverture, mettant en évidence le rôle des patients ou du public en général et la transparence du processus de décision. Alors que le processus visant à inclure de nouvelles technologies dans le panier de soins est en général très structuré, les processus d’ajustements dynamiques du panier de soins sont moins bien définis. Ce document analyse enfin les contours du panier de biens et services couverts dans les pays de l’OCDE en analysant un ensemble de biens et services de santé, dont la couverture varie largement d’un pays à l’autre. Classification-JEL: I11; I18 Creation-Date: 2016-11-03 Number: 90 Handle: RePEc:oec:elsaad:90-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Michael Gmeinder Author-Workplace-Name: OECD Author-Name: Jens Wilkens Author-Workplace-Name: OECD Title: An OECD analysis of health spending in Norway Abstract: Norway is one of the top spenders on health care among OECD countries in per capita terms but much closer to the average when seen as a share of GDP. The question is to what extent these two key measures are compatible, and how Norway really measures up to other relevant high-income countries in health spending. In considering the latter, Norway allocates more to long-term care services than any other country. So how comparable are countries in the measurement of sectors such as long-term care and does this play a key role in determining overall spending estimates? Delving further, how does spending on the key sector of somatic specialist health care compared to other countries? If too much is spent, there is a risk that there is an over-emphasis on hospitals compared to primary care. On the other hand if there are too little resources in hospitals, there may be an over-expectation from the sector. However, estimates of spending based on inpatient care still mask a number of organisational and accounting differences, requiring adjustments to be made to the underlying figures. The resulting figures provide a new insight into cross-country comparisons and trends of somatic hospital spending. Finally, to determine what is explaining the different levels of spending, the appropriate use of international spatial deflators is discussed. Recent advances in the methodology to compile comparative price information for the health and hospital sectors are used to reveal to what extent spending across the comparator countries is the result of price or volume effects.
La Norvège est l'un des pays qui dépense le plus pour les soins de santé dans les pays de l'OCDE par habitant, mais ce pays est beaucoup plus proche de la moyenne quand on regarde ces dépenses de santé en proportion du PIB. La question est de savoir si ces deux mesures clés sont compatibles et comment la Norvège se compare réellement par rapport aux autres pays à niveaux de dépenses de santé élevés. Si l'on prend en compte ce dernier point, la Norvège alloue davantage aux soins de longue durée que tout autre pays. On peut ainsi se demander si les pays sont comparables quand il s'agit des dépenses en soins de longue durée et dans quelle mesure cette comparabilité joue un rôle dans l'estimation globale des dépenses ? On peut également se demander comment compare-t-on les dépenses clés relatives aux soins somatiques spécialisés par rapport à d'autres pays ? Si l'on dépense trop, il y a un risque d’accorder une place trop importante aux hôpitaux par rapport aux soins primaires. D'autre part, s'il y a trop peu de ressources dans les hôpitaux, il peut y avoir des attentes trop fortes sur le secteur. Toutefois, les estimations des dépenses fondées sur les soins hospitaliers cachent encore un certain nombre de différences organisationnelles et comptables, nécessitant d'apporter des ajustements aux chiffres sous-jacents. Les chiffres qui en résultent fournissent un nouvel aperçu des comparaisons entre pays et des tendances des dépenses somatiques dans les hôpitaux. Enfin, pour déterminer ce qui explique les différents niveaux de dépenses, l'utilisation appropriée des déflateurs spatiaux internationaux est examinée. Les progrès récents des méthodologies permettant de compiler l'information comparative sur les prix pour les secteurs de la santé et des hôpitaux sont utilisés pour révéler dans quelle mesure les dépenses dans les pays comparateurs sont le résultat d’un effet prix ou d’un effet volume. Keywords: health care, health spending Creation-Date: 2017-01-18 Number: 91 Handle: RePEc:oec:elsaad:91-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Name: Jonathan Millar Author-Name: Franco Sassi Author-Name: Douglas Sutherland Title: Cyclical vs structural effects on health care expenditure trends in OECD countries Abstract: Health care expenditure per person, after accounting for changes in overall price levels, began to slow in many OECD countries in the early-to-mid 2000s, well before the economic and fiscal crisis. Using available estimates from the OECD’s System of Health Accounts (SHA) database, we explore common trends in health care expenditure since 1996 in a set of 22 OECD countries. We assess the extent to which the trends observed are the results of cyclical economic influences, and the respective contributions of changes in relative prices, health care volumes and coverage to the slowdown in health care expenditure growth. Our analysis suggests that cyclical factors may account for a little less than one half of the estimated slowdown in health care spending since the crisis, suggesting that structural changes have contributed to the trends. Before the crisis the slowdown in health care expenditure growth was accounted for by health care prices growing less than general prices and a reduction in care volumes, whereas the latter accounts for most of the steeper deceleration after the crisis. Although both privately and publically financed health care expenditure grew at a reduced pace during the study period, the sharp post-crisis deceleration happened mostly in the public component. When examined by function, the slowdown in publicly-financed expenditure has been largest in curative and rehabilitative care (particularly after the crisis) and in medical goods (especially pharmaceuticals), whereas the deceleration in the privately financed component is largely in medical goods (including pharmaceuticals). We conclude that structural changes in publicly financed health care have constrained the growth of care volumes (especially) and prices leading to a marked reduction in health care expenditure growth rates, beyond what could be expected based on cyclical economic fluctuations. We examine a range of government policies enacted in a selection of OECD countries that likely contributed to the structural changes observed in our analysis. Classification-JEL: C23; H51; I18 Creation-Date: 2017-02-24 Number: 92 Handle: RePEc:oec:elsaad:92-EN Template-type: ReDIF-Paper 1.0 Author-Name: Tim Muir Author-Workplace-Name: OECD Title: Measuring social protection for long-term care Abstract: This report presents the first international quantification and comparison of levels of social protection for long-term care (LTC) in 14 OECD and EU countries. Focusing on five scenarios with different LTC needs and services, it quantifies the cost of care; the level of coverage provided by social protection systems; the out-of-pocket costs that people are left facing; and whether these costs are affordable. The cost of care varies widely between countries but it is always high relative to typical incomes, meaning that LTC is often unaffordable in the absence of social protection. All countries studied have some form of social protection for LTC, but even where coverage is comprehensive, people pay some of the cost out of pocket. Coverage for home care for moderate or severe needs is often insufficient, leaving people with large out-of-pocket costs. In contrast, all countries studied ensure that institutional care is affordable. Unless family and friends can provide informal care, many people will be unable to afford LTC in their own home, leaving them with unmet needs or at risk of early institutionalisation. Benefits are usually means-tested to provide more support to those less able to afford to contribute, but it is still those with lowest incomes that are most likely to face unaffordable costs. Some countries provide financial support to informal carers, but this rarely comes close to compensating them for the time they spend providing LTC. When designing social protection systems for LTC, countries need to look systematically at the level of protection provided to people in different scenarios. Many countries aim to support people with LTC needs to remain in their own home for longer, but the results presented here suggest that gaps in social protection make this unaffordable for people with low income. Addressing these gaps should be a priority for future reforms. Classification-JEL: I13 Creation-Date: 2017-03-27 Number: 93 Handle: RePEc:oec:elsaad:93-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Alberto Marino Author-Workplace-Name: OECD Title: Understanding variations in hospital length of stay and cost: Results of a pilot project Abstract: Hospitals are the most expensive component of OECD health care systems, accounting for around one third of total health care expenditure. Given growing pressures on government budgets, this is an area of expenditure that has already been, and will continue to be, thoroughly scrutinised for potential increases in efficiency. One way to assess hospital efficiency is to measure the amount of resources each hospital uses to treat specific conditions. A care delivery process may be seen as more efficient – after accounting for broader health system and market factors that may constrain the hospital from operating at an efficient level – if it consumes fewer resources while delivering adequate care for the same condition, the dimension of efficiency under review here. In this light, measuring hospital length of stay and costs for a given condition helps the understanding of how efficient (better performing) hospitals are relative to each other. Through international comparative work, this paper helps policy makers understand the scope and nature of length of stay/costs variation across hospitals in OECD countries. It also explores whether characteristic of hospitals or of countries' regulatory and operating environments can explain differences in efficiency. Data on length of stay and costs to treat patients admitted to hospitals for nine tracing conditions/treatments were collected and analysed for Canada (Alberta province), France, Ireland and Israel for 2012-2014. Our analysis shows that hospitals with a number of beds ranging between 200 and 600, and not-for-profit hospitals report shorter length of stay and lower costs for several conditions/treatments. It also shows that variations in efficiency are more likely to exist at the hospital level for cardiac surgery (acute myocardial infarction with percutaneous transluminal coronary angioplasty and coronary artery bypass graft), and at country level for hysterectomy, caesarean section and normal delivery. These results shed some light on the importance of hospital payment system in fostering efficiency in care delivery for standard/high volume treatments such as normal delivery, whereas hospital management and organisation seem to drive efficiency for more complex/technology driven treatments such as bypass surgery. Classification-JEL: D24; I18 Creation-Date: 2017-04-11 Number: 94 Handle: RePEc:oec:elsaad:94-EN Template-type: ReDIF-Paper 1.0 Author-Name: Alberto Marino Author-Workplace-Name: OECD Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Chris James Author-Workplace-Name: OECD Title: Future trends in health care expenditure: A modelling framework for cross-country forecasts Abstract: Across the OECD, healthcare spending has typically outpaced economic growth in recent decades. While such spending has improved health outcomes, there are concerns about the financial sustainability of this upward trend, particularly as healthcare systems are predominantly funded from public resources in most OECD countries. To better explore this financial sustainability challenge, many countries and international institutions have developed forecasting models to project growth in future healthcare expenditure.Despite methodological differences between forecasting approaches, a common set of healthcare spending drivers can be identified. Demographic factors, rising incomes, technological progress, productivity in the healthcare sector compared to the general economy (Baumol’s cost disease) and associated healthcare policies have all been shown to be key determinants of healthcare spending. Classification-JEL: C53; H51; I18; J11 Creation-Date: 2017-06-23 Number: 95 Handle: RePEc:oec:elsaad:95-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luke Slawomirski Author-Workplace-Name: OECD Author-Name: Ane Auraaen Author-Workplace-Name: OECD Author-Name: Nicolaas S. Klazinga Author-Workplace-Name: OECD Title: The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level Abstract: About one in ten patients are harmed during health care. This paper estimates the health, financial and economic costs of this harm. Results indicate that patient harm exerts a considerable global health burden. The financial cost on health systems is also considerable and if the flow-on economic consequences such as lost productivity and income are included the costs of harm run into trillions of dollars annually. Because many of the incidents that cause harm can be prevented, these failures represent a considerable waste of healthcare resources, and the cost of failure dwarfs the investment required to implement effective prevention. The paper then examines how patient harm can be minimised effectively and efficiently. This is informed by a snapshot survey of a panel of eminent academic and policy experts in patient safety. System- and organisational-level initiatives were seen as vital to provide a foundation for the more local interventions targeting specific types of harm. The overarching requirement was a culture conducive to safety. Classification-JEL: H51; I10; I18; I19 Creation-Date: 2017-06-26 Number: 96 Handle: RePEc:oec:elsaad:96-EN Template-type: ReDIF-Paper 1.0 Author-Name: David McDaid Author-Workplace-Name: London School of Economics Author-Name: Emily Hewlett Author-Workplace-Name: OECD Author-Name: A-La Park Author-Workplace-Name: London School of Economics Title: Understanding effective approaches to promoting mental health and preventing mental illness Abstract: The health, social and economic consequences of poor mental health are substantial. More attention is focusing now on the development of actions to promote better mental health and wellbeing and prevent mental ill-health. This paper provides an overview of the development of approaches to promoting mental wellbeing and preventing mental ill-health in OECD countries, together with an assessment of what is known on their effectiveness and cost effectiveness. The paper finds that there is a sound and quite extensive evidence base for effective and cost effective actions which can promote mental wellbeing and prevent mental ill-health. However, the existence of actions and programmes in mental health promotion and prevention is uneven both between countries, and across different points of the life course. Many countries could stand to scale-up their promotion and prevention efforts in the mental health field, and further efforts are particularly needed to introduce interventions targeted at unemployed and older populations. Classification-JEL: I10; I12 Creation-Date: 2017-10-10 Number: 97 Handle: RePEc:oec:elsaad:97-EN Template-type: ReDIF-Paper 1.0 Author-Name: Claudia B. Maier Author-Workplace-Name: Technical University, Berlin Author-Name: Linda H. Aiken Author-Workplace-Name: University of