Health Care Systems: Efficiency and Policy Settings

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Inequalities in health status are high in several countries. Interestingly, inequalities tend to be relatively low in three of the four countries with a private insurance-based system Germany, the Netherlands and Switzerland.

One reason may be that regulations in these countries such as the requirement on insurers to enrol any applicant and equalisation schemes across insurers to compensate for high risk enrolees can help limit the hunt for better-off patients and the desire to shed bad risks so-called cream-skimming. These and other potential biases can be caused by market mechanisms if left unchecked. Note that inequalities are often caused by factors that have little to do with the health care system itself, such as social status and education.

Administrative costs tend to be higher in those countries where private insurance plays the predominant role group 1. In fact, the efficiency estimates vary more within country groups sharing similar institutional characteristics than between groups. In other words, big-bang reforms are not warranted. Rather, it may be more practical and effective for each country to adopt the best policy practices implemented by countries in its own group while borrowing the most appropriate elements from other groups.


Moving towards best practice could yield substantial efficiency gains 7. Across and within country-group comparisons allow spotting strengths and weaknesses and identifying areas where achieving greater consistency in policy settings could yield efficiency gains see Box for a concrete example. The key results from the indicators are as follows: Reinforcing priority setting would contribute to improved efficiency. This would require particular attention in countries such as Austria, Greece, Luxembourg, Mexico and Sweden that neither define the health benefit basket precisely nor use health technology assessments.

More balanced provider payment schemes, for instance between performance-related pay and set wages, would lead to a better match between demand and supply in health care in many countries. Targeting spending on this sector would bring more value for money by, for instance, reducing costly hospital admissions for conditions such as asthma and cataract surgery.

Belgium, France and Ireland, where activity-based payment systems for hospitals have recently been introduced, may need to ease regulations on hospital staffing and equipment to improve the system s ability to respond to demand and improve efficiency. By contrast, such regulations may need to be strengthened where hospitals work with relatively flexible budget limits, such as in Finland. In Japan, Luxembourg, Poland and Switzerland where choice is abundant, providing better user information on the quality and prices of health care services would foster competition.

More stringent gate-keeping would reduce the number of consultations in the countries where they are particularly high, including the Czech Republic, Korea and Japan, or limit spending in the in-patient care sector in countries such as Belgium and Iceland. Spending on health care is high but so is life expectancy. France even scores best among the OECD countries on amenable mortality that is, mortality that could be avoided thanks to timely and effective health care. Looking at performance at the sector level reveals that the quality of outpatient and preventive care is high, as shown by the low number of avoidable hospital admissions in particular for asthma and chronic bronchitis.

Efficiency in the acute care sector as measured by disease-specific length of stays as well as the turnover rate for acute care beds also tends to be above the OECD average.

Still, various indicators including the large share of spending devoted to in-patient care and that of cataract surgeries performed in the in-patient care sector point to a lack of co-ordination or misallocation of resources between the in- and out-patient care sectors. And inequalities in health status and administrative costs are high by OECD standards. Looking at the policy and institutional indicators, France stands out for relying heavily on complementary private health insurance as well as for the multiplicity of insurance funds providing the basic coverage.

These may lead to health inequalities and high administrative costs. In the hospital sector, global budgeting has been gradually replaced by an activity-based payment system, which should prompt hospitals to seek efficiency gains. However, staffing and equipment in hospitals remain heavily regulated and this may hamper the re-allocation of resources and thus limit the ability of hospitals to exploit efficiency gains.

Data points represent the deviation from the OECD average and are expressed in number of standard deviations. In Panel B, data points outside the average circle indicate that the level of the variable is higher than for the average OECD country e. France offers users more choice among providers.

They are simple deviations from the OECD average. For more details, see Joumard et al. Consistency in responsibility assignment across levels of government. Joumard, I. Nicq and O. Hoeller, C. Oliveira Martins, J.

Paris, V. Devaux and L. The U. Gini Coefficient The Gini Coefficient is a measure of income inequality which is based on data relating to household s disposable income.

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Observatoire international de la santé et des services sociaux (OISSS)

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Health care systems : efficiency and policy settings

Help Wanted? Providing and Paying for Long-Term Care Demographic ageing and social changes will make it harder to care for older people who cannot cope without help. Based on a recently published OECD. Log in Registration. Search for. Size: px. Start display at page:. Percival Gray 4 years ago Views:. Similar documents. A Gini Coefficient of zero indicates Gini Coefficient The Gini Coefficient is a measure of income inequality which is based on data relating to household s disposable income. A Gini Coefficient of zero indicates perfect income equality, whereas More information.

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