www.observatory.dk www.observatory.dk Utrecht, 25 Utrecht, 25 th th September 2007 September 2007 Josep Figueras Josep Figueras Re-examining health systems Re-examining health systems financial sustainability in financial sustainability in Europe Europe
34
Embed
Re-examining health systems financial sustainability in Europe
Re-examining health systems financial sustainability in Europe. Utrecht, 25 th September 2007 Josep Figueras. Health Expenditure as % of GDP EU 15 plus selected countries (2004). Source:OECD Health Data (2006). Health Expenditure % GDP. Health Expenditure % GDP. - PowerPoint PPT Presentation
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
www.observatory.dkwww.observatory.dk
Utrecht, 25Utrecht, 25thth September 2007 September 2007
Josep FiguerasJosep Figueras
Re-examining health systems Re-examining health systems financial sustainability in Europefinancial sustainability in Europe
www.observatory.dkwww.observatory.dk
Health Expenditure as % of GDP Health Expenditure as % of GDP EU 15 plus selected countries (2004)EU 15 plus selected countries (2004)
Reforming the funding of health care Reforming the funding of health care
• Reform statutory (insurance or tax) funding
– Stability of main systems: Bismark & Beveridge
– Increase in tax component in SHI countries
• Shift costs to patients: privatisation of funding
• Introducing insurance competition
www.observatory.dkwww.observatory.dk
“In the longer term, America, like this adamantly pro-market newspaper, may have no choice other than to accept a more overtly European-style system. In such a scheme, the government would pay for a mandate insurance system, but leave the provision of care to a mix of public and private providers.”
The Economist, January 28th 2006
www.observatory.dkwww.observatory.dk
“Rather than copying Europe’s distorting payroll taxes, the basic insurance package would be paid for directly by government, though that cash might be raised by a “hypothecated” tax which would make the cost of health care more evident”
The Economist, January 28th 2006
www.observatory.dkwww.observatory.dk
7551
62687071
747576777878
838385
90
0 25 50 75 100
EU 15 averageGreece
NetherlandsAustria
PortugalSpain
BelgiumItaly
FranceFinlandIreland
GermanyUK
DenamarkSweden
Luxembourg
Public expenditure as a % of totalPublic expenditure as a % of total EU 15 (2003)EU 15 (2003)
OECD Health Data, 2005
www.observatory.dkwww.observatory.dk
Concentration of total health expenditures, France 2001
Source : CNAMTS/EPAS
5%
51%
64%
10%
78%
20%
98%
70%
100%
90%
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% of people % of expenses
www.observatory.dkwww.observatory.dk
www.observatory.dkwww.observatory.dk
Insurance competitionInsurance competitionIn Theory:In Theory: it ought to work it ought to work
Insurance competitionInsurance competitionIn Practice: the evidenceIn Practice: the evidence
www.observatory.dkwww.observatory.dk
“Although elegant in theory, the implementation of the managed competition model in practice appears to be complex because it is hard to fulfill the necessary preconditions”
– Shift costs to patients: privatisation of funding
– Introducing insurance competition
• Reforming the supply (payment & provision)
• Strengthening public health (reducing demand)
www.observatory.dkwww.observatory.dk
Reforming the supply (payment)Reforming the supply (payment)
• From passive to active (strategic) purchasing?
• Selective contracting / provider competition
• Towards performance based payment systems
– Case mix measures, DRGs
www.observatory.dkwww.observatory.dk
Paying doctorsPaying doctors
“The only way to communicate with a doctor is to write it in the back of a cheque”
Bob Evans
www.observatory.dkwww.observatory.dk
Paying doctorsPaying doctors
“The only way to pay doctors is to change the system every three years, because by then they will have found ways to get round it to their own advantage”
Bob Evans
www.observatory.dkwww.observatory.dk
Reforming the supply (provision)Reforming the supply (provision)