Pennsylvania Author-Name: Reinhard Busse Author-Workplace-Name: Technical University, Berlin Title: Nurses in advanced roles in primary care: Policy levers for implementation Abstract: Many OECD countries have undergone reforms over the past decade to introduce advanced roles for nurses in primary care to improve access to care, quality of care and/or to reduce costs. This working paper provides an analysis of these nurse role developments and reforms in 37 OECD and EU countries. Four main trends emerge: 1) the development in several countries of specific advanced practice nursing roles at the interface between the traditional nursing and medical professions; 2) the introduction of various new, supplementary nursing roles, often focused on the management of chronic conditions; 3) the rise in educational programmes to train nurses to the required skills and competencies; and 4) the adoption of new laws and regulations in a number of countries since 2010 to allow certain categories of nurses to prescribe pharmaceuticals (including in Estonia, Finland, France, Netherlands, Poland and Spain). Classification-JEL: I10; I18; J2 Keywords: policy response, policyresponse Creation-Date: 2017-11-20 Number: 98 Handle: RePEc:oec:elsaad:98-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jillian Oderkirk Author-Workplace-Name: OECD Title: Readiness of electronic health record systems to contribute to national health information and research Abstract: All countries are investing in the development of electronic health (clinical) records, but only some countries are moving forward the possibility of data extraction for research, statistics and other uses that serve the public interest. This study reports on the development and use of data from electronic health records in twenty-eight countries. It reports on the prevalence of technical and operational factors that support countries in the development of health information and research programmes from data held within electronic health record systems, such as data coverage, interoperability and standardisation. It examines data quality challenges and how some countries are addressing them and it explores the governance of electronic health record systems and data, including examples of national statistical and research uses of data. The report provides an overall assessment of the readiness of countries to further develop health information from data within electronic health record systems and describes the outlook for the future. Ten countries are identified as having high readiness that enables them to develop world-class health information systems supporting health system quality, efficiency and performance and creates a firm foundation for scientific research and discovery. Classification-JEL: I1; O3; O5 Creation-Date: 2017-12-04 Number: 99 Handle: RePEc:oec:elsaad:99-EN Template-type: ReDIF-Paper 1.0 Author-Name: Sahara Graf Author-Name: Michele Cecchini Author-Workplace-Name: OECD Title: Diet, physical activity and sedentary behaviours: Analysis of trends, inequalities and clustering in selected oecd countries Abstract: Prevalence of non-communicable diseases has increased in past decades in the OECD. These conditions have many risk factors, including poor quality diet, insufficient physical activity, and excess sedentarism. These behaviours are also at the root of overweight and obesity, which are themselves risk factors leading to non-communicable diseases. Using the most recent data available from individual-level national health surveys and health interviews, this paper paints a picture of the situation in terms of diet and physical activity in eleven OECD countries. Fruit and vegetable consumption remains low in all countries, as daily consumption of five fruit and vegetables per day rarely reaches 40%; diet quality can also be improved, although it is higher in some countries. Physical activity levels are more encouraging, with over 50% of the population reporting to reach the World Health Organization target in all countries, and excess sedentarism is high in two of the seven countries studied. Disparities by level of education and socio-economic status are visible for all health behaviours: overall, those with higher socio-economic characteristics consume a healthier diet and are more physically active, but also more sedentary. Inequalities and gender gaps vary by country and by health indicator. A latent class analysis was run to classify individuals into different groups, depending on their various health behaviours (adherence to national diet guidelines, sufficient physical activity, and low sedentarism). This approach demonstrated that these behaviours are linked, and allowed to determine the traits (demographic, health) of individuals in each class. This analysis allows policy-makers to specifically target these populations with interventions aiming to improve their health. Globally, men with higher socio-economic characteristics were more likely to be in the groups displaying less healthy behaviours. Classification-JEL: D12; I12; I14; I18 Creation-Date: 2017-12-11 Number: 100 Handle: RePEc:oec:elsaad:100-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michael Gmeinder Author-Workplace-Name: OECD Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Michael Mueller Author-Workplace-Name: OECD Title: How much do OECD countries spend on prevention? Abstract: OECD countries face the multiple challenges of rapidly ageing societies with the associated rise in chronic diseases and the ever-present threat from new or evolving communicable diseases. This is within the context of seeking better value for money from the health sector. While a growing body of evidence shows that many health promotion and disease prevention measures can improve health outcomes at relatively low cost, less has been documented – in an internationally comparable way – on how much countries actually invest in such activities and the drivers of prevention spending over the years. This is particularly pertinent in the context of fiscal sustainability and tight public budgets. Using newly available data from across OECD countries, this study examines the differences in spending on prevention both at an aggregate and detailed level. This analysis brings a fresh perspective and raises questions as to the optimal resource allocations within the sector. Time series data is also scrutinised in conjunction with collated policy and public health developments from a number of countries to try to identify some of the drivers behind the observed prevention spending trends. In doing so, directions for further improvement in the underlying data as well as policy implications are discussed. Classification-JEL: H51; I18 Creation-Date: 2017-12-15 Number: 101 Handle: RePEc:oec:elsaad:101-EN Template-type: ReDIF-Paper 1.0 Author-Name: Rie Fujisawa Author-Workplace-Name: OECD Author-Name: Nicolaas S. Klazinga Author-Workplace-Name: OECD Title: Measuring patient experiences (PREMS): Progress made by the OECD and its member countries between 2006 and 2016 Abstract: The OECD has been leading the work on international comparisons of patient-reported experience measures (PREMs) across its member states for over a decade. This paper synthesises national developments in relation to measuring and monitoring PREMs between 2006 and 2016 across countries participating in the OECD Health Care Quality Indicator expert group. This report shows that most OECD countries measure patient experience at a national level. It also highlights that efforts to measure and report patient-reported measures which used to be conducted in an ad hoc manner previously, have been institutionalised and standardised in an increasing number of countries. This national progress has enabled the international reporting of patient experiences with ambulatory care across 17 OECD countries in the recent edition of OECD’s flagship publication, Health at a Glance 2017. The scope of these indicators is currently limited, but recent national progress suggests that there is an opportunity to expand PREMs data collection in different domains for international reporting. The OECD plans to continue developing PREMs that would be useful for policy makers, and help drive improvements in health system performance for health care users, building on the PREMs work to date undertaken in consultation with countries. Classification-JEL: I12; I18 Creation-Date: 2017-12-19 Number: 102 Handle: RePEc:oec:elsaad:102-EN Template-type: ReDIF-Paper 1.0 Author-Name: Chris James Author-Workplace-Name: OECD Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Franco Sassi Author-Workplace-Name: OECD Title: Inclusive growth and health Abstract: In response to observed growing inequalities in income and other dimensions of well-being, including health, the OECD launched an initiative on Inclusive Growth in 2012. The objective was to help governments find ways to make economic growth more inclusive, so that it translates into meaningful gains in living standards across key dimensions of well-being and different socioeconomic groups. This paper links health to the overall inclusive growth agenda. It assesses the two-way relationship between health and socioeconomic factors. An empirical health production function is specified, using data from 35 OECD countries for the period 1990-2015. This is complemented by a review of the related empirical literature, as well as successful policies across OECD countries. Classification-JEL: I12; I14; I15 Creation-Date: 2017-12-19 Number: 103 Handle: RePEc:oec:elsaad:103-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Fabrice Murtin Author-Workplace-Name: OECD Author-Name: Laura-Sofia Springare Author-Workplace-Name: OECD Author-Name: Ane Auraaen Author-Workplace-Name: OECD Author-Name: Frederic Daniel Author-Workplace-Name: OECD Title: Which policies increase value for money in health care? Abstract: The incentive structures produced by different institutional arrangements in health systems are important determinants of their performance, and can explain some of the differences in cross-country performance patterns.This paper proposes an approach and quantitative method to investigate how different policies and institutions helped achieving better value for money across 26 OECD countries for the period of 2000-2015. To this aim, it uses a panel of health system characteristics indicators - derived from questionnaires sent to countries by OECD in 2008, 2012 and 2016 - that describes primarily health financing and coverage arrangements, health care delivery systems, and governance and resource allocation. Classification-JEL: C23; H51; I18 Creation-Date: 2018-03-07 Number: 104 Handle: RePEc:oec:elsaad:104-EN Template-type: ReDIF-Paper 1.0 Author-Name: Rabia Khan Author-Workplace-Name: OECD Author-Name: Karolina Socha-Dietrich Author-Workplace-Name: OECD Title: Investing in medication adherence improves health outcomes and health system efficiency: Adherence to medicines for diabetes, hypertension, and hyperlipidaemia Abstract: Poor adherence to medications affects approximately half of the patient population, leading to severe health complications, premature deaths, and an increased use of healthcare services. The three most prevalent chronic conditions – diabetes, hypertension, and hyperlipidaemia – stand out regarding the magnitude of avoidable health complications, mortality, and healthcare costs. There are three broad reasons behind these low rates of adherence to chronic disease medications. Firstly,the problem of poor adherence has rarely been explicitly included in national health policy agendas. Secondly, interventions tend to attribute the problem exclusively to patients, while the evidence suggests that health system characteristics – in particular the quality of patient-provider interaction, procedures for refilling prescriptions, or out-of-pocket costs – are lead drivers. Thirdly, patients with chronic conditions frequently feel left out of the decision about their therapy and are inclined to rebuff. This paper identifies enablers that are needed for improving adherence to medication at the system level. Classification-JEL: I12; I18 Creation-Date: 2018-06-28 Number: 105 Handle: RePEc:oec:elsaad:105-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ane Auraaen Author-Workplace-Name: OECD Author-Name: Luke Slawomirski Author-Workplace-Name: OECD Author-Name: Niek Klazinga Author-Workplace-Name: OECD Title: The economics of patient safety in primary and ambulatory care: Flying blind Abstract: Building on published patient safety research literature, this paper aims to broaden the existing knowledge base on safety lapses occurring in primary and ambulatory care settings.The findings of this paper show that safety lapses in primary and ambulatory care are common. About half of the global burden of patient harm originates in primary and ambulatory care, and estimates suggest that nearly four out of ten patients experience safety issue(s) in their interaction with this setting. Safety lapses in primary and ambulatory care most often result in an increased need for care or hospitalisations. Available evidence estimates the direct costs of safety lapses – the additional tests, treatments and health care – in primary and ambulatory care to be around 2.5% of total health expenditure. Safety lapses resulting in hospitalisations each year may count 6% of total hospital bed days and more than 7 million admissions in the OECD. Classification-JEL: H51; I10; I18; I19 Creation-Date: 2018-11-29 Number: 106 Handle: RePEc:oec:elsaad:106-EN Template-type: ReDIF-Paper 1.0 Author-Name: Liliane Moreira Author-Workplace-Name: OECD Title: Health literacy for people-centred care: Where do OECD countries stand? Abstract: In the 21st century care, the old paradigm “because the doctor said so” no longer holds. Individuals are now seeking ways to understand their health options and take more control over their health decisions. But this is not an easy task. Professionals continue to use medical jargon, drug instructions are not always clear, and health information in clinical settings continue to be complex and challenging to navigate. Widespread access to digital technologies offset some of these barriers by democratising access to health information, providing new ways to improve health knowledge and support self care. Nonetheless, when health information is misused or misinterpreted, it can wrongly influence individuals’ preferences and behaviour, jeopardise their health, or put unreasonable demands on health systems. Classification-JEL: I12; I18 Creation-Date: 2018-12-12 Number: 107 Handle: RePEc:oec:elsaad:107-EN Template-type: ReDIF-Paper 1.0 Author-Name: Veena S. Raleigh Author-Workplace-Name: The King's Fund Title: Trends in life expectancy in EU and other OECD countries: Why are improvements slowing? Abstract: This paper reports on trends in life expectancy in the 28 EU countries and some other high-income OECD countries, and examines potential explanations for the slowdown in improvements in recent years. The slowdown in improvements in life expectancy since 2011 has been greatest in the USA, where life expectancy has fallen in recent years, and the UK, but France, Germany, Sweden and Netherlands have also seen a sharp slowdown. Overall, the pace of mortality improvement has slowed in several EU countries and Australia and Canada since 2011. Diseases of older ages are major contributors to the slowdown. Improvements in cardiovascular (CVD) disease mortality have slowed in many countries, respiratory diseases, including influenza and pneumonia, have claimed excess lives in some winters, and deaths from dementia and Alzheimer's disease are rising. In some countries, notably the USA and the UK, mortality improvements have also slowed or even reversed among working age adults because of the rising numbers dying from drug-related