1 June 2016 - CNAMTS – 37 th Annual Meeting of OECD Senior Budget Officials - Stockholm Performance information and health system efficiency in France CNAMTS (National Health Insurance Fund for salaried workers) Ayden Tajahmady – Grégoire de Lagasnerie Deputy director of the Division of Statistics and Strategic research 37th Annual Meeting of OECD Senior Budget Officials Stockholm, Sweden, 9-10 June 2016
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Performance information and health system efficiency in France - Ayden Tajahmady, France
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1 June 2016 - CNAMTS – 37th Annual Meeting of OECD Senior Budget Officials - Stockholm
Performance information and health system efficiency in France
CNAMTS (National Health Insurance Fund for salaried workers)
Ayden Tajahmady – Grégoire de Lagasnerie
Deputy director of the Division of Statistics and Strategic research
37th Annual Meeting of OECD Senior Budget Officials Stockholm, Sweden, 9-10 June 2016
The two ways to implement performance budgeting
2
The French health care system:
• Centralized health insurance system • Main issues:
– High Health expenditure as a share of GDP, 2013 : 10,9% (6th OECD country) – Medical practice variation – Equity
Change stakeholders’ behaviors to improve efficiency:
1. Financial incentives towards main health care system’s stakeholders
(professionals, structures and patients) 2. Non Financial incentives thanks to huge data collection: increase
stakeholders’ empowerments to implement medico-economic management
February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Main challenge : Making sense of the huge amount of data collected to improve efficiency
February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Political decision
Health care professionals’ management
tools
Patients’ empowerment
Indicators
4 February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Data and political decision
Data and political decision
5
One of the Medico-administrative database in France :
• National Health Insurance Information System (SNIIRAM): exhaustive
anonymous data about >60 millions individuals • Information available on ambulatory care (drugs, medical visits and
procedures, biological tests, dental care, ...), inpatient care, payment for sick leave,...
• Daily reimbursements follow-up
Use of the data for policy decision-making
• Improve healthcare pathways • Contribute to a better management of the health insurance • Contribute to a better management of health policies • Provide healthcare providers with relevant information relative to their
activity, receipts and prescriptions
February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
e.g. Describe the health inequalities due to socioeconomic status in 2013 (a geographic index of deprivation)
6 February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Source : SNIIRAM/EGB-PMSI, 2013
2% 3% 4%
6% 8%
11%
14%
20%
26%
35%
42%
48% 49%
3% 5%
7%
10%
13%
17%
21%
27%
32%
39%
45% 48% 45%
0%
10%
20%
30%
40%
50%
Age groups
Prevalence of polypathology
1 (10% les plus favorisés)
2
3
4
5
6
7
8
9
10 (10% les plus défavorisés)
10 % most well-off
10 % least well-off
Map the burden of disease and their costs in France
7 February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Source : SNIIRAM/EGB-PMSI, 2013
Cardiovascular diseases, acute
Cardiovascular disease, chronic
Treatment of vascular risk factors (no CVD)
Diabetes Cancers, active
Cancers, surveillance
Psychiatric diseases
Psychiatric treaments
Neurologic diseases
Chronic respiratory
disease
Inflammatory or rare diseases or HIV
Diseases of the liver or pancreas
Maternity
Isolated hospitalisation
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
0 2,000 4,000 6,000 8,000 10,000 12,000
Num
ber o
f pat
ient
s
Average cost per patient (€)
Medicalized approach of expenditure to target specific policies on costly disease: Sick leave
8
February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Source : SNIIRAM/EGB-PMSI, 2013
22%
3% 6% 6% 5% 5%
28%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% Soins courants/traitements antalgiques ou anti-inflammatoires
Hospitalisations ponctuelles (avec ou sans pathologies,traitements ou maternité)
Maternité (avec ou sans pathologies)
Autres
Cancers
Diabète (avec ou sans pathologies) ou traitements durisque vasculaire (hors pathologies)
Maladies cardioneurovasculaires
Maladies psychiatriques ou psychotropes
Basic care and treatments with pain killers
Isolated hospitalisations
Maternity (maternity leave excluded)
Others
Cancer
Diabetes and other vascular risk treatments
Cardiovascular diseases
Psychiatric diseases or treatments
Total 10,2 Billion out of 147 Billion € (7%)
9 February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Data and health care professionals management tools
Data and health care professionals’ management tools
10 February 2016 - CNAMTS - DELSA GOV meeting on sustainability of Health systems
Financial tools: P4P
Non-financial tools: benchmark and information
Hospital
Financial incentives for quality improvement (IFAQSS)
• Pilot phase • Quality : assessing pain, screening
for denutrition… • Reward : 0 to 0.5 % of previous
year budget
Web platform (http://hospidiag.atih.sante.fr/)
• Activity, Quality, • Organization, Human resources • Finance
Outpatient
Financial incentive for public health targets (ROSP)
• Generalized since 2011 • 29 indicators (organization,