accidental poisoning. The report also considers wider contributing factors. Although some risk factors, such as smoking, excessive alcohol consumption, high blood pressure and cholesterol levels, continue to decline in most EU countries, the prevalence of obesity and diabetes continues to rise. Adverse trends in inequalities could also have an impact if some population groups experience lower gains in longevity than others, thereby reducing the overall gain. Looking ahead, it is unclear whether the current slowdown in mortality improvements in some EU countries and the USA is a long-term trend or not, whether the slowdown in major killers such as CVD will persist, and whether or not the excess winter mortality seen in some years becomes a regular feature given population ageing and increasing numbers of frail, older people. The timely monitoring and investigation of mortality trends, including through international collaboration where possible, can facilitate early implementation of remedial strategies. Classification-JEL: I12; I14; I15 Creation-Date: 2019-02-28 Number: 108 Handle: RePEc:oec:elsaad:108-EN Template-type: ReDIF-Paper 1.0 Author-Name: Sabine Vuik Author-Workplace-Name: OECD Author-Name: Marion Devaux Author-Workplace-Name: OECD Author-Name: Michele Cecchini Author-Workplace-Name: OECD Title: Exploring the causal relation between obesity and alcohol use, and educational outcomes Abstract: Two of the most important health risk factors for children and young adults are obesity and alcohol use. These risk factors are known to affect health and wellbeing, but may also have an impact on educational outcomes. The objective of this study was to assess a potential causal relationship between obesity or alcohol use, and educational outcomes, in Germany, the Netherlands, New Zealand, the Russian Federation, the United Kingdom, and the United States. Longitudinal data from cohort studies was used to establish temporal precedence. To ensure the absence of alternative explanations, regression models were adjusted for known confounders; instrumental variables were used to address endogeneity caused by reverse causality and potential unobserved confounders; and fixed effects analyses were used to correct for unobserved time-invariant confounders. The results suggest that the presence of obesity during childhood, as well as alcohol consumption during childhood, can have a negative impact on educational performance and future educational attainment. Classification-JEL: I15; I24; I12; I18 Creation-Date: 2019-04-02 Number: 109 Handle: RePEc:oec:elsaad:109-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Alberto Marino Author-Workplace-Name: OECD Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Chris James Author-Workplace-Name: OECD Title: Health Spending Projections to 2030: New results based on a revised OECD methodology Abstract: To gain a better understanding of the financial sustainability of health systems, the OECD has produced a new set of health spending projections up to 2030 for all its member countries. Estimates are produced across a range of policy situations. Policy situations analysed include a “base” scenario – estimates of health spending growth in the absence of major policy changes – and a number of alternative scenarios that model the effect on health spending of policies that increase productivity or contribute to better lifestyles; or conversely, ineffective policies that contribute to additional cost pressures on health systems. Classification-JEL: C53; H51; I18; J11 Creation-Date: 2019-05-24 Number: 110 Handle: RePEc:oec:elsaad:110-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Workplace-Name: OECD Author-Name: Diana Pinto Author-Workplace-Name: Inter-American Development Bank Author-Name: Frederico Guanais Author-Workplace-Name: OECD Author-Name: Tomas Plaza Reneses Author-Workplace-Name: Inter-American Development Bank Author-Name: Frederic Daniel Author-Workplace-Name: OECD Author-Name: Ane Auraaen Author-Workplace-Name: OECD Title: Health systems characteristics: A survey of 21 Latin American and Caribbean countries Abstract: In 2018, the Inter-American Development Bank and the OECD launched a survey to collect information on key health systems characteristics in Latin American and Caribbean (LAC) countries. This paper presents the information provided by 21 of these countries. It describes country-specific arrangements to organise the population coverage against health risks and the financing of health spending. It depicts the organisation of health care delivery, focusing on the public/private mix of health care provision, provider payment schemes, user choice and competition among providers, as well as the regulation of health care supply and prices. Finally, this document provides information on governance and resource allocation in health systems (decentralisation in decision-making, nature of budget constraints and priority setting). Classification-JEL: I10; I18 Creation-Date: 2019-06-19 Number: 111 Handle: RePEc:oec:elsaad:111-EN Template-type: ReDIF-Paper 1.0 Author-Name: Sahara Graf Author-Workplace-Name: OECD Author-Name: Michele Cecchini Author-Workplace-Name: OECD Title: Current and past trends in physical activity in four OECD countries: Empirical results from time use surveys in Canada, France, Germany and the United States Abstract: Physical inactivity and sedentary behaviours have been rising throughout the OECD in recent decades. Lack of physical activity and excessive sedentary behaviour are well-known risk factors for non-communicable diseases, such as heart diseases, stroke, diabetes, and osteoporosis. As such, reducing physical inactivity and sedentary behaviours and increasing daily physical activity has become a crucial public health issue. Using nationally representative time use surveys, this paper presents the trends in physical activity (PA) and sedentary behaviours over time, in Canada, France, Germany and the United States. A particular focus of this analysis is placed on sport activities. Men and women spend between 80 and 105 minutes daily in physical activities, with women spending more time in domestic physical activity, and men more time in sports. Participation in sport activities has been increasing over time, but no global trend for time spent in sports is visible; additionally, women are consistently less likely than men to report engagement in sport activities. Meanwhile, participation in active travel has been decreasing, displaying no overall trend for duration either. Education-based inequalities for sports participation are higher in men than in women, while income-based inequalities for sports are higher in women than in men. Men and women with a low level of income are more likely to report active travel in all countries. Additional MET (metabolic equivalent) hours spent in sports and non-sports leisure PA, domestic PA, and active travel are all associated with an increase in total PA, while work-related PA as well as other activities are associated with a decrease in total PA. At the individual level, an increase in time spent in all previously mentioned activities is associated with a decrease in total time spent in sedentary behaviours. Classification-JEL: I1; C02; D1 Creation-Date: 2019-06-19 Number: 112 Handle: RePEc:oec:elsaad:112-EN Template-type: ReDIF-Paper 1.0 Author-Name: Alberto Marino Author-Name: Luca Lorenzoni Title: The impact of technological advancements on health spending: A literature review Abstract: The measurement of the impact of technology as a driver of health care expenditure is complex since technological effects are closely interlinked with other determinants such as income and the composition and health status of a population. Furthermore, the impact of the supply of advances in technology on health expenditure cannot be considered in isolation from demand and the policy context and the broader institutional context governing the adoption of new technologies. Hence, it is the interaction of supply and demand factors and the context that determine the ultimate level of technology use.There are also important quality changes that come with technological progress that also have monetary costs and benefits attached. Modelling quality improvements, both in terms of benefits within the health system and outside (e.g. its impact on life expectancy, ageing populations, productivity and GDP), is a challenging task, and no macroeconomic models to date have tried to capture them.This paper presents a comprehensive literature review of the impact of technological advances on health expenditure growth, the ‘cost’ side of the equation. Classification-JEL: H51; I11; O33 Creation-Date: 2019-08-22 Number: 113 Handle: RePEc:oec:elsaad:113-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michael Padget Author-Workplace-Name: OECD Author-Name: Nelly Biondi Author-Name: Ian Brownwood Author-Workplace-Name: OECD Title: Methodological development of international measurement of acute myocardial infarction 30-day mortality rates at the hospital level Abstract: International quality measurement work is moving beyond the consideration of health system or national level variations to understand variations within countries and enable more meaningful cross-country comparison. Hospital performance is one key area where policy makers are increasing their focus on reducing variation, lifting the overall standards of care while minimizing the widespread differences in access and quality of care that are evident within health systems.In 2014 the OECD launched the Hospital Performance Project to better understand performance across countries and strengthen international comparisons. From 2015-2018 the OECD developed a method for measuring hospital level acute myocardial infarction 30-day mortality for international comparison. The methodological development and pilot data collections undertaken over this time have resulted in robust and feasible approach to ongoing routine international hospital level data collections on AMI 30-day mortality rates with potential applications to other subnational level indicators. This paper discusses the development of this measurement including technical as well as practical aspects of collecting, displaying, and analysing such data. Classification-JEL: C18; C13; I14 Creation-Date: 2019-12-13 Number: 114 Handle: RePEc:oec:elsaad:114-EN Template-type: ReDIF-Paper 1.0 Author-Name: Martin Wenzl Author-Workplace-Name: OECD Author-Name: Suzannah Chapman Author-Workplace-Name: OECD Title: Performance-based managed entry agreements for new medicines in OECD countries and EU member states: How they work and possible improvements going forward Abstract: This paper presents findings of an OECD review of managed entry agreements in OECD countries and EU member states conducted in 2018 and 2019. Findings are based on discussions with the OECD Expert Group on Pharmaceuticals and Medical Devices, responses by experts from 12 OECD countries to a survey and semi-structured interviews, and on the literature as well as information published by national authorities responsible for coverage and pricing of medicines. Classification-JEL: H51; I11; I13; O32; O38 Creation-Date: 2019-12-19 Number: 115 Handle: RePEc:oec:elsaad:115-EN Template-type: ReDIF-Paper 1.0 Author-Name: Tiago Cravo Oliveira Hashiguchi Author-Workplace-Name: OECD Title: Bringing health care to the patient: An overview of the use of telemedicine in OECD countries Abstract: Telemedicine is being used across OECD countries to deliver health care in a wide range of specialties, for numerous conditions and through varied means. A growing body of evidence suggests that care delivered via telemedicine can be both safe and effective, in some cases with better outcomes than conventional face-to-face care. Telemedicine services can also be cost-effective in different settings and contexts. However, despite these benefits, these services still represent a small fraction of all health care activity and spending. Important barriers to wider use remain, with providers and patients facing regulatory uncertainty, patchy financing and reimbursement, and vague governance. Due to inequalities in health and digital literacy, patients that most stand to benefit are also often those that are least able to access and make use of telemedicine. Telemedicine has the potential to improve effectiveness, efficiency and equity in health care, but can also introduce new risks and amplify existing inequalities. Classification-JEL: I1; H51; O33 Creation-Date: 2020-01-21 Number: 116 Handle: RePEc:oec:elsaad:116-EN Template-type: ReDIF-Paper 1.0 Author-Name: Tiago Cravo Oliveira Hashiguchi Author-Workplace-Name: OECD Author-Name: Ana Llena-Nozal Author-Workplace-Name: OECD Title: The effectiveness of social protection for long-term care in old age: Is social protection reducing the risk of poverty associated with care needs? Abstract: As people grow old and their health deteriorates, they are likely to require help with everyday activities that were once second nature; they need what is commonly termed long-term care (LTC). With demand for LTC in old age expected to grow, OECD countries face significant challenges in balancing financial sustainability with the provision of effective social protection against the financial risks associated with developing LTC needs – the cost of care can far exceed median incomes and its duration can be many years. This report provides a novel set of comprehensive and internationally comparable estimates of the adequacy, equity and efficiency of public social protection systems for LTC in old age in OECD countries and EU Member States. Using a set of “typical cases” of LTC need to ensure comparability, including different levels of severity and different ways in which needs can be met, this report shows cross-country and regional variations in the total costs of LTC services, the degree of public coverage, the out-of-pocket costs that care recipients face, and the associated poverty risks. The quantitative results are discussed in the context of how different countries design LTC benefits and schemes, including cost-sharing mechanisms. Finally, to illustrate the policy relevance of the analyses, the distributive effects of actual and hypothetical policy scenarios are simulated, including an international free personal care policy, and possible reforms in Ireland and England. Classification-JEL: H53; H75; I31; I38 Creation-Date: 2020-04-28 Number: 117 Handle: RePEc:oec:elsaad:117-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michael Mueller Author-Workplace-Name: OECD Author-Name: Karolina Socha-Dietrich Author-Workplace-Name: OECD Title: Reassessing private practice in public hospitals in Ireland: An overview of OECD experiences Abstract: In 2017, the “Sláintecare Report” proposed a comprehensive overhaul of the Irish health system including a reform proposal to phase out private practice in public hospitals to end the unequal treatment of public and private patients – private patients typically have quicker access to care – and reduce waiting times for public patients. This paper summarises the arguments for and against this practice that were put forward to help inform the subsequent policy debate. The paper compares how private practice is regulated and organised in Ireland with the situation in four other OECD countries – Australia, France, Israel and the United Kingdom - and discusses the costs and benefits of private practice in public hospitals, and highlights potential consequences of a ban on this practice. It also describes the information required when making a decision whether to ban this practice or not. Finally, the paper discusses some alternative policy approaches that could replace or complement a ban of private practice to discontinue the unequal treatment of public and private patients. Classification-JEL: I13; I11; J45 Creation-Date: 2020-05-20 Number: 118 Handle: RePEc:oec:elsaad:118-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Workplace-Name: OECD Author-Name: Solvejg Kristensen Author-Workplace-Name: Aalborg University Hospital Author-Name: Magdalena Burtscher Author-Workplace-Name: OECD Author-Name: Ian Brownwood Author-Workplace-Name: OECD Author-Name: Nicolaas S. Klazinga Author-Workplace-Name: OECD Title: Culture as a cure: Assessments of patient safety culture in OECD countries Abstract: While health care quality has been improving on average in OECD members countries, patient safety remains a central priority for policy makers and health care leaders. A growing research body has found that PSC is associated with numerous positive outcomes, including improved health outcomes, improved patient experience, and organisational productivity and staff satisfaction. Tools to measure PSC have proliferated in recent decades and are now in wide-spread use. This report includes findings from OECD countries on the state of the art for measurement practices related to PSC. Overall, measurement of PSC is prevalent across OECD countries, though the application, purpose, and tools vary. International learning and benchmarking has significant potential for better understanding and improvement of patient safety and health care quality. Classification-JEL: I18; I12 Creation-Date: 2020-06-02 Number: 119 Handle: RePEc:oec:elsaad:119-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ane Auraaen Author-Workplace-Name: OECD Author-Name: Kristin Saar Author-Workplace-Name: OECD Author-Name: Niek Klazinga Author-Workplace-Name: OECD Title: System governance towards improved patient safety: Key functions, approaches and pathways to implementation Abstract: Safety governance refers to the approaches taken to minimise the risk for patient harm across an entity or system. It typically comprises steering and rule-making functions such as policies, regulations and standards. To date, governance has focused on the clinical level and the hospital setting, with limited oversight and control over safety in other parts of the health system. All 25 countries that responded to a 2019 OECD Survey of Patient Safety Governance have enacted legislation that aims to promote patient safety. These practices include external accreditation and inspections of safety processes and outcomes. Safety governance models are also moving away from punishment and shaming towards increased trust and openness. Learning from success as well as failures represents a paradigm shift in safety governance, an approach that has been increasingly adopted in OECD countries. Classification-JEL: I18; I14; I11 Creation-Date: 2020-09-17 Number: 120 Handle: RePEc:oec:elsaad:120-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Workplace-Name: OECD Author-Name: Ana Llena-Nozal Author-Workplace-Name: OECD Author-Name: Nicolaas S. Klazinga Author-Workplace-Name: OECD Title: The economics of patient safety Part III: Long-term care: Valuing safety for the long haul Abstract: Long-term care (LTC) institutions are now providing care to a greater number of people, and more residents with chronic conditions and multiple co-morbidities, than ever before. Trends suggest this strain will continue to increase as OECD populations continue to age. The total cost of avoidable admissions to hospitals from LTC facilities in 2016 was almost USD 18 Billion, equivalent to 2.5% of all spending on hospital inpatient care or 4.4% of all spending on LTC. Research shows that over half of the harm that occurs in LTC is preventable, and over 40% of admissions to hospitals from LTC are avoidable. The root causes of these events can be addressed through improved prevention and safety practices and workforce development—including skill-mix and education. Targeted investments in a number of key areas can have a significant impact by mitigating the main cost drivers of adverse events in LTC. Classification-JEL: I11; I14; I18 Creation-Date: 2020-09-17 Number: 121 Handle: RePEc:oec:elsaad:121-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Junya Ino Author-Workplace-Name: OECD Author-Name: Gabriel Di Paolantonio Author-Workplace-Name: OECD Author-Name: Fabrice Murtin Author-Workplace-Name: OECD Title: Excess mortality: Measuring the direct and indirect impact of COVID-19 Abstract: Assessing the direct and indirect health impact of the COVID 19 pandemic is central in managing public health and other policy measures while learning to co-exist with the virus. Many countries are publishing statistics on COVID 19 related mortality. While the frequent and timely publication of such figures provides insights into the ongoing trends in a given country, differences in coding and reporting practices pose challenges for international comparisons. Looking at the number of total deaths can help to overcome some of these differences in national practices whilst also providing a better view of the overall impact of COVID 19, by taking into account not just the possible underreporting of COVID 19 deaths but also indirect mortality caused, for example, by health systems not being able to cope with other conditions – acute and chronic. Classification-JEL: I30; I10 Creation-Date: 2020-10-20 Number: 122 Handle: RePEc:oec:elsaad:122-EN Template-type: ReDIF-Paper 1.0 Author-Name: Suzannah Chapman Author-Workplace-Name: OECD Author-Name: Valérie Paris Author-Workplace-Name: OECD Author-Name: Ruth Lopert Author-Workplace-Name: OECD Title: Challenges in access to oncology medicines: Policies and practices across the OECD and the EU Abstract: With rapid advancements in oncology, even the wealthiest countries around the globe find it increasingly challenging to provide – and sustain – access to new medicines. Challenges include managing the uncertainty surrounding the extent of benefit of new treatments; complexities in determining the price and place in therapy of certain products; and the need to reconcile affordable, equitable access with spending efficiency and fiscal sustainability. Differences in timing of market entry and heterogeneity of coverage processes and policies contribute to inequity in access across the OECD and EU. Future policies and practices to promote sustainable access to oncology medicines will likely focus on improving affordability for patients and value-for-money for payers. An important element will be strengthening the evidence base, drawing on both clinical trial and “real world” evidence, and enhancing international collaboration and information sharing to improve countries’ collective capacity to address clinical and economic uncertainties. Classification-JEL: H51; I11; I13; I14; I18; L11 Creation-Date: 2020-11-13 Number: 123 Handle: RePEc:oec:elsaad:123-EN Template-type: ReDIF-Paper 1.0 Author-Name: Akiko Maeda Author-Workplace-Name: OECD Author-Name: Karolina Socha-Dietrich Author-Workplace-Name: OECD Title: Skills for the future health workforce: Preparing health professionals for people-centred care Abstract: The landscape of health services delivery is undergoing significant transformation from fragmented and disease-centred toward integrated and people-centred care. Health workers find themselves at the centre of this transformation that demands from them commensurate changes in the skill-set employed in day-to-day practice, among other challenges. The paper identifies transversal (core) skills that are becoming increasingly crucial for all front-line health workers to reap the potential benefits of people-centred care, such as better patient and population outcomes, higher productivity, and higher retention/job satisfaction combined among the workers themselves. These transversal skills include interpersonal skills, such as person-centred communication, interprofessional teamwork, self-awareness and socio-cultural sensitivity, as well as analytical skills, such as adaptive problem solving to devise customised care for individual persons, system thinking, openness to continuous learning, and the ability to use digital technologies effectively. Recognising the need to prepare health professionals for meeting the dual challenges of technically and emotionally complex healthcare workplace is a prerequisite to building and maintaining resilient and resourceful health workforce. This paper provides also a brief overview of skills assessment methods and tools that could be used to evaluate the effectiveness of health workforce policies and suggests a skills assessment strategy to evaluate the impact of reforms on the skills and performance of health workforce. Classification-JEL: I18; I19 Keywords: Health Workforce, Skills Creation-Date: 2021-02-02 Number: 124 Handle: RePEc:oec:elsaad:124-EN Template-type: ReDIF-Paper 1.0 Author-Name: Karolina Socha-Dietrich Author-Workplace-Name: OECD Author-Name: Jean-Christophe Dumont Author-Workplace-Name: OECD Title: International migration and movement of nursing personnel to and within OECD countries - 2000 to 2018: Developments in countries of destination and impact on countries of origin Abstract: This paper presents the most recent data on the extent to which migrant nurses contribute to the nursing workforce in the OECD countries as well as the impact these regular migration flows have on the countries of origin, including an analysis of the developments since 2000. The objective of this paper is to provide new data for policy dialogue at the national and international levels. The shares of foreign-born or foreign-trained nurses have continued to rise over the last two decades across the OECD countries, with intra-OECD migration making up a third of the migration volume. Regarding the impact on countries of origin, emigration rates to OECD countries are generally moderate but a few countries experience significant losses of (needed) nurses. However, for a significant share of the foreign-trained nurses, the data sources do not allow the identification of the country of training. Hence, some of the results should be treated as lower-bound estimates. Classification-JEL: F22; J61; O15 Creation-Date: 2021-02-24 Number: 125 Handle: RePEc:oec:elsaad:125-EN Template-type: ReDIF-Paper 1.0 Author-Name: Karolina Socha-Dietrich Author-Workplace-Name: OECD Author-Name: Jean-Christophe Dumont Author-Workplace-Name: OECD Title: International migration and movement of doctors to and within OECD countries - 2000 to 2018: Developments in countries of destination and impact on countries of origin Abstract: This paper presents the most recent data on the number of migrant doctors in the health workforce in the OECD countries, as well as the impact these regular migration flows have on the countries of origin, including an analysis of the developments since 2000. The objective of this paper is to inform policy dialogue at the national and international levels.The share of migrant doctors has continued to rise over the last two decades across the OECD countries, with around two-thirds of all foreign-born or foreign-trained doctors originating from within the OECD area and upper-middle-income countries. The lower-middle-income countries account for around 30% and low-income countries for 3-4% of the foreign-born and 4% of the foreign-trained doctors. In countries of origin that are large, migration to (other) OECD countries has a moderate impact, but some of the relatively smaller countries or those with weak health systems experience significant losses of (needed) health professionals. Classification-JEL: F22; J61; O15 Keywords: migrant doctors Creation-Date: 2021-02-24 Number: 126 Handle: RePEc:oec:elsaad:126-EN Template-type: ReDIF-Paper 1.0 Author-Name: Jillian Oderkirk Author-Workplace-Name: OECD Title: Survey results: National health data infrastructure and governance Abstract: The strengthening of health data infrastructure and governance is a policy priority of the OECD. This report presents findings from the 2019-20 OECD survey of health data development, use and governance. Health ministries and health data authorities in twenty-three countries responded to the survey. Survey results indicate variability across countries in health data use and governance and identify a small number of countries with most of the policies and practices that protect privacy and health data security and foster the development, use, accessibility and sharing of key national health datasets for research and statistical purposes that were measured. The findings from the survey provide input for further discussion on health data development in multiple areas of work, notably in the digital community. Classification-JEL: I18 Creation-Date: 2021-04-22 Number: 127 Handle: RePEc:oec:elsaad:127-EN Template-type: ReDIF-Paper 1.0 Author-Name: Tiago Cravo Oliveira Hashiguchi Author-Workplace-Name: OECD Author-Name: Luke Slawomirski Author-Name: Jillian Oderkirk Author-Workplace-Name: OECD Title: Laying the foundations for artificial intelligence in health Abstract: Artificial intelligence (AI) has the potential to make health care more effective, efficient and equitable. AI applications are on the rise, from clinical decision-making and public health, to biomedical research and drug development, to health system administration and service redesign. The COVID-19 pandemic is serving as a catalyst, yet it is also a reality check, highlighting the limits of existing AI systems. Most AI in health is actually artificial narrow intelligence, designed to accomplish very specific tasks on previously curated data from single settings. In the real world, health data are not always available, standardised, or easily shared. Limited data hinders the ability of AI tools to generate accurate information for diverse populations with potentially very complex conditions. Having appropriate patient data is critical for AI tools because decisions based on models with skewed or incomplete data can put patients at risk. Policy makers should beware of the hype surrounding AI and identify and focus on real problems and opportunities that AI can help address. In setting the foundations for AI to help achieve health policy objectives, one key priority is to improve data quality, interoperability and access in a secure way through better data governance. More broadly, policy makers should work towards implementing and operationalising the OECD AI Principles, as well as investing in technology and human capital. Strong policy frameworks based on inclusive and extensive dialogue among all stakeholders are also key to ensure AI adds value to patients and to societies. AI that influences clinical and public health decisions should be introduced with care. Ultimately, high expectations must be managed, but real opportunities should be pursued. Classification-JEL: I10; F50; H51; H87; O38 Keywords: Artificial intelligence Creation-Date: 2021-06-11 Number: 128 Handle: RePEc:oec:elsaad:128-EN Template-type: ReDIF-Paper 1.0 Author-Name: Karolina Socha-Dietrich Author-Workplace-Name: OECD Title: Empowering the health workforce to make the most of the digital revolution Abstract: Digital technologies offer unique opportunities to strengthen health systems. However, the digital infrastructure only provide the tools, which on their own cannot transform the health systems, but need to be put to productive use by health workers. This report discusses how to engage and empower the health workforce to make the most of the digital revolution. While many health workers already use some digital tools and perceive the benefits that they bring to them and to patients, many also question the value digital technologies produce in health care or complain about technology getting in the way of work. Moreover, health workers often report not having sufficient opportunities for the up-skilling required to fully use new technologies or that the legal, financial, and organisational aspects of work – designed in the pre-digital era – do not enable them to reap the full benefits of these new technologies. Health workers and patients also demand appropriate safeguards against possible lack of transparency or threats to data privacy. Classification-JEL: I11; I13; J45 Creation-Date: 2021-07-19 Number: 129 Handle: RePEc:oec:elsaad:129-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Workplace-Name: OECD Author-Name: Luke Slawomirski Author-Workplace-Name: OECD Author-Name: Nicolaas S. Klazinga Author-Workplace-Name: OECD Title: The economics of patient safety Part IV: Safety in the workplace: Occupational safety as the bedrock of resilient health systems Abstract: Health care settings are inherently hazardous places, with very unpredictable and complex working environments. These hazards and risks not only result in a range of injuries and ill-health among workers but also jeopardise the safety of patients. The COVID-19 crisis has amplified the importance of ensuring that the health care that is provided is safe—for patients and health workers alike. A sufficient, and capable, workforce, is the foundation of resilient systems. Policy makers need to focus now on how to build and support an appropriate workforce to respond to future shocks. This includes health workers beyond the hospital—including those in community, long-term, and primary care. The safety of both patients and health workers should be protected through appropriate mechanisms to ensure the safety of protective equipment and sufficient supplies, appropriate staffing levels, training and support at the workplace. These governance mechanisms are even more relevant when policy makers face trade-offs between health, safety and economic concerns. Classification-JEL: I12; I18 Creation-Date: 2021-09-10 Number: 130 Handle: RePEc:oec:elsaad:130-EN Template-type: ReDIF-Paper 1.0 Author-Name: Eileen Rocard Author-Workplace-Name: OECD Author-Name: Paola Sillitti Author-Workplace-Name: OECD Author-Name: Ana Llena-Nozal Author-Workplace-Name: OECD Title: COVID-19 in long-term care: Impact, policy responses and challenges Abstract: The COVID-19 crisis has hit the long-term care (LTC) sector particularly hard, with large numbers of people dependent on care and particularly vulnerable to COVID-19 have fallen ill, and a disproportionate rate of LTC workers both exposed to, and infected by, COVID-19. The analysis presented in this report describes the effects of COVID-19 on LTC in OECD countries, mainly showing infection rates and mortality of LTC recipients. It takes stock of the wide range of policy responses that countries have implemented, detailing the changes over time on testing strategies, reduction of interactions and isolation measures, digitalisation of services, and workforce. The report also assesses emergency preparedness in the sector, as well as workforce, organisational and coordination challenges. Finally, the report analyses how policy responses affected care continuity and the well-being of residents while also outlining the effectiveness of vaccination. Classification-JEL: H75; I31; I38 Creation-Date: 2021-10-21 Number: 131 Handle: RePEc:oec:elsaad:131-EN Template-type: ReDIF-Paper 1.0 Author-Name: Sabine Vuik Author-Workplace-Name: OECD Author-Name: Michele Cecchini Author-Workplace-Name: OECD Title: Modelling life trajectories of body-mass index Abstract: Body-mass index (BMI) tends to follow a typical trajectory over the life-course of an individual, increasing in early life while decreasing after middle age. To be able to reflect these trends in the OECD Strategic Public Health Planning for Non-Communicable Diseases (SPHeP-NCDs) model, this paper analyses longitudinal BMI data from 22 countries to build a mixed, autoregressive model predicting an individual’s BMI based on their sex, age and previous BMI. The resulting model shows how young people are likely to see an increase in BMI year-on-year, even if they already have overweight or obesity. It also shows that that a healthy weight in childhood does not protect against future overweight, as BMI continues to increase well into adulthood even for children who start off with a healthy weight. The results of this analysis will be incorporated in the OECD SPHeP NCDs model, to better simulate the longer-term impact of interventions, in particular interventions targeting childhood obesity. Classification-JEL: I12; I18 Keywords: BMI, Public Health Creation-Date: 2021-11-11 Number: 132 Handle: RePEc:oec:elsaad:132-EN Template-type: ReDIF-Paper 1.0 Author-Name: Olivia Wiper Author-Workplace-Name: OECD Author-Name: Sabine Vuik Author-Workplace-Name: OECD Author-Name: Jane Cheatley Author-Workplace-Name: OECD Author-Name: Michele Cecchini Author-Workplace-Name: OECD Title: Cluster analysis to assess the transferability of public health interventions Abstract: A key question policy makers are interested in is whether public health interventions that can be regarded as best practices could be successful implemented in countries other than the country where the policy was originally implemented. Public health interventions that present best practice characteristics, such as Let Food be Your Medicine (LFYM), Multimodal Training Intervention (MTI) and the StopDia intervention, are being assessed as part of the OECD project on best practices. However, while these interventions have been successful in one context, they may not be successful in another for multiple reasons, including population, economic and political factors. This paper presents a data-driven transferability assessment using cluster analysis, to identify groups of countries that have the greatest potential for the successful transfer of a specific interventions. For each of the three best practice interventions mentioned above, key success factors are identified and country-level data on these factors collected from public sources. Then, countries are clustered into groups with similar characteristics. Based on these characteristics, tailored recommendations are made for each cluster of countries regarding the potential transfer of the best practice intervention. This analysis helps policy makers decide whether or not to transfer a public health intervention, and what factors to pay particular attention to when doing so. Four clustering methods are compared (k-means, k-medoids, hierarchical and DBSCAN), using two different methods for preparing the data (Gower distance matrix and aggregated context scores). On balance, k-medoids using Gower distance is found to be the most effective method for clustering countries into groups, taking into account validation statistics, data characteristics, interpretability of the results and flexibility to use with other datasets. The resulting clusters successfully separate the countries into interpretable groups depending on their potential for transferring each intervention. Classification-JEL: I10; I18 Creation-Date: 2022-05-30 Number: 133 Handle: RePEc:oec:elsaad:133-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Name: Nicolaas S. Klazinga Title: Developing international benchmarks of patient safety culture in hospital care: Findings of the OECD patient safety culture pilot data collection and considerations for future work Abstract: Improving patient safety culture (PSC) is a significant priority for OECD countries as they work to improve healthcare quality and safety—a goal that has increased in importance as countries have faced new safety concerns connected to the COVID-19 pandemic. Findings from benchmarking work in PSC show that there is significant room for improvement. Across included survey findings from OECD countries, less than half (46% ) of surveyed health workers believe that important patient care information is transferred across hospital units and during shift changes. Just two-in-five surveyed health workers in OECD countries believe the staffing levels at their workplace are appropriate for ensuring patient safety (40%) or that mistakes and event reports would not held against them (41%). International benchmarking is a feasible and useful addition to exiting measurement initiatives on safety culture and may help accelerate necessary improvements in patient safety outcomes. Classification-JEL: I10; I11; I18; J28; J81 Creation-Date: 2022-01-19 Number: 134 Handle: RePEc:oec:elsaad:134-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Workplace-Name: OECD Author-Name: Emily Hewlett Author-Workplace-Name: OECD Author-Name: Candan Kendir Author-Workplace-Name: OECD Author-Name: Solvejg Kristensen Author-Name: Jan Mainz Author-Workplace-Name: Aalborg University Author-Name: Niek Klazinga Author-Workplace-Name: OECD Title: Establishing standards for assessing patient-reported outcomes and experiences of mental health care in OECD countries: Technical report of the PaRIS mental health working group pilot data collection Abstract: Patient-reported measures are a critical tool for improving policy and practice in mental health care. However, to date, the use of patient-reported measures in mental health care is limited to a small number of countries and settings—and there is a pressing need, both within and across countries, to consistently and effectively measure the effects and impact of care for patients who use mental health care services. The PaRIS pilot data collection on mental health included 15 data sources from 12 countries, collected over the course of 2021. While the scope of included data varied, the results demonstrate increased adoption of national and subnational efforts to capture patient-reported information in mental health care systems. Analysis of data collected through the PaRIS mental health pilot documents, in general, positive patient-reported experiences of mental health care. The results also suggest improvement in patient-reported outcomes for those receiving mental health care services. Classification-JEL: I11; I18; I31 Creation-Date: 2022-02-15 Number: 135 Handle: RePEc:oec:elsaad:135-EN Template-type: ReDIF-Paper 1.0 Author-Name: Nkiruka Eze Author-Workplace-Name: University of Manitoba Author-Name: Michele Cecchini Author-Workplace-Name: OECD Author-Name: Tiago Cravo Oliveira Hashiguchi Author-Workplace-Name: OECD Title: Antimicrobial resistance in long-term care facilities Abstract: Long-term care facilities (LTCFs) provide care for extended periods to older people who frequently require antimicrobials to treat and prevent infection, a leading cause of morbidity and mortality among older LTCF residents. Evidence indicates that, due to a combination of factors related to LTCF residents, prescribers and health care systems, up to 75% of antimicrobial prescriptions in LTCFs are inappropriate, in terms not only of the duration and choice of therapy, but also the need for therapy in the first place. Inappropriate use of antimicrobials is associated with the high rates of multi-drug resistant organisms that are recovered in LTCFs, and may exacerbate the threat of antimicrobial resistance (AMR), both in LTCFs and in the community. Yet, policies to tackle inappropriate antimicrobial use and AMR in LTCFs, such as antimicrobial stewardship and infection prevention and control (IPC), remain underused or suboptimal. Some countries are starting to act but they are a minority. Countries seeking to improve antimicrobial consumption, and minimise the threat of AMR, in LTCFs can: set up routine surveillance systems dedicated to collecting and reporting data on antimicrobial use and resistance in LTCFs; design, implement and enforce multifaceted antimicrobial stewardship programmes that comprehensively address multiple determinants of inappropriate antimicrobial prescribing and use; and adopt IPC programmes tailored to the specific needs and risks of LTCFs. Classification-JEL: I10; F50; H75; O38 Creation-Date: 2022-02-22 Number: 136 Handle: RePEc:oec:elsaad:136-EN Template-type: ReDIF-Paper 1.0 Author-Name: Suzannah Chapman Author-Workplace-Name: OECD Author-Name: Guillaume Dedet Author-Workplace-Name: OECD Author-Name: Ruth Lopert Author-Workplace-Name: OECD Title: Shortages of medicines in OECD countries Abstract: Even in wealthy economies, access to medicines is increasingly affected by medicine shortages – an issue exacerbated with the onset of the COVID-19 pandemic. The aim of this paper was to examine the extent and nature of medicine shortages in OECD countries (pre-COVID-19) and explore the reasons for this growing global problem. Although differences in monitoring mechanisms make multi-country analyses challenging, a sample of 14 OECD countries reported a 60% increase in the number of shortage notifications over the period 2017-2019. While the complexity of pharmaceutical manufacturing and supply chains hampers root cause analyses, available literature suggests that shortages, as reported by marketing authorisation holders, are predominantly due to manufacturing and quality issues. Nevertheless, commercial factors - and the policy settings that influence them - may play an important role. Although several OECD countries have implemented policy measures to mitigate, monitor and prevent shortages, more robust data and further analyses of root causes and effective policy responses are needed. The way forward should involve a global approach that engages all relevant actors and looks beyond the health care sector alone. Classification-JEL: I10; I11; I14; I18; L11 Creation-Date: 2022-03-24 Number: 137 Handle: RePEc:oec:elsaad:137-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Workplace-Name: OECD Author-Name: Rie Fujisawa Author-Workplace-Name: OECD Author-Name: Tiago Cravo Oliveira Hashiguchi Author-Workplace-Name: OECD Author-Name: Niek Klazinga Author-Workplace-Name: OECD Author-Name: Jillian Oderkirk Author-Workplace-Name: OECD Title: Health data and governance developments in relation to COVID-19: How OECD countries are adjusting health data systems for the new normal Abstract: At the onset of the COVID-19 pandemic many countries found that they lacked basic, timely data for decision making—such as information on health workforce, resources, hospitalisations, and mortality. Many policy makers have since leveraged COVID-19 related information system reforms in a way that may also address long-standing barriers in the structures, policies and institutions that have kept countries from fully utilising health related data. Health data governance reforms, in particular, have been an important aspect of countries responses. Improvements in the quality, coverage, completeness, and capacity for data sharing in regard to existing national personal health datasets were widely reported. Countries have also made significant investments in digital tools, systems for public health monitoring, assessments of resource use and availability, and data to monitor the status of non-COVID related health needs. Classification-JEL: I11; I18; J18; K24; K32; L86; O38 Creation-Date: 2022-04-26 Number: 138 Handle: RePEc:oec:elsaad:138-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Fan Xiang Author-Workplace-Name: OECD Title: Improving data on pharmaceutical expenditure in hospitals and other health care settings Abstract: As a key component of health care, a full understanding of how much is spent on prescription medicines is increasingly important. Only a partial understanding of total expenditures across health systems is currently possible, as reporting is often limited to medicines dispensed in community pharmacies. However, spending on pharmaceuticals used elsewhere in the health sector, particularly in hospitals, constitutes a significant and growing proportion of the overall resources allocated to medicines. This report aims to improve the coverage and quality of data on total pharmaceutical spending across the whole health sector, by reviewing current practices, and recommending a set of definitions, concepts and guidance under the framework of A System of Health Accounts 2011. Countries are encouraged to apply these guidelines in their future reporting of pharmaceutical expenditures, as part of their annual health accounts data production. Classification-JEL: I10; I11; I; I19 Keywords: Data, Health Systemes, Pharmaceutical spending, Prescription medicines Creation-Date: 2022-04-27 Number: 139 Handle: RePEc:oec:elsaad:139-EN Template-type: ReDIF-Paper 1.0 Author-Name: Eileen Rocard Author-Workplace-Name: OECD Author-Name: Ana Llena-Nozal Author-Workplace-Name: OECD Title: Supporting informal carers of older people: Policies to leave no carer behind Abstract: Informal carers – family and friends who perform care - are the first line of support for older people. About 60% of older people who receive care at home report receiving only informal care across OECD countries.While informal carers help to contain public costs, those costs are borne elsewhere. Women perform the majority of informal care, posing a barrier to their labour market participation. It is generally impacted when caring over 20 hours per week. The COVID-19 pandemic has increased pressures on carers.Making informal care a choice without constrains requires a comprehensive set of policies. Countries have taken steps, though more could be done. While access to information has improved, counselling and training depends heavily on the voluntary sector and respite typically remains insufficient. About two-thirds of OECD countries provide direct or indirect cash benefits to informal carers. Nearly two-thirds also mandate paid or unpaid care leave entitlements. Classification-JEL: H51; H53; H75; I31; I38; J48 Creation-Date: 2022-05-04 Number: 140 Handle: RePEc:oec:elsaad:140-EN Template-type: ReDIF-Paper 1.0 Author-Name: Rie Fujisawa Author-Workplace-Name: OECD Title: Impact of the COVID-19 pandemic on cancer care in OECD countries Abstract: The COVID-19 pandemic has disrupted primary and secondary prevention efforts as well as routine cancer care including diagnosis and treatment. The number of cancer-related procedures declined across countries. Many of the OECD countries also faced challenges in maintaining and further improving cancer care quality and outcomes during the pandemic. This paper compiles initial findings from a subset of OECD countries covering the period from March 2020 to August 2021. It illustrates how several of these countries attempted to mitigate the impact of COVID-19 on cancer care systems. There have been examples of adapting treatment guidelines, changing clinical practices and reducing backlogs to minimise negative impacts of the pandemic on cancer patients. Several of the countries also undertook more frequent monitoring and in-depth analysis of cancer care performance. The analyses confirm that strong health information infrastructure is crucial for developing resilient health systems that provide effective, timely and people-centred cancer care. Classification-JEL: H12; I11; I12; I14; I18 Creation-Date: 2022-05-05 Number: 141 Handle: RePEc:oec:elsaad:141-EN Template-type: ReDIF-Paper 1.0 Author-Name: Eliana Barrenho Author-Workplace-Name: OECD Author-Name: Philip Haywood Author-Workplace-Name: OECD Author-Name: Candan Kendir Author-Workplace-Name: OECD Author-Name: Nicolaas S. Klazinga Author-Workplace-Name: OECD Title: International comparisons of the quality and outcomes of integrated care: Findings of the OECD pilot on stroke and chronic heart failure Abstract: Across OECD countries, two in three people aged over 65 years live with at least one chronic condition often requiring multiple interactions with different providers, making them more susceptible to poor and fragmented care. This has prompted calls for making health systems more people-centred, capable of delivering high-quality integrated care. Despite promising, mostly local-level, experiences, systems remain fragmented, focused on acute care and unsuitable to solve complex needs. Moreover, assessing and comparing the benefits of integrated care remains difficult given the lack of technically sound, policy-relevant indicators. This report presents the results of the first OECD pilot of a new generation of indicators to support international benchmarking of quality of integrated care. Lessons from the pilot call for further work on: (1) expanding work on indicator development; (2) performing policy analysis to understand cross-country variations on governance models and health financing; (3) upscaling data linkage; and (4) measuring care fragmentation. Classification-JEL: I10; I14 Creation-Date: 2022-05-24 Number: 142 Handle: RePEc:oec:elsaad:142-EN Template-type: ReDIF-Paper 1.0 Author-Name: Doron Wijker Author-Workplace-Name: OECD Author-Name: Paola Sillitti Author-Workplace-Name: OECD Author-Name: Emily Hewlett Author-Workplace-Name: OECD Title: The provision of community-based mental health care in Lithuania Abstract: This paper sets out the OECD’s assessment of the provision of community-based mental health care in Lithuania. It provides an overview of the burden of mental ill health in Lithuania, highlights strengths and challenges of the mental health care system and care delivery, reports on the quality and outcomes of care, and sets out a number of preliminary recommendations for reform. There are four key findings. Firstly, the burden of mental ill-health in Lithuania is significant, and considerable stigma around mental ill-health persists. Secondly, while considerable efforts have been made to strengthen community-based care, resource and capacity constraints limit the type of care that can be delivered in the community. Thirdly, the mental health system remains hospital-centric, and there is a need to clarify care pathways. Finally, greater efforts are required to monitor and ensure the quality of care. Classification-JEL: I10; I11; I12; I13; I14; H51 Creation-Date: 2022-07-13 Number: 143 Handle: RePEc:oec:elsaad:143-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Workplace-Name: OECD Author-Name: Chris James Author-Workplace-Name: OECD Title: Investing in health systems to protect society and boost the economy: Priority investments and order-of-magnitude cost estimates Abstract: COVID-19 is the most significant public health emergency in more than a century, causing a global economic crisis, and with long-term repercussions across society. COVID-19 continues to claim lives, many are suffering ill health (physical and/or mental) due to the virus, and health systems struggle to recover from the massive disruption. This unprecedented crisis has highlighted the urgent need for smart investments to strengthen health system resilience – to protect people’s underlying health, through enhanced preventive care and the ability to reinforce defences in acute times, to fortify the foundations of health systems by ensuring adequate core equipment and exploiting the potential of health information, and to bolster health professionals working on the frontline by building and maintaining sufficient numbers of doctors and nurses – thereby providing countries with the agility to respond not only to evolving pandemics but also to other health and societal shocks. This report identifies a set of priority investment areas needed to strengthen health system resilience. It then produces order-of-magnitude estimates of the expected costs of such investments, drawing extensively from existing OECD data and analytical studies. Classification-JEL: E60; H51; I15; J40; O10; O30 Creation-Date: 2022-07-28 Number: 144 Handle: RePEc:oec:elsaad:144-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luke Slawomirski Author-Name: Niek Klazinga Title: The economics of patient safety: From analysis to action Abstract: Building on previous OECD Health Working Papers on the economics of patient safety, this paper firstly provides an update on the health burden, and financial and economic cost of unsafe care. It then summarises the evidence on the cost-effectiveness and return on investment of various programmes and interventions to improve the safety of care across all care settings. Globally, unsafe care results in over 3 million deaths each year with an estimated disease burden similar to that of HIV/AIDS. In developed countries, the direct cost of unsafe care on to health budgets approaches 13% of healthcare spending (about USD 606 Billion a year or just over 1% of the combined economic output of OECD countries). Using a willingness to pay approach, the full global economic cost is estimated at over USD 1 trillion a year. A human capital approach suggests that patient harm slows global economic growth by 0.7% a year. Improving patient safety requires a whole of system approach, with the value created by implementing and investing in mutually re-enforcing interventions within a policy framework that encompasses all health system strata. Most cost-effective are multi-modal approaches that align clinical, corporate, and professional risk across system silos. Classification-JEL: H51; I10; I19; I18 Creation-Date: 2022-08-12 Number: 145 Handle: RePEc:oec:elsaad:145-EN Template-type: ReDIF-Paper 1.0 Author-Name: Eliana Barrenho Author-Workplace-Name: OECD Author-Name: Ruth Lopert Author-Workplace-Name: OECD Title: Exploring the consequences of greater price transparency on the dynamics of pharmaceutical markets Abstract: For some time, governments, stakeholders and civil society have been voicing the need for greater transparency in pharmaceutical pricing. The 2018 OECD report Pharmaceutical Innovation and Access to Medicines suggested that increased price transparency could promote public accountability, while potentially delivering efficiencies to health systems by including economic considerations in coverage, treatment decisions and budget allocation. Despite this, precisely what should be made more transparent, and how greater transparency would affect the functioning of markets, have been poorly characterised. To help frame the policy debate, the OECD undertook an exploration of the potential consequences of greater price transparency on market dynamics. The work included a roundtable and a series of semi-structured interviews, with participation by 19 experts in pharmaceutical pricing, economics of pharmaceutical markets, competition, and law. With an extensive review of the current practice and relevant literature as a preface, this report presents the key findings from those consultations. Classification-JEL: F6; L1; L2; I10 Creation-Date: 2022-09-08 Number: 146 Handle: RePEc:oec:elsaad:146-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Workplace-Name: OECD Author-Name: Laura Esmail Author-Workplace-Name: OECD Author-Name: Ruth Lopert Author-Workplace-Name: OECD Author-Name: Niek Klazinga Author-Workplace-Name: OECD Title: The economics of medication safety: Improving medication safety through collective, real-time learning Abstract: Poor medication practices and inadequate system infrastructure—resulting in poor adherence, medication-related harms, and medication errors—too often results in patient harm. As many as 1 in 10 hospitalizations in OECD countries may be caused by a medication-related event and as many one in five inpatients experience medication-related harms during hospitalization. Together, costs from avoidable admissions due to medication-related events and added length of stay due to preventable hospital-acquired medication-related harms total over USD 54 billion in OECD countries. This report includes four components; it 1) assess the human impact and economic costs of medication safety events in OECD countries, 2) explores opportunities to improve prescribing practices 3) examines the state-of-the art in systems and policies for improving medication safety, and 4) provides recommendations for improving medication safety at the national level. Classification-JEL: H51; I11; I18; L86 Creation-Date: 2022-09-14 Number: 147 Handle: RePEc:oec:elsaad:147-EN Template-type: ReDIF-Paper 1.0 Author-Name: Candan Kendir Author-Workplace-Name: OECD Author-Name: Katherine de Bienassis Author-Workplace-Name: OECD Author-Name: Luke Slawomirski Author-Workplace-Name: OECD Author-Name: Niek Klazinga Author-Workplace-Name: OECD Author-Name: Micheline Turnau Author-Workplace-Name: Canadian Institute for Health Information Author-Name: Michael Terner Author-Workplace-Name: Canadian Institute for Health Information Author-Name: Greg Webster Author-Workplace-Name: Canadian Institute for Health Information Author-Name: Eric Bohm Author-Workplace-Name: International Society of Arthroplasty Registries Author-Name: Brian Hallstrom Author-Workplace-Name: International Society of Arthroplasty Registries Author-Name: Ola Rolfson Author-Workplace-Name: International Society of Arthroplasty Registries Author-Name: J. Mark Wilkinson Author-Workplace-Name: International Society of Arthroplasty Registries Author-Name: Anne Lübbeke-Wolff Author-Workplace-Name: International Society of Arthroplasty Registries Title: International assessment of the use and results of patient-reported outcome measures for hip and knee replacement surgery: Findings of the OECD Patient-Reported Indicator Surveys (PaRIS) working group on hip and knee replacement surgery Abstract: Osteoarthritis impacts 7% of the global population, affecting more than 500 million people worldwide. As populations of OECD countries age, an increasing number of hip and knee replacement surgeries calls for further work on assessment of quality of care, particularly from patients’ point of view. Thirteen programmes from nine countries participated in the PaRIS Hip and Knee PROMs comparative reporting in 2020-21 by collecting and submitting data by generic and condition-specific PROMs. All programmes showed improvements in patient outcomes though the relative improvement varied. Crosswalks from SF-12 to EQ-5D provided valuable lessons on conversion errors. Results of this work call for improving the use of data for comparative reporting as well as further collaboration on utilising patient-reported metrics in quality-of-care improvement and policymaking. Classification-JEL: I10 Creation-Date: 2022-09-30 Number: 148 Handle: RePEc:oec:elsaad:148-EN Template-type: ReDIF-Paper 1.0 Author-Name: Candan Kendir Author-Name: Rushay Naik Author-Name: Janika Bloemeke Author-Name: Katherine de Bienassis Author-Name: Nicolas Larrain Author-Name: Niek Klazinga Author-Name: Frederico Guanais Author-Name: Michael van den Berg Title: All hands on deck: Co-developing the first international survey of people living with chronic conditions: Stakeholder engagement in the design, development, and field trial implementation of the PaRIS survey Abstract: The OECD's Patient-Reported Indicator Surveys (PaRIS) initiative aims to measure outcomes and experiences of healthcare as part of an effort to improve the value of health system investments. The PaRIS survey, a survey of people living with chronic conditions, is currently being implemented in twenty countries. The PaRIS survey has been developed together with government officials, patients, providers, and researchers. However, the extent of stakeholder involvement varies between countries. This paper reports on the stakeholder engagement in design, development and implementation of the PaRIS survey Field Trial in seventeen countries. Engagement strategies were analysed by target group (patients, providers, or other stakeholders), and engagement level (co-designing, involving, consulting, and informing). The results provide valuable lessons for the implementation of the full PaRIS survey in 2023 and illustrate how stakeholders could be more actively engaged in health services research and policymaking. Classification-JEL: I10 Keywords: Chronic condition Creation-Date: 2023-01-11 Number: 149 Handle: RePEc:oec:elsaad:149-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Name: Zuzanna Mieloch Author-Name: Luke Slawomirski Author-Name: Niek Klazinga Title: Advancing patient safety governance in the COVID-19 response Abstract: In the backdrop of the COVID-19 pandemic, ensuring the safety of health care services remains a serious, ongoing challenge. This once-in-a-century global health crisis exposed the vulnerability of healthcare delivery systems and the subsequent risks of patient harm. Given the scale of the occurrence and costs of preventable patient safety events, intervention and investment are still relatively modest. Good patient safety governance focuses on what leaders and policy makers can do to improve system performance and reduce the financial burden of avoidable care. Moreover, it is essential in driving progress in improving safety outcomes. This report examines how patient safety governance mechanisms in OECD countries have withstood the test of COVID-19 and provides recommendations for countries in further improving patient safety governance and strengthening health system resilience. Classification-JEL: I11; I14; I18 Creation-Date: 2023-02-03 Number: 150 Handle: RePEc:oec:elsaad:150-EN Template-type: ReDIF-Paper 1.0 Author-Name: Suzannah Chapman Author-Name: Anna Szklanowska Author-Name: Ruth Lopert Title: Exploring the feasibility of monitoring access to novel medicines: A pilot study in EU Member States Abstract: Ensuring affordable access to novel medicines has been identified as a policy priority among OECD and EU countries, yet systematic monitoring of the various dimensions of access is lacking. Previous efforts to measure access have focused primarily on one or at most two of these dimensions, such as availability and affordability, but a more holistic picture is needed. The OECD undertook a pilot study in EU Member States that aimed to determine the utility and feasibility of routine, cross-national monitoring of access to medicines across multiple dimensions. The work included a desk review to define the dimensions of access and associated indicators, followed by an OECD survey to explore the feasibility of collecting and analysing the relevant data for a convenience sample of 15 recently authorised product/indication pairs. This working paper presents key learnings from the desk review and country survey to which 21 EU Member States responded, with a focus on exploring the utility and feasibility of the processes of monitoring and measurement. Classification-JEL: I10; I11; I18 Keywords: acceptability, access, accessibility, affordability, availability, novel medicines Creation-Date: 2023-02-14 Number: 151 Handle: RePEc:oec:elsaad:151-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michael Mueller Author-Name: Fan Xiang Author-Name: Caroline Penn Author-Name: Chris James Author-Name: Luca Lorenzoni Author-Name: David Morgan Title: Improving the timeliness of health expenditure tracking in OECD and low- and middle-income countries Abstract: The COVID-19 pandemic has highlighted that access to timely health spending data is crucial for informed policy-making. This Health Working Paper summarises and compares the methodologies applied in around half of OECD countries to estimate public and private health spending for the most recent year (i.e., t-1) as well as the approaches taken by the OECD Secretariat to fill existing data gaps for the remaining OECD countries. For the first time, the paper also explores the feasibility of nowcasting health spending for the current year (i.e., t) and examines data sources that could be potentially useful in such an exercise. While this review should help OECD countries that do not yet have experience in estimating health spending for year t-1 to improve the timeliness in their data reporting, the paper also analyses the applicability of the methods in low- and middle-income countries. Classification-JEL: H51; I19; J11 Creation-Date: 2023-02-27 Number: 152 Handle: RePEc:oec:elsaad:152-EN Template-type: ReDIF-Paper 1.0 Author-Name: Caroline Berchet Author-Name: José Bijlholt Author-Name: Mariko Ando Title: Socio-economic and ethnic health inequalities in COVID-19 outcomes across OECD countries Abstract: The COVID 19 pandemic has disproportionately hit some vulnerable population groups. Those living in deprived areas, migrant population, and ethnic minorities are at higher risk of catching and dying from the virus than other groups, and they also face significant indirect health impacts of the COVID-19 pandemic - both mental health impacts and disruption of routine care. The working paper gathers evidence on the direct and indirect health impacts of the COVID-19 on the poor population and the ethnic minorities. It reviews factors underlying these inequalities, and maps policy interventions adopted by OECD countries to help address the disproportionate impacts of the COVID-19 pandemic on vulnerable population groups. Classification-JEL: I14; I30; I10 Creation-Date: 2023-03-09 Number: 153 Handle: RePEc:oec:elsaad:153-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lindner Author-Name: Luca Lorenzoni Title: Innovative providers’ payment models for promoting value-based health systems: Start small, prove value, and scale up Abstract: Innovative providers’ payment models represent an important policy lever that could be used to promote value-based health systems. By bundling services across the continuum of care or to target acute events or chronic conditions, innovative payment models set financial incentives for providers to increase efficiency in service delivery, improve health outcomes and enhance patient experience with care. This paper offers insights on value-based payment models, a type of innovative payment model implemented in several OECD countries and reviews the publicly available evidence on the impact of those payment models on value. Innovative payment models tend to be exceptional and small-scale compared to activity-based payment models and have been extensively piloted in the United States while implementation and evaluation in other countries is limited. The publicly available empirical evidence points to modest efficiency and quality gains from value-based payment models. Impact on healthcare spending, outcomes and patient experience varies across programmes. Given the significant variation in the key features of value-based payment models and the context-specific issues they address, those models do not offer a one-size-fits-all solution. This paper outlines several intervention points that policy makers need to consider when designing and implementing value-based payment models to maximise their positive outcome. Creation-Date: 2023-04-03 Number: 154 Handle: RePEc:oec:elsaad:154-EN Template-type: ReDIF-Paper 1.0 Author-Name: Marion Devaux Author-Name: Alexandra Aldea Author-Name: Aliénor Lerouge Author-Name: Marina Dorfmuller Ciampi Author-Name: Michele Cecchini Title: Évaluation du programme national de lutte contre le tabagisme en France Abstract: Le tabac est responsable de 13% des décès en France et est l'une des principales causes de maladies non transmissibles (MNT), telles que les cancers, les maladies respiratoires et cardiovasculaires. Pour renforcer sa politique de lutte antitabac, la France a mis en place un train de mesures entre 2016 et 2020 comprenant une augmentation progressive sur trois ans du prix des produits du tabac -correspondant à une augmentation de 41% du prix du paquet de cigarettes le plus vendu, le paquet neutre, une campagne annuelle de sevrage (#MoisSansTabac), et le remboursement des substituts nicotiniques. Ce rapport évalue l'impact sanitaire et économique du train de mesures de lutte antitabac, à l'aide du modèle de microsimulation de l'OCDE pour la planification stratégique de la santé publique pour les MNT (SPHeP-NCD), et il fournit une analyse de la charge du tabac en France et une évaluation économique de la campagne de marketing social pour le sevrage #MoisSansTabac. Classification-JEL: C53; C54; I12; J11 Creation-Date: 2023-06-16 Number: 155 Handle: RePEc:oec:elsaad:155-FR Template-type: ReDIF-Paper 1.0 Author-Name: Eliana Barrenho Author-Name: Marjolijn Moens Author-Name: Lisbeth Waagstein Author-Name: Ruth Lopert Title: Enhancing competition in on-patent markets Abstract: The 2018 OECD report Pharmaceutical Innovation and Access to Medicines noted that fostering competition in both on- and off-patent markets can improve the efficiency of pharmaceutical spending. Various policies are used to promote competition among off-patent medicines, but generally do not induce competition in on-patent markets. While tendering is widely used for hospital and other institutional purchasing, it is less common for ambulatory care medicines, or where medicines are reimbursed rather than supplied directly. As part of its broader work agenda on “Increasing the transparency of pharmaceutical markets to inform policies”, this paper explores how payers could harness competition to improve the efficiency of spending on medicines still subject to patent protection or regulatory exclusivity. The OECD undertook an extensive analysis consisting of two parts: 1) a quantitative analysis using product-level time series sales data to explore whether therapeutic competition occurs, and, if so, how it has affected prices and volumes over time, based on a sample of countries and therapeutic classes and 2) a review of current practices and policies on pricing, coverage and procurement of on-patent medicines to identify whether these have been influencing competition between alternative therapeutic products. This report presents the key findings from this analytical work. Creation-Date: 2023-06-09 Number: 156 Handle: RePEc:oec:elsaad:156-EN Template-type: ReDIF-Paper 1.0 Author-Name: Rishub Keelara Author-Name: Martin Wenzl Author-Name: Lisbeth Waagstein Author-Name: Marjolijn Moens Author-Name: Ruth Lopert Title: Developing a set of indicators to monitor the performance of the pharmaceutical industry Abstract: The 2018 OECD report Pharmaceutical Innovation and Access to Medicines noted that public debates about pharmaceutical policy are often marked by a lack of authoritative and commonly accepted information supporting the arguments of the stakeholders involved. A set of agreed indicators would facilitate better informed, more fact-based pharmaceutical policy debates to benefit all stakeholders, including the general public, policy makers, and the industry itself, and could help restore and strengthen trust among them. As part of its broader work agenda on “Increasing the transparency of pharmaceutical markets to inform policies”, the OECD undertook a comprehensive analysis to evaluate the feasibility of establishing a set of core indicators. The selection of indicators was guided by the principle that health policy aims to improve population health, and that access to effective medicines produced by a viable industry is essential to achieving that objective. To help policy makers understand how financial resources in the pharmaceutical industry contribute to the research and development of effective products in areas of need, indicators should cover three domains: inputs, including financial flows into the industry; activity, including financial performance and R&D expenditure and activity; and outputs, capturing product outflows and benefit to health systems. This paper presents the key findings on the feasibility of populating indicators to address the input and activity domains within this framework. Creation-Date: 2023-08-09 Number: 157 Handle: RePEc:oec:elsaad:157-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lindner Author-Name: Arthur Hayen Title: Value-based payment models in primary care: An assessment of the Menzis Shared Savings programme in the Netherlands Abstract: The Menzis Shared Savings Program was initiated in 2014 by the Dutch insurer Menzis and the national primary care organisation Arts en Zorg, and is among the first value-based payment models for primary care in Europe. It runs as a complement to the current – volume-driven – primary care payment system. This paper reviews the evidence of the impact of this programme against its stated objectives. The Menzis Shared Savings Program led to a lower volume of care, particularly in terms of referrals to specialist care, laboratory care and general practitioners care. Main facilitating factors were the advanced data infrastructure in place, communication and transparency about the programme’s parameters, and the programme’s focus on mitigating financial risk and uncertainty for providers. Shared savings models – even when added as a mere complement to existing volume-driven payment methods – could enhance value in health systems. Creation-Date: 2023-06-27 Number: 158 Handle: RePEc:oec:elsaad:158-EN Template-type: ReDIF-Paper 1.0 Author-Name: Candan Kendir Author-Name: Rie Fujisawa Author-Name: Óscar Brito Fernandes Author-Name: Katherine de Bienassis Author-Name: Niek Klazinga Title: Patient engagement for patient safety: The why, what, and how of patient engagement for improving patient safety Abstract: Patients’ and citizens’ perspectives and their active engagement are critical to make health systems safer and people-centred, and are key for co-designing health services and co-producing good health with healthcare professionals, and building trust in health systems. Patients, families, caregivers and citizens can contribute towards improving patient safety at all levels from clinical, local, institutional (e.g. hospital , nursing home), community (e.g. primary care, home care) and national levels of healthcare systems. This report, the sixth in the series on the Economics of Patient Safety, covers: (i) the economic impact of patient engagement for patient safety; (ii) the results of a pilot data collection to measure patient-reported experiences of safety and; (iii) the status of initiatives on patient engagement for patient safety taken in 21 countries, which responded to a snapshot survey. It also provides recommendations for countries to enhance patient engagement for patient safety. Creation-Date: 2023-09-15 Number: 159 Handle: RePEc:oec:elsaad:159-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luke Slawomirski Author-Name: Luca Lindner Author-Name: Katherine de Bienassis Author-Name: Philip Haywood Author-Name: Tiago Cravo Oliveira Hashiguchi Author-Name: Melanie Steentjes Author-Name: Jillian Oderkirk Title: Progress on implementing and using electronic health record systems: Developments in OECD countries as of 2021 Abstract: Electronic Health Records (eHR) represent a significant digital transformation in the healthcare sector. A 2021 OECD survey of 27 countries revealed a growing adoption of eHRs. However, system fragmentation remains a concern: only 15 countries have a nationally unified system. Twenty-four countries have adopted a minimum data set for standardized core health information. While patient access to eHRs has notably increased since 2016, obstacles such as provider resistance, technical barriers, and legal hurdles continue to exist. The COVID-19 pandemic underscored the pivotal role of eHRs, particularly in vaccine tracking and post-market surveillance, highlighting the pressing need for international cooperation to maximize the benefits of eHRs in healthcare. Furthermore, as eHRs integrate with artificial intelligence, new governance challenges arise. Classification-JEL: I1; O5; O3 Creation-Date: 2023-09-21 Number: 160 Handle: RePEc:oec:elsaad:160-EN Template-type: ReDIF-Paper 1.0 Author-Name: Luca Lorenzoni Author-Name: Sean Dougherty Author-Name: Pietrangelo de Biase Author-Name: Tiago McCarthy Title: Assessing the future fiscal sustainability of health spending in Ireland Abstract: This working paper uses a new method to assess the fiscal sustainability of the Irish health system by considering the effects of population change and income growth on both government revenue and health spending over time.Spending on healthcare is comparatively high in Ireland, accounting for 8.4% of GNI in 2019. Health spending from public sources is projected to account for 24% of government revenues in 2040 (up from 20% in 2019). The fiscal balance is projected to slightly deteriorate in Ireland by 2040. Population change is projected to be a much greater driver of future health spending in Ireland over the next 20 years as compared to the OECD average.By coupling health spending projections with government revenue projections, our approach provides policymakers with a broader set of whole-of-government policies to consider when addressing financing shortfalls. Classification-JEL: H51; I11; I18 Creation-Date: 2023-09-21 Number: 161 Handle: RePEc:oec:elsaad:161-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Name: Michael Mueller Title: Understanding international measures of health spending: Age-adjusting expenditure on health Abstract: Assessing health system performance over time or across countries often means comparing populations with very different characteristics, including age structure. The share of the population aged 65 years and over ranges from less than 1 in 10 in some of the Latin American countries of the OECD to almost 3 in 10 in Japan. At the same time, populations are aging rapidly - on average across the OECD, there are 20% more people over 65 since 2015. Since risk of illness and ill-health generally increases with age, a population with an older demographic structure can expect higher mortality rates, greater incidence and prevalence of certain diseases, and thus higher demands for healthcare and, by consequence, higher spending on health. This working paper argues that the level of health spending depends not only on the size of the population (among other factors), but also on the demographic structure of the population. The paper reviews the international literature on age-adjusting health spending, and examines three methods of age-adjustment to report and compare health expenditure data between OECD countries and over time. Creation-Date: 2023-10-31 Number: 162 Handle: RePEc:oec:elsaad:162-EN Template-type: ReDIF-Paper 1.0 Author-Name: David Morgan Author-Name: Paul Lukong Author-Name: Philip Haywood Author-Name: Gabriel Di Paolantonio Title: Examining recent mortality trends: The impact of demographic change Abstract: The pandemic resulted in a significant increase in the number of deaths in many OECD countries. With detailed data now available by age and sex, this OECD Health Working Paper examines the trends and differences in mortality patterns over the three-year span of the pandemic. While a simple comparison of the raw number of deaths with reference to a historical base period has proved to be an important and straightforward indicator to assess the overall impact of the pandemic, most OECD countries have undergone major changes in population size and structure. This paper reviews the methodology of calculating changes in mortality to take account of such demographic trends and, in producing a revised set of estimates using adjusted numbers of deaths, highlights some important variations in mortality across years, countries and age groups. Creation-Date: 2023-11-21 Number: 163 Handle: RePEc:oec:elsaad:163-EN Template-type: ReDIF-Paper 1.0 Author-Name: Eric Sutherland Author-Name: Rishub Keelara Author-Name: Samuel Eiszele Author-Name: June Haugrud Title: Fast-Track on digital security in health Abstract: In response to the increase of cyberattacks in health care settings, the Health Committee of the OECD asked for a paper on Digital Security as part of the OECD ongoing work on health data governance. This working paper emphasizes that as the healthcare industry undergoes digital transformation it brings significant benefits while simultaneously escalating the vulnerability to cyber threats.This working paper summarises survey results based on the OECD framework for digital security risk management. The paper reveals varying levels of digital security alignment among countries, with Ireland and Korea exhibiting full alignment. Countries with specific strategies for digital security in health showed higher alignment to leading practices. The paper identifies key areas for improvement, including fostering a digital security culture through training, strengthening strategy and governance, and embedding risk assessment and treatment.The paper also emphasises the need for collaboration on innovative tools to detect and manage digital security threats, such as multi-factor authentication and encryption. These collaborative efforts are essential to safeguard the digital foundations of modern healthcare systems and ensure the security of health data and services. Creation-Date: 2023-11-24 Number: 164 Handle: RePEc:oec:elsaad:164-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ian Brownwood Author-Name: Gaétan Lafortune Author-Workplace-Name: OECD Title: Advanced practice nursing in primary care in OECD countries: Recent developments and persisting implementation challenges Abstract: The pandemic has stimulated growing interest in using advanced practice nurses such as Nurse Practitioners (NPs) to address growing primary care needs linked to population ageing and more people living with chronic conditions, although not all countries are moving at the same speed. This OECD Health Working paper reviews recent developments in advance practice nursing (APN) in primary care in OECD countries. It focusses on NPs in those countries that are recognising this category of nurses, but also describes the emergence of other categories of nurses taking on new roles such as family and community nurses in some European countries. In those countries that have achieved decisive breakthroughs in new forms of task sharing between primary care doctors (GPs) and nurses, increasing the number of APNs in primary care is seen as a real opportunity to respond to primary care needs and reduce pressures on GPs and hospitals. Classification-JEL: I10; I18; J2 Creation-Date: 2024-04-15 Number: 165 Handle: RePEc:oec:elsaad:165-EN Template-type: ReDIF-Paper 1.0 Author-Name: Michael van den Berg Author-Workplace-Name: OECD Author-Name: Candan Kendir Author-Workplace-Name: OECD Author-Name: Diana Castelblanco Author-Workplace-Name: OECD Author-Name: Nicolas Larrain Author-Workplace-Name: OECD Author-Name: Frederico Guanais Author-Workplace-Name: OECD Author-Name: Oliver Groene Author-Name: Pilar Illarramendi Author-Name: Jose Maria Valderas Author-Name: Rachel Williams Author-Name: Mieke Rijken Title: PaRIS Field Trial Report: Technical report on the international PaRIS survey of people living with chronic conditions Abstract: As populations age and the number of people with chronic conditions increases, countries need to assess how their health systems perform with regard to the management of chronic conditions. OECD's Patient-Reported Indicator Surveys (PaRIS) initiative aims to measure outcomes and experiences of healthcare as reported by patients with chronic conditions as part of the efforts to improve quality of care. The PaRIS survey, an international survey of people living with chronic conditions who are managed in primary care, is implemented in twenty countries. Following a rigorous design and development phase, the PaRIS survey was field-tested in participating countries. This paper reports on the implementation and the results of the Field Trial. The Field Trial provided important lessons which have been used to improve the survey tools and the implementation of the Main Survey. Creation-Date: 2024-06-07 Number: 166 Handle: RePEc:oec:elsaad:166-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ana Espinosa Gonzalez Author-Name: Elina Suzuki Title: The impacts of long COVID across OECD countries Abstract: Even as countries have long emerged from the dramatic restrictions imposed on populations during the height of the COVID-19 pandemic, an important subset of people infected with COVID-19 continue to struggle with symptoms, in some cases debilitating, that persist for weeks or even months after their initial infection. The analysis in this paper looks at the burden of long COVID across OECD countries. It examines its implications for the health of individuals and how long COVID may impact productivity and the labour force, as well as what countries are doing to address the condition. It further identifies priorities for improving care for people living with long COVID. Classification-JEL: I0; I1; I3 Creation-Date: 2024-06-13 Number: 167 Handle: RePEc:oec:elsaad:167-EN Template-type: ReDIF-Paper 1.0 Author-Name: Katherine de Bienassis Author-Name: Niek Klazinga Title: Comparative assessment of patient safety culture performance in OECD countries: Findings based on the Hospital Survey on Patient Safety Culture versions 1 and 2 Abstract: Safety is a core dimension of health care quality. Measurement of patient safety culture in OECD countries has been increasingly conducted as part of efforts to monitor patient safety and to contribute to health system performance assessment. Building on four years of work, a second OECD data collection on patient safety culture was conducted in 2022-2023, with the support of the members of OECD Expert Group on Patient Safety Culture. Data from almost 650,000 health care workers, from over 3,000 different sites/hospitals, across 14 countries was added in this round of data collection. This report documents the state-of-the-art of patient safety measurement using the Hospital Survey of Patient Safety Culture (HSPSC) and is the first report to document international comparisions using the HSPSC v2, which has been recently adopted by ten countries who submitted data. Despite many commonalities between countries in the implementation of PSC measurements, there remains differences in the scope of implementation and survey response rates. Moreover, survey findings show general deficits in staff perceptions of safe staffing and workpace levels and response to errors among hospital workers, areas that could be targeted for policy action to improve patient safety. Classification-JEL: I10; I11; I18; J28; J81 Creation-Date: 2024-07-12 Number: 168 Handle: RePEc:oec:elsaad:168-EN Template-type: ReDIF-Paper 1.0 Author-Name: Pedro Isaac Vazquez-Venegas Author-Name: Marion Devaux Author-Name: Hikaru Aihara Author-Name: Michele Cecchini Title: Digital and innovative tools for better health and productivity at the workplace Abstract: Promoting health and well-being at the workplace is a valuable investment for employees, employers, governments, and society. Healthy employees are less likely to be absent or have reduced productivity. Employers benefit from improved work outputs, and health systems see reduced treatment costs. Digital tools and innovative technologies can enhance the effectiveness of health promotion programs. The market for these tools is growing globally, with employers keen to improve health and productivity. This working paper, through four case studies, underscores how wearables, mobile applications for female health, AI-driven lifestyle management applications, and health insurance engagement platforms can be utilized to promote health at the workplace. These technologies present avenues for enhancing the efficacy, efficiency, and customization of health promotion interventions. Nevertheless, they also pose challenges such as privacy issues, the requirement for digital proficiency, the necessity for conducive organisational practices for healthier work environments, and the assurance of safety and clinical suitability of the proliferating health applications and tools in the market. Classification-JEL: I15; J24; M1; O3 Creation-Date: 2024-08-14 Number: 169 Handle: RePEc:oec:elsaad:169-EN Template-type: ReDIF-Paper 1.0 Author-Name: Thomas Hofmarcher Author-Name: Caroline Berchet Author-Name: Guillaume Dedet Title: Access to oncology medicines in EU and OECD countries Abstract: Ensuring equal access to the latest cancer medicines is one of the most pressing challenges facing OECD health systems today. Despite the emergence of new oncology drugs, disparities in patient access—particularly through clinical trials and early access programs—remain a critical issue. Rising costs are also straining even the most affluent healthcare systems, making affordability a concern for all. This working paper examines various aspects of inequalities in access to cancer medicines, covering key stages in a medicine's life cycle, from marketing authorization to reimbursement decisions and uptake in clinical practice. The analysis draws on original findings from the 2023 OECD Policy Survey on Cancer Care Performance. It also explores potential strategies to stimulate competition among oncology medicine producers, which could create significant budget headroom, allowing reinvestment in new cancer medicines that offer substantial clinical benefits to patients. Classification-JEL: H51; I11; I13; I18; L11; O30 Keywords: Cancer,, Oncology medicines Creation-Date: 2024-09-10 Number: 170 Handle: RePEc:oec:elsaad:170-EN Template-type: ReDIF-Paper 1.0 Author-Name: Marjolijn Moens Author-Name: Eliana Barrenho Author-Name: Valérie Paris Title: Exploring the feasibility of sharing information on medicine prices across countries Abstract: In recent years, the call for transparency in pharmaceutical pricing has gained momentum among policymakers and stakeholders. Following a resolution of the 72nd World Health Assembly and the establishment of the Oslo Medicines Initiative, there has been a concerted push for greater transparency in pricing practices. However, the exact scope of transparency measures remains unclear. Key questions persist regarding which prices and for which medicines should be disclosed, the conditions under which countries are willing to share this information, and the barriers hindering such efforts. To clarify these issues and advance the policy debate, the OECD examined the feasibility of sharing medicine price information across countries. A country survey was conducted to explore the willingness, expectations, and motives of governments and payers for sharing information on medicine prices. This report presents the key findings derived from the survey and concludes with an assessment of the feasibility of sharing net medicine price information among OECD countries. Classification-JEL: F6; H51; H57; I11; I18; K12; K23; K32; L1; L65 Creation-Date: 2024-09-11 Number: 171 Handle: RePEc:oec:elsaad:171-EN Template-type: ReDIF-Paper 1.0 Author-Name: Ece Özçelik Author-Name: Suzannah Chapman Author-Name: Michele Cecchini Title: Tackling antimicrobial resistance in Indigenous, rural and remote communities Abstract: In many OECD countries, recent efforts to tackle antimicrobial resistance (AMR) have not always addressed concerns for certain populations. This working paper places a spotlight on AMR in Indigenous, rural and remote communities (IRR). It shows that the burden of AMR in IRR communities can be 1.5 to 3 times higher than the general population. Limited access to healthcare services, exposure to contaminated water, socio-economic factors, substandard sanitation and living conditions, mobility patterns across communities and climate change play a pronounced role in fueling AMR rates in IRR communities. The working paper presents 14 policies tailored to optimise antibiotic use and reduce the incidence of infections in human health and beyond. It underlines that promoting strong co-ordination and collaboration between national authorities, Indigenous partners and representatives from rural and remote communities is paramount to ensuring that policies are designed and implemented in accordance with needs and practices in local contexts. Classification-JEL: H75; I15; I18 Keywords: AMR, antimicrobial resistance, indigenous Creation-Date: 2024-09-20 Number: 172 Handle: RePEc:oec:elsaad:172-EN